Medicaid 101 texas


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  • The topic of Medicaid in Texas recently came up in a November 14th article in The Houston Chronicle that discussed Republicans talking about opting out of Medicaid Program
  • Federal Medicaid rules require HHSC to determine the citizenship status of all Medicaid applicants.
    Medicaid is available to all US citizens who meet all other eligibility criteria. Medicaid MAY be available to individuals who are LEGAL Permanent residents.
    CHIP is available to citizens and legal permanent residents who meet all other criteria.
    CHIP Perinatal is available to undocumented pregnant immigrants who meet all other eligibility criteria.

    US Citizenship or Immigration Status documentation includes:
    Front and back of Permanent Resident Card (I-551)
    Arrival/Departure Form (I-94) from US Citizenship and Immigration Services
    US birth certificate
    US Passport
  • The only income reported is income earned from a parent, step-parent, and working child. If the child lives with anyone besides a parent or step-parent, the only income reported is the child’s income.
  • Individuals who reside in a facility or participate in certain waiver programs may have an applied income or co-payment. The amount is based on their income each month. The recipient is allowed a personal needs allowance.
  • Medicaid 101 texas

    1. 1. Monica Lewis, BSN, RN Keyra White, MBA Chuck Lalonde, M.Ed Wendy Watkins, RN, MS Jason Lacy, MBA Raymond Turner, LMSW-AP MEDICAID 101 TEXAS
    2. 2. TODAY’S OBJECTIVES • Provide insight in which the Medicaid Program is administered within Texas • State the original intentions of Title 19 to the Social Security Act • Discuss percentages related to the Texas Medicaid Program • Explain eligibility requirements for Texas Medicaid Program • Explain the “Estate Planning” part in reference to Medicaid • Explain the benefits and challenges of the Texas Medicaid Program • Assign a letter grade to the current Medicaid Program and offer our professional advice to program administrators going forward
    3. 3. HOTOff The Press TEXAS MEDICAID NUMBERS In fiscal year 2011, Texas expects to spend $24.7 billion on Medicaid, including $16.6 billion in federal funds. More than 60 percent of nursing home residents in Texas have Medicaid coverage that covers at least part of their nursing home costs. As of April 2010, there were 52,235 Medicaid clients in nursing homes. There currently are 3.1 million Texans on Medicaid. That includes:2.2 million children who qualify based on their age and income. Source: Health and Human Services Commission
    4. 4. MEDICAID FACTS • The intention of Title 19 (Medicaid) is to provide “medical assistance” part or all payment of health care services • Payment will be made based upon meeting primary qualifying criteria of people who are below the 250% poverty level
    5. 5. • Medicaid was designed to literally provide AID to persons receiving welfare and for comparable groups of persons who were defined as medically indigent • Longer term prospects protect and optimize Medicaid funding • Reduce the number of uninsured Texans • Focus on keeping Texas Healthy • Establish infrastructure to facilitate accomplishment of reform goals IMMEDIATE AND LONGER TERM PROSPECTS FOR MEDICAID PROGRAM Source: Department of Health and Human Services (2006) Center for Medicare and Medicaid Services
    6. 6. • Consider options to facilitate the availability of affordable insurance benefits for all Texans and administrative simplicity for employers • Build public-private partnerships for employer sponsored insurance, individual and small group market insurance, and multi-share programs • Optimize and improve upon current Medicaid operations to ensure efficient integration of reform • Help individuals transition from being uninsured or receiving public assistance to become insured in the private market PUSHING AND PRESERVING MEDICAID FOR THOSE WHO NEED IT Source: Department of Health and Human Services (2006) Center for Medicare and Medicaid Services
    8. 8. • Inpatient hospital services • Outpatient services • Labs • Home Health • Private Duty • Clinics • Dental Services • Therapy • Medication • Psychiatric • Hospice • Respiratory • Community Care / Personal Care • Long-Term Care MEDICAID WILL PAY FOR . . .
    9. 9. UNDERSTANDING THE ORIGINAL INTENTIONS – 1935 Social Security Act Announced by FDR Source: Youtube video, “1935 Social Security Act Announced by FDR”
    10. 10. 1965 – LBJ SIGNS MEDICARE/MEDICAID BILL Source: Youtube video, “1965-LBJ Signs Medicare”
    11. 11. ESTATE PLANNING • A person takes the steps to make sure that when they pass on their wishes are honored when it comes to their personal property, life insurance policies, stocks, and home • Estate Planning in reference to Medicaid is when a person or couple gets rid of all assets in order to qualify for long term Medicaid. These include: 1. IRA 2. Certificate of Deposits 3. Savings Bonds 4. Cash 5. Investment Property 6. Burial Spaces 7. Vehicles 8. Nursing Home Trust funds 9. Savings Account 10. Checking Account
    12. 12. THE DEFICIT REDUCTION ACT OF 2005 (DRA) Two major changes: 1. Anyone applying for Medicaid must be US citizen or qualified immigrant 2. Financial eligibility rules for long-term Medicaid Changes: • Those who have homes valued above $500,000 are not eligible • Once the equity in the home is less than $500,000, the applicant is eligible • If a transfer is made and the reason is to qualify for long term Medicaid, the transfer can make the person ineligible • If a gift or charitable contribution is over $207 a month, the applying applicant must provide convincing evidence that the purpose was not to qualify for Medicaid • The department will look back 5 years for any transfers, etc… Source: Medicaid Changes as a result of the DRA of 2005 (n.d.) Retrieved from:
    13. 13. Estate Planning and Medicaid Program Integrity  People are going to lie about what they have to in order to qualify for benefits  Consider the monthly costs associated with staying in a nursing home Source: Medicaid Estate Planning (n.d.) retrieved from
    14. 14. LIFE WITHOUT MEDICAID Earlier onset of death due to lack of funds to obtain treatment Emergency room would be forced to treat illnesses that could be treated with a routine office visit
    16. 16. PERCENTAGE BUDGETED FOR MCD • 2010 Federal Budget- $3.55 trillion • 2010 Medicaid Budget- $290 billion • 8.17% spent on MCD in 2010 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 2006 2007 2008 2009 2010 10.61% 9.87% 7.21% 7.23% 8.17% MDC Budget MDC Budget
    17. 17. DIFFERENCES IN STATE SPENDING ON MEDICAID 2008 $0 $5,000,000,000 $10,000,000,000 $15,000,000,000 $20,000,000,000 $25,000,000,000 $30,000,000,000 $35,000,000,000 $40,000,000,000 $45,000,000,000 $50,000,000,000 New York California Texas Wyoming $47,618,463,035 $38,747,885,430 $21,461,296,293 $492,700,594
    18. 18. Texas MCD Budget 2008 & 2009 Budget- $167.8 billion 2008 & 2009 spending on MCD- $45 billion MCD accounts for 26.82% on total budget
    19. 19. • Increase provider base • Decrease paperwork for renewal • Increase rates • Provide better training for facility staff ADVICE FOR ADMINISTRATORS OF MEDICAID GOING FORWARD
    20. 20. MEDICAID ELIGIBILITY • Based on income and assets • Potential Applicants – any adult who lives with an uninsured child and provides care for that child can apply including: 1. Parents (including adoptive parents) 2. Step-parents 3. Grandparents 4. Other relatives 5. Legal Guardians 6. Adult Siblings
    21. 21. CITIZENSHIP AND MEDICAID • Citizenship status is one factor used to determine which pregnancy related program the woman may qualify including: 1. Regular Medicaid 2. Medicaid for Pregnant Women 3. CHIP 4. CHIP Perinatal • Medicaid for pregnant women proves full Medicaid benefits for eligible women • Income limit is based on family size, including the unborn child • The income limit for Medicaid for pregnant women is higher than for regular Medicaid because it included the needs of the unborn child
    22. 22. • Household income reported is income received by – parents, step-parents, working children • Income from working children who attend school is not counted toward family income; however, it must be reported within the household income section • The most common mistake seen is that the verification provided does not reflect amounts. The amount listed should be the same or close to the amount listed on the application HOUSEHOLD INCOME
    23. 23. MEDICAID PROGRAMS FOR THE ELDERLY AND PEOPLE WITH A DISABILITY • For individuals living in a facility, Medicaid will pay for: A. Facility Care – bed, medical staff B. Medication Individuals eligible for institutional or waiver services: ① Reside in an approved facility ② Meet functional eligibility requirements ③ Have income below $2022 for individual and $4044 for a couple ④ Have resources below $2000 for individual and $3000 for a couple • People who are elderly or have a disability and don’t receive SSI may qualify for assistance when they live in these environments: 1. Nursing facility 2. Intermediate care facility for people with mental retardation (ICF/MR) 3. State school 4. State hospital
    24. 24. MEDICAID PROGRAM LETTER GRADE BY GROUP ONE • User Friendly • Resourceful • Had a good list of specialist • Opened a gateway to care • Made life easier for our elderly