Reference no: EM131108934

NEED A QUICK POST

Please read the below and provide a quick response, nothing fancy, use a few references to back up statements. thanks in advance.

My dear 62 year old friend is in a bind. Her 72 year old husband was recently hospitalized in Washington, DC, which makes getting insurance a priority. Using the website https://www.medicaid.gov/medicaid-chip-program-information/by-state/stateprofile.html?state=district-of-columbia along with others, I was able to find the required information my friend needed in order to determine whether Medicaid would be a good solution for them.

Medicaid is a health and long-term coverage program that was enacted in 1965 (Medicare.gov, 2016). As of April 2016, 89,704 people were enrolled in Medicare in Washington, DC (CMS, 2016). This is an incredible amount of people for such a small area, which is why it is important to know eligibility guidelines. How can the government create uniform guidelines when each state's population is considerably unique? One solution is through utilizing modified adjusted growth income (MAGI), where income levels are tied to the federal poverty level. DC has set standards based on MAGI that pertains to Medicaid eligible individuals including children, pregnant women, care takers/parents, and other adults over the age of 65 or adults that are permanently disabled. The following MAGI-based eligibility levels are expressed as a percentage of the FPL (Medicaid.gov, 2016):

My friend's husband would be eligible for Medicaid, regardless, strictly because of his age, but thankfully to the new ACA guidelines my friend is also included as DC has expanded coverage to low-income adults. The January 2016 poverty guideline for the District of Columbia for a family of two is $16,020 (ASPE, 2016), which means that my friend and her husband would qualify for Medicaid in DC if they combined are making less than $33,642, which includes current income, retirement, disability, workers comp, and pension. For elderly or disabled individuals, assets (belongings or savings) must be shown. The value limit is $4,000 for one person or $6,000 for couples (DC Medicaid and Alliance, 2012). Some belongings are not counted, such as the house they live in or personal vehicles.

Medicaid includes the following benefits: Doctor visits, hospitalizations, eye care, ambulatory surgical center, medically necessary transportation, dental services and related treatment, dialysis services, durable medical equipment, emergency ambulance services, hospice services, laboratory services, radiology, medical supplies, mental health services, physician services, NP services, HCBS, and transplants (DC.gov, 2016). The DC Office of Aging also offers a single Medicaid waiver that is relevant to my friend's circumstances; the Elderly and Persons with Disabilities Waiver (EPD Waiver or HCBS Waiver). This waiver is intended to allow beneficiaries who would otherwise require nursing home care to receive care services outside of that environment and to remain living in their homes or in assisted living communities (The American Elder Care Research (AECR) Organization, 2016). The qualifications for this waiver include medically documented needs for nursing home level care and the need to be over 65 years old or over 18 and be officially disabled. Married couples with a single applicant are subjected to a different, more complicated rule set in order to enable the "well spouse" to continue to live independently (The AECR Organization, 2016). Under this waiver, my friend's husband can be covered through assisted living (up to $65 daily rate and does pay for room and board), case management, chore services, environmental accessibility adaptations (home modifications), homemaker services, light housekeeping, meal preparation, personal care, personal emergency response services, and/or respite services (up to 480 care hours per year). Her husband would most likely benefit from homemaker services and personal care, especially while my friend is at work.

Overall, Medicaid.gov is a very feasible way of obtaining needed information about Medicaid. However, for people such as myself that are not as familiar with the lingo used when discussing health insurance, it can be a bit confusing and requires further research to fully grasp the concepts. This could pose a problem for those with limited hand function and/or short term memory loss, as it requires a lot of back and forth clicking and remembering of information between websites. The window of opportunity for enhancing Medicaid/Medicare is widening, as physicians, patients, government officials, etc are becoming more interested in it. Government officials have the ultimate power when it comes to determining guidelines, and as of now Medicaid has been beneficial for several individuals living in the United States.