Medicaid, Medicare and Long Term Care

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Medicaid


Medicaid is government health insurance that helps many low-income people in the United States to pay their medical bills. Although the Federal government establishes general guidelines for the program, each state has its own rules.


The Center for Medicaid and CHIP Services 
The Center for Medicaid and CHIP Services (CMCS) is one of six Centers within the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services (HHS). CMCS serves as the focal point for all national program policies and operations related to Medicaid and the Children’s Health Insurance Program (CHIP).


Medicaid State Waiver Programs
The Social Security Act authorizes multiple waiver and demonstration authorities to allow states flexibility in operating Medicaid programs. Each authority has distinct purposes, and requirements.

Section 1115 Research & Demonstration Projects: projects that test policy innovations likely to further the objectives of the Medicaid program.

Section 1915(b) Managed Care/Freedom of Choice Waivers: managed care delivery systems

Section 1915(c) Home and Community-Based Services Waivers: Facilitates long-term care services delivered in community settings. This program is the Medicaid alternative to providing comprehensive long-term services in institutional settings.
Website: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html?filterBy=district of columbia


Medicaid entitlement programs for people with disabilities provide an array of benefits and services designed to promote independence and autonomy. Home and community-based waivers can provide many benefits, including home health aide services and/or personal care attendant services and residential and home care services in lieu of institutional care. There may be other waivers and options.

“Money Follows the Person” Rebalancing Demonstration Program (MFP) 

The “Money Follows the Person” Rebalancing Demonstration Program (MFP) helps States rebalance their long-term care systems to transition people with Medicaid from institutions to the community. Forty-three States and the District of Columbia have implemented MFP Programs.  From spring 2008 through December 2010, nearly 12,000 people have transitioned back into the community through MFP Programs. The Affordable Care Act of 2010 strengthens and expands the “Money Follows the Person” Program to more States.
Website: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Balancing/Money-Follows-the-Person.html


Real Choice Systems Change
In 2001, Congress began funding the Real Choice Systems Change Grants for Community Living program (hereafter, Systems Change grants) to help States change their long-term care systems to rely less on institutional services and to increase access to home and community-based services. The overarching purpose is to help States develop the necessary regulatory, administrative, program, and funding infrastructure to enable individuals of all ages who have a disability or long-term illness to live in the most integrated community setting of their choice; exercise meaningful choice and control over their living environment, services, and service providers; and obtain high-quality services in a manner consistent with their preferences.
Website: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Balancing/Real-Choice-Systems-Change-Grant-Program-RCSC/Real-Choice-Systems-Change-Grant-Program-RCSC.html


The Desk (Medicaid Reference Desk)
This site is a tool to help people with developmental disabilities find out what Medicaid can offer them.
Website: http://www.thedesk.info/about/


Medicaid Information for the District of Columbia
Facts, Programs, and Waivers for DC Medicaid
Website: http://www.thedesk.info/state/district-of-columbia/


Medicaid Waiver Manual
If you are confused about the variety of Medicaid Waivers, you are not alone. This manual written for individuals with developmental disabilities is from the Georgia Developmental Disabilities Council and it explains some of the waivers for individuals with developmental disabilities in their state. Just remember that each state is a little different.
Website: http://www.unlockthewaitinglists.com/MedicaidWaiverManual.pdf


Medicare Ombudsman Can Help You
The Medicare Beneficiary Ombudsman helps you with complaints, grievances, and information requests. Learn more:
Website: http://www.medicare.gov/Publications/Pubs/pdf/11173.pdf

 

Medicare

Medicare is the federal health insurance program for Americans age 65 and older and for younger adults with permanent disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). Knowing the basics about Medicare can help you make good decisions about your health coverage and care. For specific questions about your claims, medical records, or expenses:
Phone: 1-800-MEDICARE (1-800-633-4227)
Website: http://www.medicare.gov/default.aspx    


Medicare and You 2010
Summary of Medicare benefits, coverage options, rights and protections, and answers to the most frequently asked questions about Medicare.
Website: http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=10050


How the Affordable Care Act Helps Seniors and People with Disabilities
Website: 
http://familiesusa2.org/assets/pdfs/health-reform/in-perspective/Seniors-and-People-with-Disabilities.pdf


Long Term Care

National Clearinghouse on Long-Term Care Information
This clearinghouse provides information and resources to help plan for future long-term care. It is primarily focused on care of individuals over age 65. The Administration on Aging (AoA) is the Administrator of the National Clearinghouse for Long-Term Care Information. For information about the Clearinghouse website, contact AoA here:
Phone: (202) 619-0724; Fax: (202) 357-3555
E-mail: oainfo@aoa.hhs.gov
Website: http://www.longtermcare.gov/LTC/Main_Site/index.aspx


SSI and SSDI
SSI, or Supplemental Security Income is a national program that pays benefits to disabled adults and children who have limited income and resources. SSI benefits also are payable to people 65 and older without disabilities who meet the financial limits. The Red Book is an authoritative resource for learning about SSI. The Red Book is a general reference tool designed to provide a working knowledge of SSI and SSDI. The Red Book is as self-help guide written primarily for educators, advocates, rehabilitation professionals, counselors and applicants and beneficiaries.
Website: http://www.ssa.gov/redbook/eng/introduction.htm