Can I ask a quick question about Medicaid?

[6packofun]

I saw this comment on FB today:  "People on Medicaid pay INTO Medicaid..."  and I can't remember what came after.  What does this mean?  That they pay taxes or something else?  DO people who qualify for Medicaid tend to still pay taxes?

 

Also, I know that every state is different but do those on Medicaid pay co-pays or anything at all for their healthcare?  (Does it work like insurance and some things aren't covered?)

 

I truly don't know all of this.  We were on food stamps for a little over 2 years while dh finished his degrees and also qualified for Medicaid but opted to stay on the insurance through his job at the time (a children's hospital; we had good insurance and it didn't kill us but we chose to sacrifice a bit more to have it rather than Medicaid).  

 

So no judgments about the program from me, I just want to understand a bit more how it works and our state's Medicaid site was confusing to me!  Sorry, that was more than one quick question.  lol

[Ali in OR]

I'm no expert. They may be thinking of Medicare for seniors over 65, and most of those people worked and paid taxes through their adult lives. My disabled adult dd receives Medicaid which I believe is for low/no income people. She will never be able to work (blind, nonverbal, wheelchair, etc).

[Ottakee]

Can I say "it depends"?

 

Most medicaid for kids has no co pays or deductibles. Some states have a "Healthy Kids" type program for low income where there is a small monthly premium and small co-pays. Some people call that medicaid as well.

 

After 18 or 21 there are often $1-5 co-pays and I think for some services up to a $50 copay (like ambulance/ER) but it can be waived depending on the medical situation.

 

Adoptive families often have kids on Medicaid if they were adopted through the state foster care system and have special needs. Those parents pay taxes and often the Medicaid is secondary to their own insurance.

 

Disabled people (those disabled since childhood) are often on disability Medicaid and likely don't pay taxes.

[hjffkj]

We are on Medicaid and do pay taxes. So my guess it that is what that comment means but who knows.

 

We have no co-pays and all necessary things are covered. Prescriptions are free for kids, if dh or I need something(aside for my pregnancy related meds) we pay $1 per prescription filled.

 

We have never paid anything and this is some of the care we've received. Heart evaluations for dd, broken bones, mental health assessment for a child, chest x-rays in emergency room, foot x-ray at walk in clinic, all pregnancy related visits including delivery and hospital stay, appointments with bed wetting specialist, all wellness checkups, etc.

 

Things that wouldn't be covered, fertility treatment, vasectomy, plastic surgery that is elective. Can't think what else

Edited July 18, 2017 by hjffkj

[Daria]

Income taxes aren't the only kind of taxes.  Every person in America, whether they are on Medicaid or not, is paying sales taxes, and property taxes (unless they are homeless), or someone else is paying these things on their behalf.  

 

But beyond that, there are people on Medicaid who are suffering from a temporary period of poverty, and have previously paid income tax and will again.  There are also people on Medicaid who make enough to pay some income tax, but little enough that they still qualify.  There are also people who qualify for Medicaid because of adoption, or because of a waiver that exempts them from income requirements.  

 

As for what it covers, and whether there are co-pays, I think that varies according to state. 

[6packofun]

Can I say "it depends"?

 

Most medicaid for kids has no co pays or deductibles. Some states have a "Healthy Kids" type program for low income where there is a small monthly premium and small co-pays. Some people call that medicaid as well.

 

After 18 or 21 there are often $1-5 co-pays and I think for some services up to a $50 copay (like ambulance/ER) but it can be waived depending on the medical situation.

 

Adoptive families often have kids on Medicaid if they were adopted through the state foster care system and have special needs. Those parents pay taxes and often the Medicaid is secondary to their own insurance.

 

Disabled people (those disabled since childhood) are often on disability Medicaid and likely don't pay taxes.

 

Ooh, I thought of another question!  Do only adopted kids with special needs (I'm talking needs like cystic fibrosis where the child needs specific medical care for their entire life) qualify for Medicaid, regardless of income?  Or can other families who make enough to NOT qualify get some sort of assistance with just those special needs medical costs?

 

Thank you for responding!

[zoobie]

In addition to the people paying income taxes (or who have paid or will pay), there are programs under the Medicaid umbrella such as the Children's Healthcare Insurance Program where parents who are above the poverty line for regular Medicaid but under another income level (depends on state) can pay a reduced fee to insure their children. In states that expanded Medicaid under the ACA, there are people who pay a reduced fee for state-sponsored insurance. 

[Ottakee]

Ooh, I thought of another question! Do only adopted kids with special needs (I'm talking needs like cystic fibrosis where the child needs specific medical care for their entire life) qualify for Medicaid, regardless of income? Or can other families who make enough to NOT qualify get some sort of assistance with just those special needs medical costs?

 

Thank you for responding!

Our state offers Children's special health care services which includes medicaid for kids with special medical needs.

[Insertcreativenamehere]

We pay to access Medicaid for our (biological) disabled son. Because he qualifies for Medicaid based on his lifelong disability and not on our income, we have a parental fee that is fairly substantial but because he has such extensive needs it's worth it for us. He's covered through my husband's employer's health plan as a primary and Medicaid is secondary, picking up anything the primary doesn't -- which is quite a bit. We also pay regular federal and state taxes. 

Edited July 18, 2017 by insertcreativenamehere

[MedicMom]

My son could technically qualify for Medicaid regardless of income. However it's so difficult to find providers around here who are taking new Medicaid patients that's it easier for us to not put him on it.

[historically accurate]

We looked at putting our kids on our state's medicaid when DH switched jobs a couple of years ago. Since we are above poverty line, there was a monthly premium. So, if we had chosen to take it, we would be paying for it just like any other health insurance. We have paid federal income taxes in the past (currently the EIC and the child tax credits counteract our federal income tax due), so we would have "paid our part" in the past as well. We also pay state income taxes; that may be part of medicaid's funding as well - I'm not really sure - is it all federal income taxes that funds the program?

[zoobie]

We looked at putting our kids on our state's medicaid when DH switched jobs a couple of years ago. Since we are above poverty line, there was a monthly premium. So, if we had chosen to take it, we would be paying for it just like any other health insurance. We have paid federal income taxes in the past (currently the EIC and the child tax credits counteract our federal income tax due), so we would have "paid our part" in the past as well. We also pay state income taxes; that may be part of medicaid's funding as well - I'm not really sure - is it all federal income taxes that funds the program?

 

Jointly funded

[Daria]

Ooh, I thought of another question! Do only adopted kids with special needs (I'm talking needs like cystic fibrosis where the child needs specific medical care for their entire life) qualify for Medicaid, regardless of income? Or can other families who make enough to NOT qualify get some sort of assistance with just those special needs medical costs?

 

Thank you for responding!

Generally Medicaid is available for kids who are considered "Hard to place", which can be due to some combination of special needs, risk factors, age, gender, and the need to stay with siblings. Some kids are eligible federally and will have Medicaid that is portable and can be used wherever they live. Some states qualify kids who don't meet the federal guidelines, in which case you need to stay in that state. Or at least that is how I understand it.

[6packofun]

Very informative!  Thank you so much.  I had no idea there were so many different possible scenarios and options.

[AmandaVT]

In VT, we have Medicaid and under the Medicaid umbrella, we have Dr. Dynasaur (for kids up to 19) and Green Mountain Care for adults. Depending on income, adults can have a premium payment and co-pay. One of my friends had a $50/month premium payment and a $5 copay for appointments I think. It's on a sliding scale depending on income. 

 

 

[SKL]

I've seen people confuse Medicare and Medicaid.

 

And there is the logic that people receiving benefits today probably have paid or will pay income taxes in another season of life.  I do believe that is true of most people.

[Χά�ων]

Ooh, I thought of another question! Do only adopted kids with special needs (I'm talking needs like cystic fibrosis where the child needs specific medical care for their entire life) qualify for Medicaid, regardless of income? Or can other families who make enough to NOT qualify get some sort of assistance with just those special needs medical costs?

 

Thank you for responding!

Like others have said, it depends. Our combined income would exclude DS but the medicaid he is on is structured in such a way that almost all our income is exempt due to his medical health.

 

I got the impression when talking to the 3 different people who were reading the qualifications for his medicaid that it is not commonly used. The caseworker had never heard of it, neither had her supervisor.

[6packofun]

Like others have said, it depends. Our combined income would exclude DS but the medicaid he is on is structured in such a way that almost all our income is exempt due to his medical health.

 

 

 

I was thinking about our friends whose dd has cystic fibrosis and wondering if family income as guideline should be used in conjunction with the average yearly or lifetime cost of treating the specific disease.  I don't know if that's a thing or if it should be, just thinking that even if a family didn't qualify for Medicaid or even lower income insurance of some kind, $15k-35k in annual medical costs (current info on CF) is a lot for most financially secure middle class families!  ("Regular" insurance is hard to pin down on what they cover and an unexpected uncovered expense can ruin people.  For example, with newer medical devices that are needed to improve health and quality of life but are so expensive and not covered!)

 

It's all so complicated.  I do not envy those who have to play in this system.

[Daria]

Ooh, I thought of another question!  Do only adopted kids with special needs (I'm talking needs like cystic fibrosis where the child needs specific medical care for their entire life) qualify for Medicaid, regardless of income?  Or can other families who make enough to NOT qualify get some sort of assistance with just those special needs medical costs?

 

Thank you for responding!

 

I think I misread your question.  I read it as are adopted kids with medical special needs like Cystic Fibrosis the only kids who qualify due to adoption.  That answer is no, it's more complicated.

 

But I think you were really asking is whether kids who aren't adopted can qualify if their medical needs are significant enough, even if they don't meet the income requirement.

 

The answer to that is that in theory yes.  However, in some states, such as Maryland where I live, the waiting list for the waiver that provides Medicaid to medically fragile kids is so long that many kids will reach adulthood before they qualify.

 

The Katie Beckett waiver, which provides medicaid to medically needy kids who live in the community (e.g. with their parents) as opposed to in nursing homes or other institutional settings, and the waivers that provide support for adults with disabilities who live in the community, are not considered "entitlements", meaning that states don't have to provide them, and can have waiting lists for these services.  As a result, if Medicaid payments to the states are capped, these are one place where states will likely make cuts, resulting in a return to larger numbers of people living in institutions, or having to make choices between meeting medical needs and things like keeping children with their families, or independence for adults.  

[SKL]

It might vary by state, but here, it is my understanding that both children and adults with chronic health issues qualify for Medicaid.  There might also be an income cutoff for adults.

[SKL]

And adoption is considered a special need in some contexts.  I think that is also state specific.  When I looked into counseling for one of my daughters, the counselor refused to see us until I applied and qualified for some state subsidy for adopted kids' mental health treatment.  Apparently it is not need based.  (I didn't follow through though.)

[Crimson Wife]

I saw this comment on FB today:  "People on Medicaid pay INTO Medicaid..."  and I can't remember what came after.  What does this mean?  That they pay taxes or something else?  DO people who qualify for Medicaid tend to still pay taxes?

 

Also, I know that every state is different but do those on Medicaid pay co-pays or anything at all for their healthcare?  (Does it work like insurance and some things aren't covered?)

 

There are different categories of Medicaid eligibility and some categories do charge premiums and co-pays. My SN child is in one category while her siblings were briefly under Obamacare Medicaid when my DH was between permanent positions. We didn't ever use the Medicaid coverage for the children who were under Obamacare so I'm not sure what the co-pays would've been like. But the premiums were something like $26/month.

[Crimson Wife]

Ooh, I thought of another question!  Do only adopted kids with special needs (I'm talking needs like cystic fibrosis where the child needs specific medical care for their entire life) qualify for Medicaid, regardless of income?  Or can other families who make enough to NOT qualify get some sort of assistance with just those special needs medical costs?

 

Thank you for responding!

 

Yes, biological children whose SN are severe enough can qualify for Medicaid regardless of parental income. My SN child does not receive a Social Security Disability payment at the current time due to DH's income but she has been officially deemed disabled through her 18th birthday and qualifies for Medicaid through that. Once she turns 18 we will need to reapply and at that time she may qualify for SSI payments.

 

[Χά�ων]

Yes, biological children whose SN are severe enough can qualify for Medicaid regardless of parental income. My SN child does not receive a Social Security Disability payment at the current time due to DH's income but she has been officially deemed disabled through her 18th birthday and qualifies for Medicaid through that. Once she turns 18 we will need to reapply and at that time she may qualify for SSI payments.

 

I think that is the same process DS qualifies. He recieved a grand total of nothing in SSI but the medicaid has been priceless. I was able to sleep at night not terrified about how I would pay for the lext level of treatment for him.

 

I had the statues and links a few months ago but lost them in a phone reboot. Do you have them by chance? I know we are not the only boardies would could use the information to sleep at night.

[AimeeM]

Ooh, I thought of another question!  Do only adopted kids with special needs (I'm talking needs like cystic fibrosis where the child needs specific medical care for their entire life) qualify for Medicaid, regardless of income?  Or can other families who make enough to NOT qualify get some sort of assistance with just those special needs medical costs?

 

Thank you for responding!

In my state, children who are considered to have a life-long / chronic special need or illness have the opportunity to qualify for a special type of medicaid that isn't income dependent. It only covers services related to that illness or special need, though. So, for example, if I chose to pursue it for our sons' autism, it would cover their related OT, ST, PT, evaluations, or whatever else could be tacked onto their "autism plate," but our private (employer) insurance would be necessary for everything else not related to their autism (and the private insurance would be tagged first, even for autism-related services, with the special needs medicaid as secondary).

[PinkyandtheBrains.]

 

 

Varies by state, but yes people on Medicaid do pay into the system via taxes. Most people on Medicaid are still working and paying taxes.

[Crimson Wife]

I think that is the same process DS qualifies. He recieved a grand total of nothing in SSI but the medicaid has been priceless. I was able to sleep at night not terrified about how I would pay for the lext level of treatment for him.

 

I had the statues and links a few months ago but lost them in a phone reboot. Do you have them by chance? I know we are not the only boardies would could use the information to sleep at night.

 

Apparently the automatic qualification for Medicaid through SSI is state-by-state (figures). https://www.ssa.gov/policy/docs/ssb/v76n3/v76n3p17.html

 

My DD had been on Medicaid through the Regional Center due to her developmental disability but had that coverage terminated in error (we think it was a clerical mistake) and I was in the middle of trying to straighten that mess out when Social Security issued their decision that she was "disabled". Within a week Medi-Cal retroactively restored her eligibility to 3 months prior to the date that I had applied for SSI. Months and months of going back and forth between Regional Center and Medi-Cal to try & get her back on with no luck and all it took was SSI to move her into a different category for approval.

[chiguirre]

There are also elderly patients who have Medicare but need Medicaid to pay for nursing home care after depleting all their assets. They would definitely have "paid into the system" throughout their working life but they've outlived their savings/home equity. That's very easy to do if you need nursing home care.

[Mergath]

Dd is on Medicaid (well, our state's Medicaid-funded medical assistance program, which is basically the same thing) and I'll be on it for the duration of this pregnancy. We paid in both federal and state income taxes for last year.

 

The income limits for kids and pregnant women are fairly high here in MN- if your family makes under 280% of the poverty level any children or pregnant women in the family can get Medicaid. Our family would have to make almost $70k a year before we'd make too much. So where I live there's definitely a lot of people who both benefit from Medicaid and pay income taxes.

 

Dd and I (dh has insurance through his employer which is obviously completely different) don't have to pay a penny for anything for medical care. No co-pays, no premiums. I get EOBs in the mail that show everything that was paid, but never any bills.

 

 

[Crimson Wife]

Dd is on Medicaid (well, our state's Medicaid-funded medical assistance program, which is basically the same thing) and I'll be on it for the duration of this pregnancy. We paid in both federal and state income taxes for last year.

 

The income limits for kids and pregnant women are fairly high here in MN- if your family makes under 280% of the poverty level any children or pregnant women in the family can get Medicaid. Our family would have to make almost $70k a year before we'd make too much. So where I live there's definitely a lot of people who both benefit from Medicaid and pay income taxes.

 

CA is the same way. When we had to briefly go on an exchange plan, I kept putting in higher and higher income numbers to see when they'd let us buy a regular plan for the kids rather than going on Medicaid (which we didn't want due to the difficulty finding providers who will accept it as primary). I can't remember what the cutoff was, but at that point the subsidy for DH's and my private plans were too small to make the plans affordable while he was between jobs and we were paying from our savings.

 

Fortunately we were able to get back on an employer-based plan fairly quickly but there are definitely plenty of middle-class families out here whose kids still qualify for Medicaid.

 

[Ottakee]

Crimson wife makes a good point....there are many families that have their children (and sometimes the entire family) on Medicaid as sometimes that is the only option offered at your income level when you go to the marketplace exchange. You can't buy insurance if you qualify for medicaid in some cases.

[mom2scouts]

In my state, Medicaid and the CHIP program does not have any premiums or co-pays. My aunt has never worked and now has major health problems. She has been on Medicaid her entire adult life and has never paid anything for medical care. She says she's never seen a bill.

[JanetC]

Medicaid varies by state, so some may have small copays. Those who qualify for Medicaid based on income tend to move in during recessions and leave during better economic times, so they pay more in to the system while employed. That wouldn't apply to the disabled though.

[Lanny]

I think that would be the case with Medicare but not with Medicaid. Also I think Medicaid varies from state to state?

 

Sent from my SM-G355M using Tapatalk

[Tap]

As others have said, there are many variations.....

 

I will offer another.

 

DDi10 s a ward of the state, Biodad surrendered her to the state and into our guardianship.   He pays $400 month in court ordered/ state managed child support.  $100apx goes to pay for her health insurance.  $100apx to past due support/insurance payments and $200 to us for cash support.   He is also required to provide private insurance for her, so only the remaining medical co-pays go to the state.   She also has my health insurance, so after claims go through 2 private insurances, what the state actually pays is not more than that $100 he pays in each month. 

 

 

DD18 has medicaid due to her chronic illness, income level and tax status.  We used state medical for about a year, when our son was born (22 years ago-) but not since then.  I could say that we have paid for her insurance in taxes over the years. LOL  Again....they are only paying co-pays and our private insurance out of pocket max is $5000, so the state won't have to pay more than that. She wlll only quailfy for 6 months, so a short period of time, but still helpful to out finances this year.

Edited July 19, 2017 by Tap

[JFSinIL]

One of my twins is on Medicaid, it covers most everything he needs.  He had to go on it when he went on SSI after turning 18, rather than staying on our insurance.  We are lucky enough to live in an area where I can find doctors and specialists that accept Medicaid.  And for now Illinois Medicaid is covering basic dental stuff - we pay out of his supplemental needs trust for major dental work no covered, though.  I think it all depends on the state, and is the person on Medicaid as a disabled person or child or lower income or ?  

 

His twin needs to apply, he makes only a thousand a month and ages off our insurance in late Sept :-(    

[Carrie12345]

I always mix up Medicaid and Medicare, so it wouldn't surprise me if someone else did, too!

[Janeway]

In Texas, you can "buy in" to medicaid. However, I suspect that is rare. Ours is free, except that we pay taxes. 

[6packofun]

Thank you all for sharing your experiences!  I think it's very helpful to see all of the widely varied family and health situations that can access Medicaid.  Relating this to real people is always good!

[TechWife]

It might vary by state, but here, it is my understanding that both children and adults with chronic health issues qualify for Medicaid.  There might also be an income cutoff for adults.

 

It most definitely varies by state. 

[QueenCat]

It most definitely varies by state. 

 

Yep. In my state, no matter how impoverished you are, even if you are trying to find work, if you do not have a dependent or are not disabled, you cannot get Medicaid.

[Daria]

Yep. In my state, no matter how impoverished you are, even if you are trying to find work, if you do not have a dependent or are not disabled, you cannot get Medicaid.

How does that mesh with Obamacare? If someone has no income, are there no options?

[PinkyandtheBrains.]

How does that mesh with Obamacare? If someone has no income, are there no options?

 

This is because the state chose not to expand Medicaid. The ACA didn't require states to do so.

[TechWife]

How does that mesh with Obamacare? If someone has no income, are there no options?

 

Correct. Many states didn't expand their Medicaid programs, so their coverage for those with no income didn't expand. Since our current system insists on tying health insurance to employment, there are no options for many unemployed people. 

[QueenCat]

How does that mesh with Obamacare? If someone has no income, are there no options?

 

If your state didn't expand Medicaid, you are sol. This is the part of the ACA/Obamacare that needs fixing......... but it won't happen. If you happen to have a county health dept that actually gives medical care, you're in luck for some basics like immunizations. But if you need specialists, nope. Hospitals will only stabilize, not treat.

Edited July 20, 2017 by QueenCat

[Janeway]

If your state didn't expand Medicaid, you are sol. This is the part of the ACA/Obamacare that needs fixing......... but it won't happen. If you happen to have a county health dept that actually gives medical care, you're in luck for some basics like immunizations. But if you need specialists, nope. Hospitals will only stabilize, not treat.

We do not have a county health department that does vaccinations where I live. So people on medicaid where I live use the ER for all medical care, which does not include things like well checks or vaccinations or referrals to specialists. The ONLY reason the forced-against-our-will-medicaid was ever used when we had it is because we had been on a waiting list and had a referral from when we had private insurance. Otherwise, the f-a-o-w-medicaid would never have been used. I found out that because of the lack of access to medical care, our school district gives out vaccinations for free to those who want them as well as it is easy to get vaccination exemptions from the state. But if your child is home schooled, you would not have access to vaccinations at all if on medicaid. It irks me big time that extremely wealthy insurance companies are getting rich off of this and that the government mandated that people consent to going on to medicaid (aka be used as a pawn to give money to wealth insurance companies) against their will. In our case, the state won't allow us to cancel the medicaid, but won't let us stay on, or wont cancel, but they are not sure...but they insist they cannot cancel, but it will be cancelled if I want to keep it, but will not be cancelled if I don't want to keep it. Now I have decided to ignore it and just stew in the anger that if this is happening here, it is happening in many households, meaning, our tax dollars given to wealthy corporations. Kill the middle and working class still.

Edited July 21, 2017 by Janeway