Medicaid future under Obama vs. Romney

MEDICAID
Basics & comparison of Romney vs. Obama plans
Presented at informational on 9/19/12
at the Cheboygan Public Library

B A S I C S


ELIGIBILITY requirements: U.S. Citizenship, Michigan Residency, Non-financial criteria, asset and income limits.

U.S. Citizenship, there are rare exceptions. While being a Medicaid eligibility specialist in Mackinac County for 11 years, not a single non-citizen was ever approved. One example: Jamaican workers from Mackinac Island applied, needed help due to STD affecting many. All were denied.

Non-financial categories: in order to qualify for Medicaid, you must fit into one of the available Medicaid programs. There are programs for persons under 21, 65 and older, pregnant ladies, disabled persons, and parents of minor children in the home. NOTE: persons between 21-64 may well not fit the remaining categories of pregnancy, disability and parenthood, thus application for Medicaid would be denied.

Those qualifying based on being parents, disabled or seniors often face MONTHLY deductibles. Such could range from $10 a month to Oe..highest one I actually handled was $1800 per MONTH. Let's say this couple had a hospital bill accrued on the fifteenth of the month to the tune of $2,000. They'd be responsible for $1800 of the bill and Medicaid would pay the remaining $200, plus the couple would have Medicaid for the remainder of that month.

ASSETS: Some programs do not have asset tests. Those for the disabled and seniors do have limits. For single adults: $2,000, for couples still in their own homes: $4,000.

INCOME: The various Medicaid programs vary. Healthy Kids for infants has one figure, for children 1-18 it's another; for persons 19 & 20 another; for the other groups, again varies. Income is what determines a persons' “monthly deductible”. Persons on disability and senior-related categories often have monthly deductibles, as do parents of minors.



CASE EXAMPLES

Guess which of these cases would be approved:

Seventeen year old pregnant girl living alone, with earnings, but just above poverty.

Nineteen year old male, zero assets, makes $30,000 a year.

Twenty-two year old, no assets, unemployed and UCB ended, needs immediate heart surgery or he will die within days or may weeks.

Fifty-seven year old female, no assets, income barely above poverty level, doctors say she must have knee surgery. The pain is a problem. Left untreated indefinitely....could?

Forty-four year old male, blue collar worker. Meets countable asset limit. Has had severe pain in his side for months. Doctors want to run tests to determine cause. (any pain could be a life-threatening condition just waiting to be diagnosed).


Approved or denied?

17 year old would be approved based on two potential Medicaid categories. She is pregnant, and she is under 21, and she met the income limit for either of those programs.

19 year old could go either way. Some workers would deny the case until he met his huge MONTHLY deductible. If he were to meet the deductible he could get help based on his age for the Medicaid program for those aged 19 and 20.

22 year old did get the life saving surgery, as there was not time for surgeons to wait for the Medicaid application to be completed. The Medicaid case was denied. The young man was not: under 21, not pregnant, not a parent of minor, and he was denied Disability -Based Medicaid. Why? He was able to return to work within 3 months. For Medicaid disability a patient must be disabled for 12 months.

57 year old. She was denied because: she was not under 21, not 65 or older, not pregnant, not parent of minor in home, and not considered disabled. She did not get the surgery she needed.

44 year old with pain. Denied for same reason.




MEDICAID IN THE FUTURE
Under Obama vs. Romney/Ryan

OBAMA:
17 million more persons would qualify for Medicaid; would end the existing
categories discussed above; the first 3 years of the Medicaid expansion the states would be subsidized 100 percent covered by Federal govt., after 3 years. 95 percent and by 2020 federal govt. would cover 90 percent of the expansion.

ROMNEY:
Cuts of $1.4 trillion over ten years (34 percent cut) per Forbes; up to 30 million would lose coverage per Urban Institute and Forbes; repeal of the Affordable Care Act leading to 15 million more who would lose coverage; the federal govt. would give BLOCK GRANTS to the states which could lead to reduction in payments to providers..per Congressional Budget Office; reduce Medicaid eligibility and provide less coverage to Medicaid recipients per Washington Post 8/13/12.


NOTE: I left the Dept. of Human Services in January of 2008. The facts, figures are from 2008. The primary change I'm aware of is that Michigan finally joined the other states and now has an “estate recovery program” for some persons in Long Term Care. I was told by an attorney in Lansing that there is such a large loop hole one could drive a freight train through it.

One last comment: the republicans will drastically cut funds to Medicaid. You should know that most Medicaid funds are to cover low-income children, and seniors in Nursing homes. You might want to ask our Congressman, which group will be hit the hardest? Poor children, or LTC residents. Could YOUR parents, grandparents, siblings, spouses afford the $5,000 or more monthly price tag?
Information researched by
Karen Martin Cheboygan Retired Eligibility Specialist