What is Medicaid?
Medicaid is a program that provides medical insurance for people with limited income and resources. It covers hospital services, physician services, mental health care, prescription drugs, and more. Unlike Medicare, Medicaid also covers some long-term care services, such as home care and nursing homes.
In Arizona, the Arizona Health Care Cost Containment System (AHCCCS) is the state Medicaid program that covers healthcare expenses based on medical needs and ability to pay. The Arizona Long-Term Care System (ALTCS) provides long-term services for lower-income older adults and disabled people who do not receive payments for long-term services from other medical insurance sources.
What is the difference between Medicare and Medicaid?
Medicare is federal health insurance for people over 65, some younger people with disabilities, and people with End-Stage Renal Disease. Medicaid is a state and federal program that offers medical coverage for low-income individuals and families of any age.
How (and where) do I apply for Medicaid? What makes me eligible for Medicaid?
Medicaid eligibility varies by state based on financial and non-financial factors, including residency and medical needs. To apply for Medicaid, contact your local area agency on aging or visit USA.gov. Financial eligibility includes income and resource limits, and some states allow you to "spend down" the amount of your income above the Medicaid limit. Non-financial eligibility requires that beneficiaries be residents of the state where they receive Medicaid and either US citizens or qualified non-citizens. Age, pregnancy, parenting status, and disability may also affect eligibility.
Where can I receive long-term Medicaid services?
Medicaid provides long-term services that vary by state. In-home care, nursing services, and affordable housing communities are available for those who require it. Skilled nursing facilities offer Medicare-covered services after hospitalization. Nursing homes provide long-term care for individuals with intensive needs. Assisted living costs are usually out-of-pocket, but some states offer waivers for Medicaid recipients. Considering future resources and ensuring the chosen community accepts ALTCS when private funds run out is important.
Are Medicaid benefits, services, and eligibility the same across states?
While the federal government requires consistency in Medicaid services, each state runs its own program. This means that eligibility requirements and benefits may vary from state to state. If you are currently a Medicaid recipient and considering moving to another state, it is important to check with both states about transfer requirements. These requirements may include the length of residency, income and resource requirements, and eligibility criteria for transferring your benefits.
Does Medicaid cover mental health services?
Medicaid is the largest payer of mental health and substance abuse services in the US. Around 40% of non-elderly adults enrolled in Medicaid have a mental health or substance abuse disorder. States have expanded behavioral health services and benefits coverage in recent years. Medicaid benefits cover mental health care under the "Physician services" category. States may also cover behavioral health benefits through optional benefit categories. Arizona Medicaid services include mental health counseling, psychiatric services, opioid use disorder treatment, serious emotional disturbance, and severe mental illness resources.
When thinking about long-term care and Medicaid, what other considerations come up?
- It's important to educate yourself about care options and home care, even if you don't think you'll need them in the future. Make sure you understand what resources and Medicaid requirements are involved.
- If you're searching for options for a disabled child or adult child, you may come across terms like "assisted living homes," "adult care homes," "residential group homes," etc. It's important to research what these residences and programs entail in your state, as well as Medicaid coverage and service requirements.
- If you or the person you're caring for is a veteran, long-term benefits and services may be available through the Department of Veterans Affairs.
- Even if you don't need it now, it's important to understand the differences between Medicaid and Medicare, as there may come a time when you'll need this knowledge.