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Publications & Products
Minnesota Consumer Awareness Education and Resource Guide for 1998
CHAPTER II: Overview of Medicaid
What is Medicaid?
Medicaid is a system of medical assistance for indigent (impoverished) individuals.
What is the objective of the Medicaid program?
The objective is to provide payments for medical assistance to low-income persons who are 65 or older, blind, disabled, members of families with dependent children or qualified pregnant women or children.
How is the program financed?
The program is jointly financed by the federal and state governments. They share in the cost of providing medical services, as well as the cost of administration. Payments for services rendered are made by the state directly to individuals or entities that furnish the services.
What services are covered by Medicaid?
Inpatient hospital services, outpatient hospital services, rural health clinic, lab, x-ray, health practitioners' services ( nurse practitioner, physician assistant), personal care assistant [PCA] services, mental health services, nursing facility services and home health services, physicians' services, medical surgical services of a dentist, prescription drugs, clinic services, prosthetic devices, hearing aids, intermediate care facilities for mentally retarded.
Breakdown Of Services And Assistance Through Medicaid
Health care for Minnesota's programs is provided by fee-for-service medical providers or managed care health plans. Once enrolled in a managed care health plan, all medical care except a life-threatening emergency must be obtained from that health plan.
What are the covered services offered by Medicaid?
- Medical assistance: Covers health-care expenses for most individuals receiving AFDC and SSI. As of 1-1-98, AFDC ended in Minnesota and was replaced by Minnesota Family Investment Program-Statewide [MFIP-S] which has a 60 month time limit with some exceptions. Residency requirements remain the same. A new work incentive will enhance a cash grant with up to 36% of earned income not being counted toward a grant; and, continuation on the program is permitted until income is at 120% of the federal poverty level. Assistance with job search and employment is also provided.
- Medical Supplemental Policies with Medicaid are Qualified Medicare Beneficiaries [QMB] and Specified Low-Income Medicare Beneficiary [SLMB].
QMB/SLMB:
- Federal law requires that State Medicaid programs pay Medicare costs for certain elderly and disabled persons with low incomes and very limited assets.
QMB:
- Pays Part B premium and annual deductible, 20% copayments-payments, Part A benefit period deductible, copayments-payments for SNF and inpatient stays; OBRA-90 provides for 24 month suspension period of a MC supplemental policy during MA eligibility (insurer who fails to comply with these requirements is subject to civil money penalty)
SLMB:
Spend down:
- Program for those who do not meet the monetary requirement for Medicaid; medical expenses are allowable deductions from their income.
Aid to the blind:
- Income is supplemented if eligibility criteria is met.
Nursing home benefits:
- Program assists persons who reside in a certified nursing facility; must meet income and asset criteria for reimbursement.
What is fraud disqualification if you are on Medicaid?
Fraud disqualification: people found guilty of welfare fraud are disqualified from assistance for one year after the first offense and two years after the second offense. After the third offense, disqualification is permanent.
What is a sanction?
People who fail to comply with the MFIP-S work requirements will be sanctioned with a 10% reduction in their grant for the first violation and 30% for the second and subsequent violations. Before the 30% sanction can be imposed, though, the client's rent must be vendor paid and, at the county's option, the utilities can be paid.
- Home Care Utilization: Programs funded jointly by state and federal funds.
- Home Care Nurse Consultants: Resource for information and decision making.
- prescription drugs
- transportation services
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