Senior Care Solutions: What is Medicaid?

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Generous benefits are available to help pay for assisted living, in-home care, and nursing home care.

What is Medicaid?

30-second summary:

Every resident of Indiana is entitled to Medicaid benefits.
There are several benefit programs that cover many areas of need.
Medicaid pays for in-home care, assisted living, and nursing home care.
Medicaid covers co-pays, deductibles, etc.

Medicaid is a program that helps cover costs across a variety of areas relating to health care, nutrition, children, etc. This program is available to every resident of the state. Understanding what benefits are available to your aging loved ones and determining what is takes to qualify is what we do at Senior Solutions Consulting (SSC). If you have ever tried to apply for benefits, whether it’s basic health care, in-home care, assisting living, or nursing home care, then you know how easy it is to get lost in an endless stream of paperwork and regulations. Medicaid works in conjunction with Medicare and supplemental or Advantage plans to ensure that no one goes without basic health care. Medicaid is not just for the poor or those with low incomes. Anyone with substantial health issues and/or large health care costs could potentially benefit from Medicaid services. If you need help determining what programs might be of assistance to you and how to qualify, you can take advantage of an initial free consultation with SSC. We are experts at making sure your aging loved ones get all the benefits they deserve! Give us a call at 317-863-0213 to learn more about how we can help you.

What is Medicaid? The Big Picture

Medicaid can be thought of as a health insurance program that works with Medicare and private health insurance to be the payer of last resort. Medicaid picks up deductibles, co-pays, etc. for those who need help. The program is a 50/50 split with the states and the federal government of the United States through the United States Department of Health and Human Services, the Centers for Medicare and Medicaid Services (CMS), and Medicaid.gov.

While the funds come from the federal government, they are passed on to the states, and each state is responsible for administering its own Medicaid program but must meet federal regulations and requirements if they want to keep receiving those federal funds. As a side note, you may see the acronym CHIP in relation to Medicaid. That stands for the Children’s Health Insurance Program, but our focus is more on aging adults and/or seniors with disabilities.

Medicaid in the State of Indiana

In the Hoosier state, Indiana Medicaid is the website for information about Medicaid, which falls under the umbrella of the Indiana Family and Social Services Administration (FSSA), including the following:

Providers (find a Medicaid health care provider)
Federal Marketplace (those who don’t qualify for Medicaid can apply at healthcare.gov)
Get Help Applying (navigators in each county help explain options and how to apply)
Member Rights & Responsibilities (learn about your rights and responsibilities)

Medicaid provides services for children, pregnant women, adults, and the category where SSC has deep expertise: the aged, blind, and disabled.

Medicaid Expansion in Indiana

The passage of the Affordable Care Act (ACA) in 2010 opened up the opportunity for states to expand their Medicaid programs. In 2014, many states signed on to the federal Medicaid expansion process, which meant more people could qualify for Medicaid, and the federal government would provide a significant amount of funding to those states to help with the increased costs of covering more people. Many states, including Indiana, opted to apply for a waiver from some of the federal requirements in order to create its own innovation program and still receive federal funds as long the insurance provided is at least as comprehensive as that provided by the ACA.

Indiana passed its own innovation expansion program called Healthy Indiana Plan and referred to as HIP 2.0 (since it was an amended form of a previous plan). While it expanded the number of people who qualify significantly, it took a more rigid approach with the requirements of some members having to pay monthly premiums. In 2019 Indiana started to implement a work requirement for Medicaid expansion enrollees but soon had to stop the implementation because of a lawsuit. Several other states that tried Medicaid work requirements had them overturned in the courts. Whether Indiana will be successful in eventually implementing a Medicaid work requirement remains to be seen. It would not apply to seniors age sixty five or over.

Indiana Division of Aging and Medicaid Waivers

Original Medicaid pays for long-term care at a long-term care facility. For those who may not need that level of care, the Waiver program can provide payments for care in assisted living facilities or in a person’s home. Indiana Medicaid home and community-based services is where the Waiver for in home care and assisted living services is obtained. The Aged and Disabled Waiver page of Indiana Medicaid has basic information about how that works and what it covers.

Medicaid Eligibility for Seniors in Indiana

There are many things that determine eligibility for Medicaid in Indiana. The two major issues are monthly income and countable assets. Property, automobiles, life insurance, investments, and many other items all factor in to whether a person would be eligible for benefits. There is also a 5 year look back period to identify any transfers of property or money. Transfers are deemed by Medicaid to be in anticipation of qualification for benefits and are scrutinized closely. Any transfers that are made for less than fair market value are considered gifts and will most likely result in a penalty period during which Medicaid will not pay for care. The asset limits are as follows: A single person may not have more than $2,000 at the end of each month to qualify and stay qualified for benefits. This number increases to $3,000 for a married couple where both spouses are applying or on benefits. Usually one vehicle, prepaid funeral plans, the IRAs, 401ks, or other qualified money of the non-applicant spouse are exempted from being counted. Every case and situation is different so seek council to determine which items in your particular case are countable or exempt. Do not try to hide or dispose of assets without the knowledge of the local Medicaid office. This could result in criminal charges or discontinuation of benefits. There are rules that allow for the protection of a majority of a person’s assets so following the rules can still be beneficial to an applicant and their family.

The various programs that fall under the Indiana Medicaid program include the following:

Healthy Indiana Plan (expanded Medicaid program)
Hoosier Care Connect (this is for the elderly and disabled)
Hoosier Healthwise (this is for children, youth, and pregnant women)
HoosierRx (helps seniors pay for medications and Medicare Part D premiums)
Medicare Savings Program (helps seniors and the disabled pay for Medicare costs)
Pharmacy Benefits (overview of how to fill subscriptions for Medicaid members)
Traditional Medicaid (this is the regular low-income program)
Indiana Medicaid Covered Services (helpful list of common medical services covered)

The Indiana Medicaid website also has an Understanding Terms page that defines many of the words and phrases used when discussing Medicaid and its benefits.

Is Your Head Already Spinning? We Get It! Contact SSC for Help

If you have never faced these issues before and you would like help determining what benefits are available and what is needed to qualify then contact us at Senior Solutions Consulting, Inc. We can help. It is our goal to explain all of the different benefit programs available and which ones would provide the best possible benefits. Find out how we can assist you by scheduling a free initial consultation. You may also contact us directly at 317-863-0213 to find out more about our services.

When you have questions about benefits for long-term care, SSC has answers!

SCHEDULE YOUR FREE APPOINTMENT!