Di$abl€d (Part 3): Medicaid I

Share Button

Before I get into the meat of today’s post, I want to say that I am a proud American, and I feel extremely fortunate that I live in the United States. I am thankful that I was born in a country where my physical limitations do not automatically make me an outcast of society. I am also grateful that our government has implemented programs, such as Medicaid, Social Security and Disability, and Vocational Rehabilitation Services, to help individuals with disabilities overcome the obstacles they face. That being said, this does not mean that I necessarily agree with the way these programs have been implemented or managed, and it definitely does not mean that I agree with how the American government has treated the disabled community in general. Despite the fact that I may disagree with some of the decisions that have been made by the government in regards to disability rights and such, I still greatly appreciate everything that federal assistance programs have done for me. I know that without the assistance of these programs I would have never been able to achieve everything that I have or live the happy, successful life that I do. So if I come across as angry or overly harsh throughout this series, it is not that I am unappreciative or un-American, I am merely exercising my right to free speech/press and trying to create positive change for the disabled community.

All of the numbers and information I will be presenting in this series are based upon my own life and research. Private insurance and Medicaid benefits can vary greatly from plan to plan and state to state, respectively. While my experience may not be universal, it will still give you a good general idea of how these programs work in the real world.

At this point in the “Di$abled” series, you are well aware of the huge financial burden that the medical expenses associated with having a physical disability can be. You also learned in the previous entry about the large amount of relief that private health insurance coverage can provide for the disabled community, but that there are often insurmountable obstacles that either eliminate this source of financial assistance for disabled individuals or at least limit its effectiveness. For those people who are unable to obtain private insurance and/or require additional financial help with their medical bills above and beyond their insurance coverage, the federal government has created multiple programs to assist physically disabled individuals with their extra expenses. The most well known and widely used of these medical assistance programs is Medicaid. This program is available to any United States citizen who is determined to be physically disabled and not have the financial means to afford all of their medical needs. While this sounds great in theory, and this program does do a lot of good for the disabled community, in practice you will see that there are definitely some problems within the Medicaid system that make this program far from perfect.

Scott Drotar Medicaid Eligibility
You must be deemed both medically and financially eligible in order to receive Medicaid benefits.

Medicaid was created as a part of the Social Security Amendments of 1965 signed into effect by President Lyndon Johnson. According to the HIAA, Medicaid is a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.” It is obviously much more complicated than this, and there are a few other eligibility requirements, but in a general sense this is what the program was designed to accomplish. It provides medical insurance coverage for people who cannot afford their medical expenses, at little to no cost for the recipient. A unique aspect of this assistance program is that, although it is federally funded, each state is given the autonomy to administer their Medicaid funds however they deem best. This has the effect of making the Medicaid financial eligibility criteria, benefits, and physical disability determination process different from state to state. While this flexibility does have the positive result of allowing each state to make the most effective use of its funds, as you will see, the huge differences between states can be a large obstacle for many people who require these services. Even though every state is different to some degree, you will still gain a good understanding of the pros and cons of the Medicaid system by reading about my personal experiences using these services. If you would like to find more specific information for your state after hearing my story, you can visit the official Medicaid website at www.medicaid.gov.

When I think about the Medicaid program as a physically disabled person trying to lead a happy, successful life, there are two main aspects of these services that should be discussed. These two key ideas that need to be addressed are the eligibility requirements to receive services and the benefits that are provided. In terms of eligibility, there are two types of criteria that must be met in order for you to be approved for Medicaid assistance. You have to be deemed both medically and financially eligible before you can receive services. This is a lengthy process that involves obtaining numerous medical and financial documents, as well as filling out a more than 20 page application booklet. Once you complete this mind-numbing circus of bureaucracy and are finally approved for this program, you then have to become familiar with what benefits your state provides and how to use them to cover your medical expenses. This involves both understanding what your benefits are, and also finding health care providers that will accept Medicaid as payment.

Scott Drotar Medicaid Application
The Medicaid application booklet is a 20 plus page document that you have to complete in order to be approved for services.

In order to receive Medicaid services, you have to meet certain medical requirements. Medicaid is designed for people with minimal financial assets (the financial eligibility criterion that is discussed next) who fall into any of the following categories: children, pregnant women, parents of eligible children, people with disabilities, and the elderly. In most cases, the medical requirements for eligibility are very similar to the requirements for receiving Social Security benefits (SSI), and by being approved for SSI, you are frequently also automatically deemed medically eligible for Medicaid. Basically, you have to prove that you are physically unable to work enough to support yourself financially and cover your medical expenses. This process usually involves having your doctors write letters and fill out forms detailing the severity and limitations of your disability, which are then mailed to your state’s Medicaid office where it is reviewed. Making this long and time consuming process even more complex is the fact that, on top of each state having its own set of rules, there are usually several different medical assistance programs within the Medicaid system for each state. Every subgroup has its own set of eligibility criteria and benefits, and depending on your specific diagnosis and financial situation, you will need to apply for one of these plans. This means in addition to getting approved as medically eligible for Medicaid services in general, you also need to understand the separate benefits programs for your state and apply for the correct one. For example, in Kansas there are separate plans and benefits for developmentally disabled children, called Home and Community Based Services (HCBS), and for adults who are severely disabled but can still work, the Working Healthy Program. Even though I do qualify for Medicaid benefits, if I were to apply for any program other than the Working Healthy Program, due to my specific set of circumstances I would be denied services.

Once you have taken the time to educate yourself on your state’s Medicaid programs, obtained the necessary medical documentation from your doctors describing your disability, and have filled out the medical portion of the Medicaid application booklet describing your physical limitations, you are halfway to reaching your goal of being approved for services. Now that you have met the medical criteria, you must also show that you meet the financial eligibility requirements before you can receive your benefits. This involves filling out several more pages of questions in the Medicaid application booklet, as well as gathering various financial documents from your employer and your bank. In Kansas, you are required to send in 90 days of bank statements for all of your accounts, three months worth of pay stubs, and documentation of any other income (like home business income, trusts, real estate, etc.) when you apply for benefits. Since Medicaid is designed to give assistance only to people with “low financial assets,” you are trying to prove that your financial situation is insufficient to cover your medical expenses resulting from your disability. While every state is different in terms of what “low assets” means, in my experience it basically means that you are living month to month paying your bills, but you have no extra money beyond that. You have to have next to no savings or emergency money in the bank (typically the limit is $2,000 in liquid assets), and you must make just enough money to survive, in order to qualify for services. A more specific definition that several states have adopted is that you are only financially eligible for Medicaid if your income is less than 133% of the poverty line (roughly $30,000 for a family of four). While it does make sense to only provide these free, medical benefits to people who truly need it, the strict financial eligibility requirements that must be met to receive services can put some disabled individuals in a very difficult situation.

Scott Drotar Working Healthy
The Working Healthy Program is designed for people who are disabled, but still would like to work without losing their Medicaid benefits.

For many disabled people, these strict financial requirements you must meet in order to receive Medicaid benefits are a major, and possibly insurmountable, obstacle that prevent them from getting services. In my case for example, I am severely, physically disabled and could never afford all of my medical expenses, but I can still work and earn money despite my limitations. In some states, the financial eligibility criteria would force me, and others like me, to choose between working, making a living, and contributing to society without any Medicaid benefits and not working, sitting at home, and living on disability checks with benefits. Basically, either way I end up broke and sitting at home living off the government waiting to die. You surely agree that neither of these options is especially appealing, and thankfully there are some states, like Kansas, that have started Medicaid programs to give people like myself a third choice. I am able to work, actually earn and save some money (I cannot save a lot), and still receive Medicaid services thanks to a program called Working Healthy. Under the Working Healthy Program, if you are medically eligible for benefits, but are still able to work at least part time, you can still receive benefits, so long as you do not accrue too much wealth ($15,000 in liquid assets and roughly $35,000 earned a year in Kansas). This is a wonderful program as it is a winning situation for everyone involved. I get to lead a happy, fulfilling life as a functioning member of society without having to give up my Medicaid benefits, my employer gets a good employee who helps his business, I pay taxes on the money I earn that helps the government, and the government can then put more money into Medicaid funding. Everyone who is involved gains something through this program, and this is obvious by the number of other states that have adopted similar options. I know Kansas was the first state to start this type of coverage roughly a decade ago, and now more than 13 states have developed similar programs.

We are finally through our “brief, simple” discussion of what Medicaid is and the eligibility criteria for receiving these benefits. As you can already see from how much information you have just covered, this is an extremely complicated topic. My head is practically spinning from covering all of this federal bureaucracy, so I am sure that you are mentally saturated as well. So that we can both give our full attention to the rest of the information on Medicaid still left to discuss, I am going to stop here and finish our conversation in the next post in this series. In fact, this whole notion of the complex nature of these medical assistance programs is actually a topic that will be discussed in that article, when we cover more obstacles to receiving these services. We will not only discuss the obstacles, but also the benefits that the Medicaid program can provide the disabled community to improve their lives.

Share Button

Leave a Reply

Your email address will not be published. Required fields are marked *