The Medicaid Program provides medical benefits to groups of low-income people, some who may have no medical insurance or inadequate medical insurance. Although the Federal government establishes general guidelines for the program, the Medicaid program requirements are actually established by each State..."
This primer provides an overview of the basic components of Medicaid, the nation's largest health coverage program, which covers nearly 60 million low-income individuals, including children and families, people with disabilities and seniors who are also covered by Medicare..."
Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by Federal and state taxes. Medi-Cal is a large program made up of many separate programs designed to assist Californians in various family and medical situations..."
If you are enrolled in one of the following programs, you can get Medi-Cal... You can also get Medi-Cal if you are..."
Tens of thousands of California seniors and people with disabilities are eligible for no-cost health care coverage from Medi-Cal, California’s version of Medicaid, even if they do not receive SSI or any other needs-based public benefit. But the rules are complex and change often. Below is a current summary. If you’re not sure about your status, get individual legal advice...."
"...The poverty thresholds are the original version of the federal poverty measure... The poverty guidelines are the other version of the federal poverty measure.
...How Does Eligibility for Medicaid Change in 2014? In most states today, to be eligible for Medicaid, an adult must not only have a low income but must also be 65 or over, pregnant, a parent living with a dependent child, or a person with a disability that meets Supplemental Security Income (SSI) disability standards. Generally, adults who are not in one of these categories are not eligible for Medicaid regardless of how poor they are. ..."
This report examines Medicaid eligibility policies and operations in five states— California, Colorado, Florida, Minnesota, and Wisconsin—following initial changes introduced by PRWORA and the new Children's Health Insurance Program (CHIP), which was part of the Balanced Budget Act of 1997...."
Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.
A new law says most Medi-Cal applicants and beneficiaries who are U.S. citizens or nationals must show proof of citizenship and proof of identity. Read below to learn how this law may apply to you or your family. If you are not a U.S. citizen or national, this law does not apply to you...."
Data Matches with Social Security Administration Are Easing Burdens on Families and States..."
The Medi-Cal Mail-In Application is available in 11 languages in a View and Print Version. (See Chart Below) ...Please mail your completed Medi-Cal Mail-in Application to your nearest Local County Welfare Office.... Should you require additional assistance after reading the Mail-In Instructions, contact your nearest Local County Welfare Office..."
To apply, fill out a joint Medi-Cal and Healthy Families application. You may call to get an application, or you may download the application..."
"...Click on the first letter of your county from the A-Z list below to receive more information on your county..."
"...MMCD contracts for health care services through established networks of organized systems of care, which emphasize primary and preventive care. Managed care plans are a cost-effective use of health care resources that improve health care access and assure quality of care. ..."
"...The purpose of this guide is to provide you with information to help you choose the best Medi-Cal Health Plan for you and your family. The more you know about your Health Plan, the easier it is to get the best care for you and your family. This guide will help you learn about quality of care and important services provided by your health plan and where to get answers if you have questions..."
...How do I get health care for my child? Children under 21 years-old may be eligible for Medi-Cal. Medi-Cal pays for health care, including regular check-ups. Your child may get Medi-Cal if: Your child lives in California; Your family doesn’t earn more than the limits set by Medi-Cal; Your child is a US citizen or is a lawful permanent resident (Your child ..."
...The Healthy Families program is a state-designed program that provides health coverage to low-income children under the age of 19 who do not have insurance today and do not qualify for no-cost Medi-Cal..."
...In order to qualify for this benefit program, you must be a resident of California, under 19 years of age or be a primary care giver with a children under the age of 19 or be pregnant, not covered by health insurance (including Medicaid), a US national, citizen, legal alien, or permanent resident, and you must have an annual household income before taxes of less than ..."
"General information about children’s health coverage... - State-based resources, including possible enrollment partners - Steps for enrolling a child in coverage program - Follow-up flyer for parents - Health resources, by county, for children who are not eligible for coverage...
California provides free and affordable comprehensive health insurance programs (medical, dental, and vision coverage) to many children and their families. Counties also have programs to help children who are not eligible for Healthy Families or Medi-Cal."
How affordable is health coverage for California’s children?..."
How does Medicaid help children in California? Children make up 40% of California’s Medicaid population, but are of very low cost, accounting for only 23% of the state’s Medicaid spending."
...The two major federal funding sources for low-income children’s public health insurance are Medicaid and the State Children’s Health Insurance Program (SCHIP). States enjoy some flexibility in their Medicaid programs for children,..."
Most family plans are funded through Medicaid, but a handful of states have waivers to use State Children’s Health Insurance Program (SCHIP) funds to cover parents. ..."
In California, there are 5,162,161 families, with 9,391,913 children. (2009)..."
Individual state profiles..."
...Medical Services... Pharmacy and Vision... Durable Medical Equipment... Waivers"
...More than one in ten women in California receive health care coverage through Medicaid... Medicaid is the most important source of coverage for low-income women. In 2006-07, 26 percent of all low-income women in California were enrolled in the program..."
Medicaid benefits: Online database"
As of July 2003, 7,125,996 people were covered under California’s Medicaid/SCHIP programs. Of those enrolled, 6,459,012 participated in the traditional Medicaid program and 666,984 were financed by a Medicaid/SCHIP §1115 waiver program. In Federal fiscal year 2001, California spent $19.8 billion to provide Medicaid services...."
How much should I be charged for my prescription medications?... Can I get my medication early?... Can I get my medications early if I am going on vacation?... Why can I only get 30 pills if my prescription is for 60?... My Pharmacy told me my diabetic supplies are not covered. Is that true?"
If you are receiving both Medicare and Medi-Cal benefits, the Medicare Part D drug benefit will provide your prescription-drug coverage instead of Medi-Cal. However, Medi-Cal will pay for certain categories of drugs not covered by Part D, including..."
How do I locate a dentist?... Can I be charged for services?... What is the Share of Cost program?... Can I get a copy of my x-rays and records from my dentist?..."
Click on an appropriate county or city to view a list of dentists who may be accepting new Denti-Cal patients. This is not a guarantee they will be available to accept additional patients at the time you contact them. If you can not find a dentist in your area who is accepting new patients, please contact the Denti-Cal Telephone Service Center for additional help at 1-800-322-6384..."
"The Guide is intended to serve as a resource of current information on clinical practice, evolving technologies and recommendations in dental care. The guide is not intended to change current Medicaid policies, nor is it intended to impose any new requirements on states..."
Dental services under Title XIX of the Social Security Act, the Medicaid program, are an optional service for the adult population, individuals age 21 and older. However, dental services are a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit..."
"...The IHSS Program will help pay for services provided to you so that you can remain safely in your own home. To be eligible, you must be over 65 years of age, or disabled, or blind. Disabled children are also eligible for IHSS. IHSS is considered an alternative to out-of-home care, such as nursing homes or board and care facilities..."
The Assisted Living Waiver (ALW) is the Medi-Cal program that provides for assisted living, care coordination and other specified benefits provided to eligible seniors and persons with disabilities..."
1.In the first model, Assisted Living services are provided to participants who reside in Residential Care Facilities for the Elderly (RCFEs). In this model, services are delivered by the RCFE staff.
2.In the second model, Assisted Living Care services are provided to participants who reside in publicly subsidized housing. In this model, services are delivered by Home Health Agency staff. ...
These are California Nursing Homes in cities A - Z." In addition to the state directory described above, there are nursing home directories for principal California cities. A few examples:
A consumer's guide to information and help about assisted living in California, with a directory of assisted living facilities..."
Medi-Cal, the Medicaid program in California, provides health coverage to people with low-income and asset levels who meet certain eligibility requirements. While there are several ways to qualify for Medi-Cal, this section focuses only on Medi-Cal beneficiaries who also qualify for Medicare — individuals who are over a certain age and/or disabled. People who qualify for both Medicare and full Medi-Cal are known as "dual eligibles" or "Medi-Medis."..."
Medicare offers several Medicare Savings Programs (MSPs) that assist people with low income and assets: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI) and Qualified Disabled Working Individual (QDWI). California also offers the 250% California Working Disabled (CWD) program..."
Individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit are often referred to as “dual eligibles.” These benefits are sometimes referred to as Medicare Savings Programs (MSPs). Dual eligibles are eligible for some form of Medicaid benefit, whether that Medicaid coverage is limited to certain costs, such as Medicare premiums, or the full benefits covered under the State Medicaid plan..."
Nearly 8.8 million Medicaid beneficiaries are “dual eligibles” – low-income seniors and younger persons with disabilities who are enrolled in both the Medicare and Medicaid programs. Dual eligibles are among the sickest and poorest individuals covered by either the Medicaid or Medicare programs..."
"The following is a list of all California 1915(c) Waivers by name - complete with a description, contact information and web link..."
...This list contains information about state-specific Medicaid waiver and demonstration programs. Users can access fact sheets, copies of proposals, approval letters, and other documents related to specific programs..."
"Medi-Cal fraud is generally defined as the billing of the Medi-Cal program for services, drugs, or supplies that are: •Unnecessary •Not performed •More costly than those actually performed ..."
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