Medicaid is the federal, state and county program that covers
the cost of medical care services and supplies. Authority
for the Medicaid program stems from Article XIX of the Social Security Act
and it has been an active program in
New York
State
since 1966.
The federal statute mandates certain services must be
available to all Medicaid recipients. These include hospital inpatient and
outpatient care, physician services, radiology and other lab services, home
health care, family planning services, transportation for medical care, care
in a skilled nursing facility and early periodic screening and diagnosis and
treatment (Child/Teen Health Program). States
were given the option of covering additional medical services, and
New York
State
has chosen to provide an extensive
list of non-mandated services. Among
the optional services are podiatric services, private duty nursing, clinic
services, dental services, physical, speech and occupational therapy,
prescription drugs, medical supplies and durable medical goods, orthopedic
and prosthetic devices including hearing aids, intermediate care facilities,
emergency hospital services, personal care services, care by an optometrist
and eye glasses, and any other care recognized under state law, i.e.,
clinical psychologists, shared health facilities, physician assistants,
certified social workers, etc.
In
2004 the Medicaid unit received 3259 applications, 36% of which were denied. Additional
cases result from the automatic eligibility for Medicaid that is associated
with Supplemental Security Income (SSI) eligibility determination by the
Social Security Administration. At the conclusion of 2004, there were 8108
residents of
Washington
County
who were covered by Medicaid.
There are many aspects of the Medicaid program that reflect
the particular medical needs of the persons included in each component.
They are as follows:
Chronic Care provides assistance to elderly and
disabled individuals who require ongoing care in a skilled nursing or
intermediate care facility. These individuals account for about 4.5% of the
Medicaid caseload.
Long Term Home Health Care and Personal Care
provide for the home care needs for elderly and disabled individuals to
allow them to remain in their homes instead of entering as chronic care
facility. Only about 1% of the Medicaid caseload is reflected in this group.
MA-SSI provides Medicaid coverage to
individuals and families who are not in receipt of cash assistance or SSI,
and who do not reside in a chronic care facility. MA-SSI accounts for 18% of
the Medicaid population.
Medicaid Only provides Medicaid coverage to individuals who are neither
elderly, disabled, or in receipt of SSI.
Family Health Plus provides a managed care
package of benefits to adults living in the community who are not eligible
for Medicaid only coverage. The managed care plans cover most common health
care needs, but most facility care and long term home care are specifically
excluded. As of the end of 2004,
21.6% of all Medicaid cases were eligible under this program.
Managed Care is a system under which Medicaid
finances the purchase of a package of care options from an HMO or a similar
organization. When medical care is needed, the individual’s costs are
billed first to the HMO. Again, there are several excluded types of services
including chronic care and rehabilitation services.
Child/Teen Health Program
monitors the health care needs of children.
Third Party Health Insurance
seeks to identify and access the resource of other health insurances in
order to ensure that Medicaid is the payer of last resort.
Disability Review and Disabled Client Assistance
Program assists certain disabled clients in applying for Social
Security disability and/or SSI to maximize Federal participation in the cost
of providing for their care.
Medicaid Transportation is
a federally mandated component of care that requires that Medicaid provide
for the purchase of transportation services to medical care by appropriate
means of conveyance.
Special Low Income Medicare Beneficiaries, Other
Qualified Individuals, and Medicare Buy-In are all programs that
provide for Medicaid to subsidize the cost of the Medicare premium for
eligible elderly and disabled clients. Additional programs authorized under
the Federal Consolidated Budget Reconciliation Act allow Medicaid to
subsidize the cost of third party health insurance premiums where it is cost
effective, and where it may reduce the liability incurred by the Medicaid
program itself.
Pre-natal Care Program
is a presumptive eligibility program offered to pregnant women for a period
of 45 days pending a full determination of their eligibility for Medicaid. Pregnant
women have their eligibility for Medicaid determined at the level of 200% of
the federally established poverty level.
Family Planning Benefit Program
provides coverage for family planning and reproductive health. Eligibility
for this component is established at 250% of the Federal Poverty level.
Medicaid authorized to cash assistance recipients
constitutes about 6 % of the total Medicaid population. Medicaid eligibility
is virtually assured for cash assistance recipients, due to the
significantly lower and more stringent eligibility standards.
The
majority of Medicaid expenditures go to medical providers in our immediate
area.
For example
Glens Falls
Hospital
received $5.5 million in 2004 for inpatient and outpatient services
provided to
Washington
County
recipients.
Washington
and
Warren
County
nursing homes received $9.45 million, with $3.89 million paid to
Pleasant
Valley
. Washington County Public Health Nurses received $1.17 million for services
provided to Medicaid eligible
Washington
County
residents.
