Inpatient/hospital Care And Services
- If you need hospital care or need help paying your hospital bills, you may be able to get Medicaid inpatient services, in addition to the outpatient care described above. You must have medical bills that are at least equal to your monthly excess income amount for six months. These bills can be paid or unpaid. They can also be for medical services other than hospital care.
- Once your medical bills are at least equal to your excess income amount for six months, you must bring or send these bills to your local department of social services. You will then receive Medicaid for six months.
Effective Date Of Coverage
Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.
People Who Have Both Medicare & Medicaid
People who have both Medicare and full Medicaid coverage are dually eligible. Medicare pays first when youre a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.
You can still pick how you want to get your Medicare coverage: Original Medicare or Medicare Advantage . Check your Medicare coverage options.
If you choose to join a Medicare Advantage Plan, there are special plans for dual eligibles that make it easier for you to get the services you need, include Medicare coverage , and may also cost less, like:
- Special Needs Plans
- Medicare-Medicaid Plans
- Program of All-Inclusive Care for the Elderly plans can help certain people get care outside of a nursing home
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How To Apply For Mississippi Medicaid Health Benefits
Online
Mississippis Common Web Portal at Access.ms.gov is a convenient way to apply for children, pregnant women, low-income parents of children under age 18 and anyone else who needs to apply. Documents can be uploaded and sent electronically with your application to the Medicaid Regional Office serving your county of residence. Medicaid Specialists in the Regional Office check available electronic sources to verify as much information as possible and then follow-up if additional information is needed. NOTE: If you want to apply for Medicaid due to age, blindness or disability on Access.ms.gov, be sure to check YES to a limiting or disabling condition when those questions appear in the application flow. This lets us know you are asking for a Medicaid decision that considers age, blindness or disability as a condition of your eligibility.
The Mississippi Division of Medicaid and the federally facilitated marketplace has one single application for all insurance affordability programs. Application for any of the insurance affordability programs may be filed online through Access.ms.gov or the FFM at Healthcare.gov. If you apply through Healthcare.gov, the FFM will assess your potential eligibility for Medicaid or CHIP and then return your application to the Division of Medicaid for the final eligibility decision.
To fill out this application, you will need:
What Medicaid Helps Pay For
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If you have Medicare and qualify for full Medicaid coverage:
- Your state will pay your Medicare Part B monthly premiums.
- Depending on the level of Medicaid you qualify for, your state might pay for:
- Your share of Medicare costs, like deductibles, coinsurance, and copayments.
- Part A premiums, if you have to pay a premium for that coverage.
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How Does Payment Work
Medicaid does not pay money to you if you qualify. Medicaid sends payments to your health care provider after you receive services. Depending on your states program, you may be responsible for paying a small copayment for some medical services.
What extra benefits and savings do you qualify for?
What If I Need Help Gathering And Submitting My Bills Or If It Is Difficult For Me To Travel To The Medicaid/dss Office Every Month
People with disabilities who find it difficult to go into a DSS/Medicaid office have a right to fax in bills as a reasonable accommodation for a disability. In some districts, including New York City, anyone can fax in their bills. Ask your caseworker for a fax number and fax cover sheet, or for another procedure to accommodate your disability. The fax number in New York City is 917-639-0645. If you fax bills, you must include your name, case and CIN number, the amount of your excess income, and say which month you want coverage. If you need help with producing your bills because of a disability, you can contact your local department of social services to see what reasonable accommodations can be made.
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How Did The Affordable Care Act Change Medicaid
Medicaid plays an even more important role in insuring low-income Americans due to the Affordable Care Act. As noted, the ACA provides coverage for poor and low-income adults by expanding eligibility for Medicaid to 138 percent of the poverty line. As of April 2020, 35 states plus the District of Columbia have implemented the Medicaid expansion to serve poor and low-income adults. By 2029, 14 million more low-income adults will have enrolled in Medicaid and gained access to affordable comprehensive health coverage due to the ACA, CBO estimates.
The expansion is a very good financial deal for states. After picking up all expansion costs for the first three years, the federal government now pays 90 percent of expansion costs on a permanent basis. And by greatly reducing the number of uninsured, the expansion will save states and localities substantial sums on uncompensated care for the uninsured. Some expansion states have also experienced savings in mental health programs, criminal justice systems, and other budget areas.
How To Apply For Medicaid
Virginia Medicaid accepts applications for health coverage year-round. You can choose from three different ways to apply:
Visit CoverVa.org for more information:
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When Do I Enroll
You can qualify for both Medicaid and Medicare, and enrolling in both is dual eligibility. To apply for Medicare and Medicaid, it takes only a simple application. You can apply for Medicare online or over the phone. Then, you can complete Medicaid applications in person, by phone or online.
Once enrolled, you can change your plan once every calendar quarter for the first three quarters. All changes are active on the first day of the following month.
Fourth-quarter changes must be made during the Annual Enrollment Period between October 15 and December 7. Fourth-quarter changes take effect on January 1.
Other Mo Healthnet Programs
When you apply for MO HealthNet, we will also check to see if you can get help through:
- Spend Down: If you make too much money, you may still be able to get MO HealthNet coverage if you agree to pay, or spend down, a certain amount. Once you spend this amount, you will have MO HealthNet coverage for the month. For more information visit our frequently asked questions.
- Ticket to Work: If you are disabled and make too much money to qualify for MO HealthNet, you can still get help with your healthcare costs if you agree to take part in this program. Learn more about Ticket to Work.
- Home & Community Based Services: These services may be able to help you or a loved one stay at home and out of a nursing home by providing the in-home services you need.
- MO HealthNet Nursing Home Coverage: If you live in a nursing home, we may be able to help pay for any nursing home costs you arent responsible for. You will be responsible for using all of your income towards costs except for a $50 monthly allowance, any health insurance premiums, and any income set aside for a spouse or other dependents.
NOTE: There is no separate application process for these programs. You will automatically get more information if your MO HealthNet application shows you are eligible.
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How To Apply For Aged Blind Or Disabled Medicaid Benefits
If you are applying for aged, blind or disabled Mississippi Medicaid benefits and services, an in-person interview may be required. If so, you will be contacted by staff at the regional office that serves your county of residence.
- Apply by filling out the Mississippi Medicaid Aged, Blind and Disabled Application Form and submitting the application to the regional office that serves your county of residence or if the applicant is in a nursing home, the regional office that serves the county where the nursing facility is located. Mail or bring in the application at the time of the in-person interview if one is required. It is advised that you do not email forms or submit online forms with protected health information or personally identifiable information, to protect your confidentiality in accordance with the Health Insurance Portability and Accountability Act of 1996.
Outpatient Care And Services
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- If you need outpatient care in a hospital, clinic or doctor’s office, prescription drugs or medical supplies, you may be able to get help with these bills. If you have medical bills that are equal to or more than your monthly excess income, you can get Medicaid outpatient services for one month at a time.
- You must bring in, send or fax your medical bills to your local department of social services when they are at least equal to your excess income amount. These bills can be paid or unpaid. You will need to do this each month you need outpatient care.
- You may be able to get long-term care services like adult day health care, personal care services and the Assisted Living Program. Your social services worker will be able to tell you if you are eligible for these services.
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Who May Enroll In A Statewide Medicaid Managed Care
Some Medicaid recipients are not required to enroll in an MMA plan, but may choose to enroll if they meet all other enrollment requirements.
Some Medicaid recipients will receive directions that they must enroll in a plan:
Who Is Eligible For Medicaid
You may qualify for free or low-cost care through Medicaid based on income and family size.
In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program covers all low-income adults below a certain income level.
- First, find out if your state is expanding Medicaid and learn what that means for you.
- If your state is expanding Medicaid, use this chart to see what you may qualify for based on your income and family size.
Even if you were told you didn’t qualify for Medicaid in the past, you may qualify under the new rules. You can see if you qualify for Medicaid 2 ways:
- Visit your state’s Medicaid website. Use the drop-down menu at the top of this page to pick your state. You can apply right now and find out if you qualify. If you qualify, coverage can begin immediately.
- Fill out an application in the Health Insurance Marketplace. When you finish the application, we’ll tell you which programs you and your family qualify for. If it looks like anyone is eligible for Medicaid and/or CHIP, we’ll let the state agency know so you can enroll.
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Who Qualifies For Medicaid & Chip
- In all states, Medicaid and CHIP provide health coverage for certain children, parents, pregnant women, elderly people with limited income, and people with disabilities.
- In some states the programs also cover other adults below a certain income level. Children in families with household incomes too high to qualify for Medicaid may still qualify to enroll in CHIP.
- Use our savings tool to see if you qualify for Medicaid in your state based only on your income.
How Do I Apply For Medicaid
You can apply for Medicaid in any one of the following ways:
- Write, phone, or go to your local department of social services.
- In New York City, contact the Human Resources Administration by calling 557-1399.
- Pregnant individuals and children can apply at many clinics, hospitals, and provider offices. Call your local department of social services to find out where you can apply.
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Check The Status Of An Application
The Division of Family Resources provides tools to strengthen families through services that focus on prevention, early intervention, self-sufficiency, family support, and preservation.
You can check the status of your application online by clicking on your county of residence or by calling 1-800-403-0864. You will need to have your case number to check the status of your application.
Please remember that your application must be completed and all required documentation submitted before DFR can begin processing your application.
Pursuant to HIPAA and other applicable federal regulations, DFR is committed to respecting the privacy of each client. For that reason, DFR will not share or disclose information about your case without a signed release. You may download the DFR online.
How Is The Amount Of My Excess Income Determined
Your Medicaid caseworker will determine the monthly excess income amount. The amount is the difference between the monthly Medicaid income limit and your countable income. When we count your income, we take your gross monthly income and then subtract certain deductions. There are different deductions depending on whether you are certified disabled or blind or age 65 or older, or whether you are under age 21, pregnant, or a parent of a child under age 21.
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Past Unpaid Medical Bills
Past unpaid medical bills may be used to meet your excess income amount even if they are old, as long as they are still viable, meaning that the medical provider is still able to bring a legal action to collect them. These bills may be applied to meet your excess income indefinitely into the future.
- Example: You have a hospital bill from four years ago and received a collection notice from the hospital this year. The bill is for $2,000. Your excess income is $200. You may submit this bill to meet your excess income for six consecutive months. After the six months is over, if the provider is still trying to collect on the bill, you can continue to use the balance of the bill for four more consecutive months.
Past Paid Medical Bills
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Past paid medical bills may be used if the medical services were provided and paid for within the three calendar months before the month you applied for Medicaid with excess income. They may be applied to meet your excess income for up to six months beginning in the month you applied, and sometimes beginning up to three months before you applied, if you want “retroactive coverage” for Medicaid to pay your recent medical bills.
Bills paid by EPIC or ADAP in the three months before the month in which you applied for Medicaid may be used to meet your excess income.
- Example 1: You paid your 17-year old child’s dental bill in June for dental care provided in May. You have your own unpaid medical bills in the months of June and July. You apply for Medicaid in August. You may use the paid dental bill toward your excess income beginning in the month of June.
- Example 2: Each month EPIC has been paying $100 for your prescriptions and you have been paying your $20 co-payment. In October you apply for Medicaid. You have no unpaid medical bills. You are determined eligible for Medicaid and your case is opened effective October 1 with a $50 monthly excess income. Since you do not need coverage in the three month retroactive period , the paid amount of $360 can be used to meet your excess income for six months . The $60 balance will be lost as paid bills can only be used up to a maximum of six months.
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Policy Basics: Introduction To Medicaid
In 2018, Medicaid provided health coverage for 97 million low-income Americans.
In 2018, Medicaid provided health coverage for 97 million low-income Americans over the course of the year. In any given month, Medicaid served 32 million children, 28 million adults , 6 million seniors, and 9 million people with disabilities, according to Congressional Budget Office estimates.
Children account for more than two-fifths of Medicaid enrollees but only one-fifth of Medicaid spending. Only one-fifth of Medicaid enrollees are seniors or people with disabilities, but because they need more health care services, they account for nearly half of Medicaid spending.
Medicaid is sometimes confused with Medicare, the federally administered, federally funded health insurance program for people over 65 and some people with disabilities. And there is overlap between the two programs: nearly 10 million low-income seniors and people with disabilities so-called dual eligibles are enrolled in both Medicare and Medicaid.