Xac/280 Week 9 Final Paper

Adults, 65 years old and older and people with disabilities are eligible for Medicare and Medicaid. Physician services and hospitalizations are covered by medicare. An additional supplemental program may be purchased to cover prescription drugs. Low income families and children may qualify for Medicaid and Children’s Health Insurance Program (CHIP). Medicaid has significantly lower copays and out of pocket expenses compared to private insurance. Unemployed individuals may qualify for Medicaid depending on the state.

In present times, people with high incomes that’s above the 100 percent poverty level is eligible for premium subsidies to purchase private plans in the health care market. Individuals that are below the 100 percent of poverty in states that don’t wish to expand Medicaid; do not have access either to subsidized private coverage or Medicaid (Garber & Collins, 2014). Originally, the law require that all states expand Medicaid eligibility, to enable those people living with income that is increasing to 138 percent of the poverty level. These factors are equivalent to $15,856 for each individual and $32,499 for a family living in a single dwelling (Garber & Collins, 2014). In 2012, the Supreme Court made these regulations optional for ruling.

All of the health care programs in Michigan have an income test and some of the programs also have an asset test. These income and asset tests may vary with each program. For some of the programs, the applicant may have income that is over the income limit and still be able to obtain health care benefits when their medical expenses equal or exceed their deductible (formerly known as spend-down) amount.

Current numbers show substantial growth from the eighties, and estimates suggest that the demand for long term care among the elderly will more than double in the next thirty years. (Feder, Komisar, and Niefeld) This growth will exacerbate concerns about balancing institutional and noninstitutional care, assuring quality of care, and most importantly adopting and sustaining financing mechanisms that equitably and adequately protect the elderly who need long-term care.

Low income families who are unemployed can apply for healthcare coverage through Medicaid. Low income families with children can apply to have

Low-income: Applicants must have income at or below 185 percent of the U.S. Poverty Income Guidelines, or be enrolled in TANF, SNAP, or Medicaid.

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

Consequently, to qualify for Medicaid, which is designed for beneficiaries with low income, one must receive a monthly income below the average poverty level, which is around $2,000 per month and have no cash assets, in order for Medicaid to cover long-term care facilities. When applicants spend down his or her assets, Medicaid will look at any “financial gifts” made within the past 5 years; this could result in the denial of benefits depending on the number of months the gift could have paid for a long-term care facility (Fischer, 2011).

The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.

First of all, keeping track of a monthly spend down of an elderly, disabled patient is ridiculous. In Mrs. Jackson’s case, she needed Medicaid to cover her transportation needs. Its close to impossible to schedule appointments and procedures if you are not sure how you are going to get there. Other patients use Medicaid for numerous reasons. A better option for Medicaid would be to take an average of a few months expenses and use that to determine eligibility for longer than a month at a time. It is common for patients to spend the same amount on medication each month. They also try to visit doctors on a regular basis. Knowing they are covered by Medicaid for longer than a month, would be a huge relief. The patients could keep their appointments without worrying about transportation costs. Also, medicine could be taken as directed instead of trying to make it last longer in fear of losing coverage the next month. Another area which needs addressing is in the area of medically necessary items. Who determines if adult diapers is necessary or a convenience? For an elderly person who does not want to walk to the wash room after going to the bathroom, I can see how diapers would be convenient. But what about the person with no legs and not adequate enough help to lift them out of bed? I would definitely say adult diapers is medically necessary for this person.

Per the Health Care Safety Net Increased Eligibility Amendment Act of 2005, its first manifest goal proposes that individuals 18 years of age or younger whose total gross income is more than 200% but less than 250% of the federal poverty guideline will be afforded reasonably priced healthcare and medical services. In addition, the act’s second goal proposes that the Mayor will create a thorough plan within 180 days of its enactment that outlines specific eligibility criterion for the aforementioned individuals whose gross income is more than 200% but less than 250% of the federal poverty guideline (Health Care Safety Net Increased Eligibility Amendment Act of, 2005). The individual’s total gross income will represent all money received, including but not limited to cash.

Usually Medicare does not pay for long-term care; it will only pay for medically necessary skilled nursing facilities or home health care. With Medicare certain criteria has to be met for certain conditions for Medicare to pick up the cost. Medicare also does not pay for any kind of long-term care that helps assist with activities of daily living. This kind of care includes dressing, bathing, and using the bathroom. Medicare Advantage plans can offer limited skilled nursing facility and home care coverage if the patient’s long-term care is medically necessary. Medicaid offers coverage for both medical and non-medical associated long-term care, but the person will only qualify if they have less than $2000 in assets and income that is inadequate to pay for the cost of their care. If a veteran is at least 70% service connected disabled the Veterans Administration will pay the costs of long-term care for life. Long-term care that is not provided by the government is usually paid out-of –pocket by family members. Most people choose the option of home health care because long-term care is too costly.

Medicaid provides a comprehensive benefit package for those who enroll. The federal government requires coverage of thirteen services, including inpatient and outpatient hospital services, nursing home and home health care, and for children under the age of twenty-one. The benefits do not end there, Medicaid offers a

Seniors who fall under a coverage hole will start getting some help. Some are saying that seniors may lose Medicare benefits they now enjoy, but that is not true. The health reform act will not cut guaranteed benefits; a person will still be able to maintain the coverage they want. Americans on Medicare will receive free preventive care without co- payments or deductibles. Seniors will also receive $250 to help pay for their prescriptions. There will also be alternatives to nursing home placement, such as day-service programs, home-care aides, meal programs, senior centers and transportation services. A public, voluntary long-term care insurance program known as the Community Living Assistance Services and Supports, have enrolled individuals who have substantial daily needs to receive at least $50 a day. This money is to be used to defray the costs of services such as home care, family caregiver support, and adult day-care or residential care.

Drug and health plans are major resources to long-term care. Medicare does not cover most of long-term care services, but it may pay a portion depending on selected coverage. Medicaid may step in and help pay as well. “The Medicare Plan Finder tool provides one central point to view and compare all available drug and health plan