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Medicaid Disability Eligibility, Services, and Changes.

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Presentation on theme: "Medicaid Disability Eligibility, Services, and Changes."— Presentation transcript:

1 Medicaid Disability Eligibility, Services, and Changes

2 Medicaid Disability Must meet disability requirements Does count resources/assets ($2000 Single or $3000 Couple), except for house and 1 vehicle Resources are counted include savings, retirement (401K) plans, life insurance with cash value, land, farming equipment, etc. Does not count parent income/resource for children over age of 18, regardless of school status Comprehensive plan with no cap for Durable Medical Equipment (DME) and increased drug formulary/list Children CAN be enrolled in Medicaid Disability (MAD)

3 Services Covered This list does not include everything Medicaid covers. Some services require Prior Approvals Preventive Services - This includes medical services like: Family Planning Prescription Drugs Doctor Office Visits Behavior and Mental Health Services - Coverage includes outpatient mental health services you receive from: Physicians Local Center for Mental Health Social workers in your community Eye Care - Coverage includes exams and glasses every two years Diabetes Self Care Management Training - Activities include: Nutrition Medication counseling Blood glucose self-monitoring Insulin injection Foot, skin and dental care

4 Inpatient/Outpatient Hospital Care - Services include: Rx Drugs Laboratories, X-rays Other diagnostic tests that are considered medically necessary during the stay Home Health Care & Services - Medicaid covers: Durable Medical Equipment (DME) Incontinence Supplies Medical supplies, equipment, and appliances Transportation - Medicaid will pay for up to 20 one-way trips without prior authorization. Dental - Covered services include annual exams and preventive care. Pregnancy Care - Medicaid covers: Prenatal Care Delivery Midwife Services Emergency Care - Medicaid benefits include Hospital Admittance Transportation Medically necessary screening services

5 Changes in Application Process Apply to Social Security Administration/ Division of Family Resources SSA will determine whether disabled IF currently receiving SSI (Supplemental Security Income, then eligible for Medicaid Disability IF currently receiving MAD, will be asked to apply for SSI Increase full coverage income eligibility limit to 100% FPL (going from $721/month to $973/month)

6 Spend-down Changes The spend-down program has been eliminated. If you currently have a spend down and your income is less than $973/month (single) or $1,311 (married), you will receive full benefits without a spend down. IF you are over on income/resources, you will be sent to the Marketplace to get an insurance plan with whatever tax credit that you are eligible.

7 Medicaid Waiver Changes IF you are receiving a Medicaid Waiver, you can have income up to $2,163/month. If your income exceeds this you are required to set up a MILLER TRUST. This trust must be established for you to remain eligible for Medicaid benefits and any extra income over the amount must be placed in the trust to help pay for medical expenses. You will need an attorney to set up the trust and upon the death of trustee, all money will go to the state of Indiana.

8 1915(i) Eligibility Criteria Targeting Criteria Age 19 + Medicaid Rehabilitation Option (MRO) eligible primary mental health diagnosis – (ex: schizophrenia, bipolar disorder, major depressive disorder, psychotic disorder) Needs-Based Criteria –Income can be higher than 100% FPL Demonstrated need related to management of behavioral & physical health Demonstrated impairment in self-management of physical and behavioral health services 3+ score on the Adult Needs and Strength Assessment (ANSA), a behavioral health screening tool Demonstrated health need which requires assistance and support in coordinating behavioral health & physical health treatment

9 If you have questions ASK 7172 Graham Road, Suite 100 Indianapolis, Indiana (Fax) Family Voices 445 N Pennsylvania St Ste 941 Indianapolis, IN (Fax)


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