Medicaid

People often confuse Medicare and Medicaid.

MEDICARE PROGRAM

Medicare is guaranteed to every individual who paid into social security system through their employment taxes. That contribution is automatically deducted from your pay. Upon reaching retirement age, you will qualify for Medicare as the primary provider for payment of doctors, hospital and prescription costs.

Medicare does not cover long term care for a nursing home, but will assist with the cost of short term rehabilitation services, where the goal is for the individual to return to the community they were previously living in.

MEDICAID PROGRAMS

Unlike Medicare, Medicaid is a federally funded medical program for the elderly, blind and disabled persons. It is offered to persons who meet eligibility requirements of the program. The goal of Medicaid is to assist the individual in need by paying for medical services. The Medicaid program provides assistance in the community, in assisted living and nursing home. Each county has programs available to meet these needs.

Medicaid is administered by each state. As a result, there are differences between states on what is available. Medicaid pays all medical related bills for the qualified applicant, including all hospital bills, all doctors’ bills, all pharmacy bills, the entire residential care facility bill, medical transportation costs, medical equipment rental bills, and any other medically necessary bills incurred by the Medicaid recipient.

APPLYING FOR MEDICAID

The Medicaid program is based solely on the health of the applicant and the financial situation of the applicant. In other words, in order to qualify for Medicaid assistance, you must establish that you are in need of institutionalized care, such as assisted living or a nursing home and that you do not have the resources to pay for the care you require.

Once an applicant has been “medically” certified for Medicaid for health reasons, you must pass both an income and an assets test. This is a means tested program, that means that Medicaid is only available if you meet the specific criteria set forth in the regulations associated with the program.

In order to qualify for Medicaid, the applicant must apply through the local county Board of Social Services. That agency reviews the financial and medical situation to determine if the applicant is qualified to receive benefits and what type of benefits are available in the community or in a facility to meet the needs of the applicant. If the applicant is deemed qualified, the county will pay the costs of medical care to the providers. If the applicant is not deemed qualified, there is an appeal process to attempt to secure those medical benefits.

CONTACT AN EXPERIENCED MEDICAID ATTORNEY

The attorneys at Weiss & Tom are familiar with the Medicaid process having assisted its clients in securing government benefits. For more information on Medicaid and how to apply, you may you may contact the lawyers at Weiss & Tom online.