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Medicaid

  1. What is Medicaid?

    Medicaid helps needy people pay for medical care. It pays for medical services, which protect your health.

    What Medicaid Pays For

    This is a general listing of Medicaid covered services that are available when medically necessary and furnished by enrolled providers. Some services are only for certain age groups or may require prior approval.

    The services listed below are subject to change. Payment is made directly to the provider. You cannot be reimbursed directly.

    • Inpatient hospital services
    • Outpatient hospital services
    • Nursing
    • Home care
    • Mental hospital care (under age 21 and age 65 or older)
    • Services of physicians (MD or DO)
    • Chiropractors and podiatrists (limited)
    • Laboratory and x-ray services
    • Family planning services
    • Home health services
    • Oxygen (limited)
    • Medicaid health screening for recipients under age 21
    • Vision services (limited)
    • Dental Services (limited)
    • Hearing services, including hearing aids (limited)
    • Ambulance services (limited)*
    • Personal care services
    • Community mental health services (limited)
    • Therapy (occupational, physical, speech)
    • Treatment for drug addiction and alcoholism
    • Methadone maintenance
    • Pharmacy service and medical supplies
    • Prenatal care and delivery services
    • Allergy testing and treatment
    • Hospice care
    • Diabetic patient education
    • Mental health care (inpatient/outpatient)

    *Contact your local FIA office about transportation to a Medicaid covered service.

  2. Are Medicaid and Medicare the same?

    Medicare is a federal health plan run by the Social Security Administration. Medicaid is a state program run by the Michigan Family Independence Agency. A person may have both Medicare and Medicaid. Medicaid may help with expenses not paid by Medicare.

  3. Who may receive Medicaid?

    • Anyone who gets Michigan Family Independence Program (FIP) checks.
    • Anyone who gets Supplemental Security Income (SSI) checks in Michigan.
    • Anyone who is financially needy and is:

      1. under age 21, or
      2. pregnant, or
      3. age 65 or order, or
      4. blind or disabled, or
      5. parent or close relative living with a child. The child must be under age 18 or 18, in high school full time and expected to graduate before age 19.
  4. Is there a limit on assets?

    Family assets cannot be more than the asset limit. Sometimes the asset limit does not apply to pregnant women and children born after June 30, 1980.

    Asset Limits

    For a one person family - $2,000
    For a two person family - $3,000
    For three or more add $200 for each additional person.

    Assets must be at or below the asset limit at least part of each month for which Medicaid is requested.

  5. What assets are counted?

    • Cash, savings and checking account
    • Real estate (other than your home)
    • More than one car
    • Nursing home trust fund
    • Credit union accounts
    • Trusts
    • Stocks, bonds and mutual funds
    • Land contracts
    • Recreational vehicles
    • Pension plans
    • Individual retirement accounts (IRA)
    • Certificates of deposit
    • U.S. Savings Bonds
  6. What assets are NOT counted?

    • Your home in Michigan
    • Personal belongings
    • Life insurance (sometimes)
    • One car
    • Funds set aside for burial (sometimes)
    • Income producing assets (sometimes)
    • Irrevocable prepaid funeral contract
    • Burial space items
  7. What income is counted?

    • Social Security benefits
    • Veteran's benefits
    • Self-employment
    • Training income
    • Unemployment benefits
    • Wages
    • Pensions
    • Rent income
    • Child support
  8. Is there a limit on income?

    Income is compared to an income allowance based on family size. The allowance varies across Michigan.

    Medicaid Maximum Monthly Income Levels by County
    (match roman numeral with counties following)
    Number of Persons Area I Area II Area III Area IV Area V Area VI
    Notes:
    For each additional person beyond 10, add $76
    These amounts are adjusted by the State each year.
    1 Person $341 $341 $350 $375 $391 $408
    2 Persons $458 $466 $475 $500 $516 $541
    3 Persons $493 $502 $512 $532 $547 $567
    4 Persons $528 $538 $548 $563 $578 $593
    5 Persons $624 $634 $644 $659 $674 $689
    6 Persons $757 $767 $777 $792 $807 $822
    7 Persons $833 $843 $853 $868 $883 $898
    8 Persons $909 $919 $929 $944 $954 $974
    9 Persons $985 $995 $1005 $1020 $1035 $1050
    10 Persons* $1061 $1071 $1081 $1096 $1111 $1126

    Counties in Each Area
    Area Counties in Area
    Area I Alger, Baraga, Gogebic, Huron, Iron, Keweenaw, Luce, Mecosta, Menominee, Presque Isle, and Schoolcraft
    Area II Arenac, Chippewa, Delta, Houghton, Iosco, Lake, Manistee, Oceana, Ontonagon, Osceola, and Oscoda
    Area III Alcona, Benzie, Calhoun, Cheboygan, Crawford, Dickinson, Gladwin, Hillsdale, Jackson, Kalkaska, Mackinac, Mason, Missaukee, Moncalm, Muskegon, Newaygo, Ogemaw, Sanilac, and Wexford
    Area IV Allegan, Alpena, Antrim, Berrien, Branch, Cass, Charlevoix, Clare, Emmet, Gratiot, Ionia, Isabella, Marquette, Montmorency, Roscommon, St. Joseph, Shiaassee, Tuscola, and Wayne
    Area V Barry, Bay, Clinton, Eaton, Gr. Traverse, Kalamazoo, Kent, Lapeer, Leelenau, Midland, Otsego, Ottawa, Saginaw, and Van Buren
    Area VI Genesee, Ingham, Livingston, Macomb, Monroe, Oakland, St. Clair, and Washtenaw

    A person may be helped even when income is more than the income allowance. Medicaid might be able to pay a part of the medical bills. Ask for the pamphlet "Medicaid Spend-Down Information" from your local Family Independence Agency office.

    Medicaid Spend-Down

    If the family's or individual's net income is over the Medicaid limit, the amount in excess is established as a "spend-down amount." In order for the person to qualify for Medicaid during the months, he/she must incur medical bills equal to the spend-down amount. Medicaid will pay expenses incurred above this amount. If a group member is liable for bills incurred before the spend-down period began, these bills can be used to meet the spend-down. (If they are incurred within the 3 months before application, Medicaid may pay the bills.) Persons in long-term care facilities have a monthly patient-pay amount.

    The following kinds of medical expenses are considered as allowable deductions in cases where a "spend-down" is established due to excess income:

    • cost of personal care services paid for by the family or individual for the care of a family group member unable to perform necessary activities in daily living;
    • cost of any incurred medical expenses of any family group member;
    • incurred expenses for the rental or purchase of durable medical equipment;
    • transportation for medical purposes (with limitations.)
  9. How do I apply for Medicaid?

    Contact the local Family Independence Agency office in your county. You must complete and sign an application. You may authorize someone to do this for you. You or your representative may be asked to come to the local office. Tell the worker if you need help with past medical bills. Medicaid coverage may begin three months before your application date. You must ask for this retroactive Medicaid coverage when you first apply for Medicaid whether or not you have other insurance that might cover the expense.

    You will be asked questions

    About yourself, your spouse, your children at home and about:

    • Income and assets
    • Age
    • Medical expenses
    • Marital status
    • Living arrangements
    • Medical insurance
    • Ability to work

    Information you will need to bring with you.

    They will need proof of your income and assets. If you cannot work, FIA may need doctor's reports and proof of medical expenses. These are some of the proofs needed:

    • Bankbooks or statements, including joint accounts
    • Wage stubs or pension checks
    • Doctor reports
    • Real estate value (not your home)
    • Medical bills

    You must have a Social Security number. FIA will need to see your Social Security number card; if you do not have one, they will help you apply for one. They will need proof of your United States citizenship.

  10. After you apply

    The local office and regional medical reviewers decide your eligibility. You are notified of the decision:

    • Within 60 days if you are disabled
    • Within 45 days in other cases
  11. If you are eligible

    You get a Medical Assistance authorization Card. It lists family members covered. A new card is mailed the first of each month. You must present the card each time any of the eligible persons listed on the card requests medical services. The card may only be used for the eligible persons whose names are listed on the card.

    You may be required to enroll in a Health Maintenance Organization (HMO), a Clinic Plan or the Physician Sponsor Plan, if available in your area. Ask for the pamphlet, "Choose Now," DSS Publication 557, for more information.

  12. If things change

    You must report to your caseworker within 10 days any changes of:

    • Income
    • Employment
    • Health Insurance coverage and premiums
    • Persons at home
    • Assets
    • Address
    • Any other change that may affect eligibility

    FIA may ask you to send them a written report each month. Your worker will decide if the change affects your Medicaid and you will be notified if it does. Everyone's eligibility is reviewed at least once a year.

  13. If you leave Michigan.

    Tell your worker. Temporary absences do not change your Medicaid. However, you must have prior approval from FIA to use Medicaid in another state, except in emergencies.

  14. If you think the FIA's decision on your eligibility is wrong.

    Talk with your worker or the worker's supervisor. If you still believe the action is illegal, you may have a hearing. A hearing request must be filed within 90 days of the Notice of Action. Hearing requests must be in writing. If you are on Medicaid and are notified that your coverage is being terminated, you can have your coverage continued while you contest the decision to terminate your benefits simply by requesting a hearing within 10 days of receipt of the notice of termination of benefits. Send your request to your local FIA office and retain a copy of your request for your records.

  15. If you think you have been discriminated against.

    Medicaid is to be provided without regard to race, sex, religion, age, national origin, color, marital status, disability or political beliefs. If you believe you have been discriminated against, you may file a complaint with the:

    Secretary Department of Health and Human Services
    Washington DC 20201

    You must use other available resources such as medical or hospital insurance first. You must use providers enrolled in Medicaid.

This information is not a substitute for legal advice. If you need legal advice, see a lawyer.

If you fee you are being harassed, call a lawyer or your legal aid office.

Legal services of Northern Michigan can provide legal assistance to low-income persons in civil matters.

Click for free Michigan legal help and legal aid, or go to lsnmirp.org

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