MEDICAID PROGRAM OVERVIEW

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MEDICAID PROGRAM OVERVIEW Powered By Docstoc
					                                         SOUTH CAROLINA HEALTHY CONNECTIONS PROGRAMS: MAJOR COVERAGE GROUPS (Effective 4/1/08)
                                                 Eligible Population                Income Limits         Resource Limits                                                                  Benefits
O     ABD – Aged, Blind or         ABD – Aged (65+), blind or totally and permanently                100% of Federal Poverty Level (FPL):      $4,000 per individual         Medicaid benefits
      Disabled (32)                disabled                                                          $867 per individual                       $6,000 per couple
                                                                                                     $1,167 per couple
O      HCBS – Home and             Aged, blind or disabled and determined to be medically in         300% of Federal Benefit Rate (FBR)        $2,000 per individual         Medicaid Card and Medicaid
       Community Based             need of institutional care but chooses to remain at home –        $1, 911 per month                                                       sponsored vendor payment –
       (Waivered) Services         Must require/receive at least one waivered service for a                                                                                  Individuals are required to pay a
      Includes DDSN & AIDS         minimum of 30 consecutive days                                    Spousal Allocation: $2,610                                              part of the cost of care
      waivered services (15)
O      MAO – Institutional         Aged, blind or disabled and determined to be medically in         300% of FBR                               $2,000 per individual         Medicaid Card and Medicaid
       Long-Term Care              need of institutional care and reside in an approved medical      $1,911 per month                                                        sponsored vendor payment –
       (10, 14, 15, 54)            facility for at least 30 consecutive days                                                                                                 Individuals are required to pay part
                                                                                                     Spousal Allocation: $2,610                                              of their cost of care
O     OSS – Optional State         Individuals residing in approved, licensed Residential Care       Individual’s net income limit is $1,120   $2,000 per individual         State-funded cash assistance
      Supplementation              Homes who meet SSI eligibility requirements, except for           per month                                                               payment plus Medicaid benefits
       (85, 86)                    income
M     QDWI – Qualified             Disabled individuals who lost eligibility for Title II benefits   Countable income must be below 200%       $4,000 per individual         Payment of monthly Medicare Part
      Disabled Working             and Social Security support of Medicare premiums because          of FPL                                                                  A premiums only – NO Medicaid
      Individuals (50)             of wages                                                                                                                                  Card
M     SLMB – Specified             Must have Medicare Part A benefits                                Income level must be greater than         $4,000 per individual         Medicare Part B premiums only –
      Low Income Medicare                                                                            100% and less than 120% of the FPL        $6,000 per couple             NO Medicaid Card
      Beneficiaries (52)                                                                             for an individual ($1,040) or a couple
                                                                                                     ($1,400)
M     SSI Pass-Along (16)          Individuals who lost eligibility for SSI due to increases in or   SSI limits once SSA benefit increase is   SSI resource limits           Medicaid benefits
                                   receipt of certain Social Security benefits                       disregarded
M  SSI – Supplemental              Aged (65+), blind or totally and permanently disabled             $637 per individual $956 per couple       $2,000 per individual         A cash payment individual with no
   Security Income                                                                                                                             $3,000 per couple             income receives $637 per month
  Administered by SSA (80)                                                                                                                                                   Medicaid benefits
O TEFRA – Katie Beckett            Disabled children under age 19 who meet level of care             Parent’s income not counted.              $2,000 per child              Medicaid benefits
   Children (57)                   required in ICF-MR facility, nursing facility or hospital         Child’s limit is $1,911 per month         (Parent’s income &
                                                                                                                                                resources NOT considered.)
O     WD – Working                 Under age 65, totally and permanently disabled and                250% of FPL $2,167 per month              $4,000 per individual         Medicaid benefits
      Disabled (40)                working                                                           Individual’s unearned income must be
                                                                                                     below 100% of FPL for an individual
                                                                                                     (currently $867)
O     Breast and Cervical          Women who have been diagnosed and in need of treatment            Income limit of 200% FPL $1,734 per       No resource test              Medicaid benefits
      Cancer Program (BCCP)        for breast or cervical cancer or pre-cancerous lesions (CIN       month
      (71)                         II/III) and have no treatment coverage
O     GAPS (92)                    Must be 65 or older                                               200% of FPL                               No resource test              After paying a monthly premium for
      This is a state funded                                                                         $1,734 per month                                                        their Prescription Drug Plan,
      program and not paid for                                                                                                                                               participants will only have to pay 5%
      with Medicaid funds                                                                                                                                                    of the Prescription Drug Plan’s costs
                                                                                                                                                                             between $2,510 & $5,726.25
    Page 1         NOTE: (O) = Optional Coverage Group     (M) = Mandatory Coverage Group                                                                                        July 1, 2008
                                            SOUTH CAROLINA HEALTHY CONNECTIONS PROGRAMS: MAJOR COVERAGE GROUPS (Effective 4/1/08)
                                                   Eligible Population                 Income Limits         Resource Limits                                                             Benefits
 O       Foster Children              Children under 21 years of age who reside in licensed        Eligibility is generally established on an   $30,000 per Budget Group Medicaid benefits
         Includes certain special     foster homes or private child care facilities supported in   individual basis
         needs children in adoptive   whole or in part by state or federal foster care board                                                                              Certain categories of children may
         placement (13, 60)           payments                                                     Income cannot exceed $425 per month                                    also receive a cash payment
 M       IV-E Foster Care (31, 51)    To qualify under this category, a Title IV-E Foster Care     No limit                                     No resource test          Medicaid Benefits
                                      Maintenance payment must be made for the individual
 M       Four-Month                   Individuals who lost eligibility for Family Independence     No limit                                     No resource test         Medicaid benefits for up to 4 months
         Extended Medicaid (11)       (FI) cash assistance due to an increase in child support                                                                           beginning with the month of FI
                                                                                                                                                                         Ineligibility
 M       PHC – Partners for Healthy Low-income children up to age 19 if their family income Based on family size, family income cannot          $30,000 per Budget Group Medicaid benefits for the qualifying
         Children (88)              is at or below 150% of federal poverty level            exceed 150% of FPL. Net income (after                                        children
                                                                                            income and child care deductions) for a
                                                                                            family of 4 cannot exceed $2,650 per month.
 O       HCK-Healthy Connections Uninsured low-income children up to age 19 if their        Based on family size, family income         $30,000 per Budget Group          Managed Care Insurance coverage
         Kids (99)               family income is above 150% of federal poverty level but   cannot exceed 200% of FPL. Net income                                         with vision and dental benefits
                                 less than or equal to 200% of the federal poverty level    (after income and child care deductions)
                                                                                            for a family of 4 cannot exceed $3,534
                                                                                            per month.
 M       LIF – Low Income        Low income families with children under 18 years of age or Income limit based on family size           $30,000 per Budget Group          Medicaid benefits
         Families (58, 59)       under 19 years of age, if attending a secondary school
                                 full-time                                                  Net income limit for family of 4
                                                                                            cannot exceed $860 per month
 M       OCWI – Optional         Pregnant women and infants under age 1                     Based on family size, family income         $30,000 per Budget Group          Medicaid coverage for the pregnant
         Coverage for (Pregnant)                                                            cannot exceed 185% of Federal Poverty                                         woman for the duration of the
         Women and Infants (87)                                                             Level. Net income (after income and child                                     pregnancy
                                 Note: Deemed Infants – Infants born to a Medicaid          care deductions) for a family of 4 cannot
         OCWI – Children Under   eligible mother – no application required                  exceed $3,269 per month.                                                      Medicaid coverage for any child
         Age 1 (12)              Others– application required                                                                                                             under age 1
 M       TM – Transitional       Individuals who lost eligibility for LIF because of the    Gross earned income at or below 185%        No resource test                  Medicaid benefits for up to 2 years
         Medicaid (11)           earned income of the parent/caretaker(s) or loss of the    of FPL – earned income is disregarded                                         beginning with the month of LIF
                                 earned income disregard (50%)                              for 18 months. Gross earned income                                            ineligibility
                                                                                            over 185% of FPL, case may be eligible
                                                                                            for 6 months. At end of 18 months, gross
                                                                                            earned income is compared to 185% of
                                                                                            FPL. If income is less, the family is
                                                                                            eligible for additional 6 months.
 O       FP – Family Planning    Females age 10-55 are eligible if their income is at or    Family income cannot exceed 185% of         No resource test                  Family planning services only
         Waiver (55)             below 185% of poverty                                      poverty. Net income (after income and
                                                                                            child care deductions) for a family of 4
                                                                                            cannot exceed $3,269 per month.
 M       Ribicoff (91)                To qualify for this category, child must be under 18         Family income must be below $ 860 for a      $30,000 per Budget Group Medicaid Benefits
                                      years old (under 19 if a full-time student)                  family of four


Page 2              NOTE: (O) = Optional Coverage Group     (M) = Mandatory Coverage Group                                                                                      July 1, 2008

				
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