E-mail the Coalition2. State Drug Programs for those "Too Rich" for Medicaid
3. A Survey of Eligibility Rules of Public and Semi-Public Health Coverage Programs Draft 12/07/01
STATE ELIGIBILITY POLICIES WHICH EXCLUDE THE DISABLED IN THE MEDICAID, MEDICAID WAIVER EXPANSION, CHIP, STATE-FUNDED HEALTH ASSISTANCE & STATE PHARMACY ASSISTANCE PROGRAMS
Some state Medicaid, Medicaid waiver expansion, Child Health Insurance (CHIP), state-funded health assistance and state pharmacy assistance programs have eligibility rules which deny coverage or equal income eligibility levels to disabled and aged persons.
State Pharmacy Assistance Programs
Most state pharmacy assistance programs for Medicare patients who are somewhat "too rich" for Medicaid deny eligibility to disabled persons under age 65 and only cover persons over 65. Yet the fact is that---even in today's troubled budget climate for states---reforms which extend coverage to younger disabled persons are easily within reach for states. Social Security statistics show that, for every 100 over-age-65 beneficiaries, there are only 12 younger disabled beneficiaries. Moreover, Centers for Medicare and Medicaid Services (CMS) data reveal that about30% of disabled recipients are already on Medicaid, while only a tiny portion of the non-nursing home aged are on it. And another 30% or so of the disabled already have employer group health insurance secondary to Medicare as dependents of working spouses, which virtually no aged do.
Therefore, while the disabled only represent about 12% of the number of the aged, 60% of that 12% are already covered by Medicaid or employer health insurance---leaving only 4.8% of the number of currently-covered aged caseload to be potential disabled applicants who might seek expanded state prescription program coverage. States could easily fund more recipients with small copayment increases or slightly lowered income levels..
| State Prescription Assistance Programs Which Exclude the Disabled Under Age 65 | State Prescription Assistance Programs Which Cover the Disabled Under Age 65 |
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States Which Exclude Disabled (and Aged) on Medicare From
Medicaid and CHIP Section 1115 Waiver Income Eligibility Expansions
Delaware---gives Medicaid to all uninsured, childless adults under
100% of poverty except Medicare eligibles (who must meet far lower
SSI income level to get Medicaid).
Minnesota---gives Medicaid to all uninsured, childless adults under 175% except Medicare eligibles, who must meet lower 100% level to get Medicaid
Missouri---gives Medicaid to all uninsured parents under 100%
except Medicare eligibles who must meet far lower TANF (welfare)
income level to get Medicaid
Nevada---gives Medicaid to aged using $567.40 SSI monthly income
level, but disabled must meet lower $531 SSI monthly income level
to get Medicaid.
New York---gives Medicaid to all uninsured childless adults under 100% except Medicare eligibles who must meet far lower SSI income level to get Medicaid
Oregon---gives Medicaid to all uninsured adults under 100% except Medicare eligibles who must meet far lower SSI or TANF income levels to get Medicaid
Vermont---gives Medicaid to all uninsured adults under 175% but Medicare eligibles over 100% get Medicaid drug coverage only and not other Medicaid services
States Which Exclude Disabled (and Aged) on Medicare From State-Funded Health Care Programs
Colorado---offers state-funded "Medicaid" to anyone over age 60 using income level of $568 monthly, but uses income level of only $531 (the SSI level) for disabled under 60
District of Columbia---offers city clinic care to all under 200% except Medicare eligibles who must meet lower 100% level to get Medicaid; but aged alone do get clinic drugs only
New Jersey---offers state-funded health insurance to all parents under 400% of poverty except Medicare eligibles who must meet lower 200% (if parents) or 100% (if childless) levels to get Medicaid
Pennsylvania---offers state-funded health insurance (with no drug coverage) to everyone under 200% except Medicare eligibles who must meet lower 100% level to get Medicaid
Washington---offers state-funded Basic Health Insurance to all persons under 200% except Medicare eligibles who must meet far lower SSI or TANF (welfare) income levels to get Medicaid
States With State-Funded Health Insurance Risk Pools Which Deny Enrollment to Disabled (and Aged) Medicare Eligibles or Deny Them Premium Discounts
Twenty nine states sponsor state health insurance risk pools, which offer health insurance for those who cannot get insurance at all, at reasonable rates or without prohibitive preexisting condition limitations. Most, but not all, ban enrollment of Medicare eligibles. Of those that do allow them, only a few offer premium discounts because Medicare is primary payer. (And a few states that do cover Medicare eligibles give them only a standard Medigap plan [without meaningful drug coverage] rather than full secondary coverage in the risk pool.) See Comprehensive Health Insurance For High-Risk Individuals, 2000 (Communicating For Agriculture at http://www.selfemployedcountry.org, [218] 739-3241); contact Natl Assoc of State Comprehensive Insur Plans (NASCHIP) [email protected] (225) 926-6245; and see "Insuring the Uninsurable: An Overview of State High Risk Insurance Pools" (08/ 01) at www.cmwf.org .
State Health Insurance Risk Pools: Access, Characteristics
and Typical Premiums
| State | Characteristics* | Typical Premiums** |
| AL | 1, 6, 9 | $206 |
| AK | 2, 3, 4 | $445 |
| AR | 1, 6, 7 | |
| CA | 1, 6, 10 | $319 |
| CO | 5, 6, 8 | $229 |
| CT | 2, 6, 7, 8 | |
| FL | 2, 3, 4, 6, 7, 10 | |
| IL | 2, 3, 6, 10 | $307 |
| IN | 2 | 225 |
| IA | 2, 3, 6 | |
| KS | 1, 6 | $371 |
| KY | 5, 6, 7 | |
| LA | 1, 6, 7 | |
| MN | 2, 3, 6 | |
| MS | 5, 6, 7, 11 | |
| MO | 5, 6, 7 | |
| MT | 2, 3, 4, 6 | $233 |
| NE | 2, 6, 7 | |
| NM | 2, 6, 7 | $237 |
| ND | 2, 3, 4, 6 | $224 |
| OK | 1, 6 | $218 |
| OR | 2, 6, 8 | $313 |
| SC | 5, 6 | $280 |
| TN | 2, 6, 8 | $0 - $155 |
| UT | 5, 6 | $238 |
| WA | 2, 3, 4, 6, 8 | $298 |
| WI | 2, 3, 6, 8 | $186 |
| WY | 2, 3, 4, 6 | $239 |
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* Characteristics: **Premium shown is the 1999 or 2000 rate for a 35 year-old male non-smoker in largest city for plan with lowest deductible and least managed care limits, not reflecting any low income or Medicare discounts. |
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Written by Tom McCormack 11/14/01; [email protected] (202) 479-2543.
STATE DRUG PROGRAMS FOR THOSE "TOO RICH" FOR MEDICAID
Pharmaceutical companies' own discount programs for aged and (sometimes) disabled persons are now in the news. It might be useful to have an overview of the programs now operated by nearly half the states to cover prescriptions for those limited income aged (and sometimes disabled) persons who are somewhat "too rich" for Medicaid.
(It should also be pointed out that the VA offers prescriptions at $2 each to ALL honorably- and generally-discharged veterans---whether or not they're disabled or have served in wartime. Those enlisting since 1980 must have served at least two years---unless they're activated Reservists or Guardsmen with shorter call-ups or were discharged early for disability or hardship. Very small additional copayments for medical care apply to those with incomes over $23,000.)
13. A growing number (at least 20) of states now use their
own funds to run state pharmacy assistance programs for the aged
and (sometimes) disabled who are "too rich" for Medicaid.
Programs are funded by state general revenues, dedicated gambling
and lottery taxes and, increasingly, state tobacco settlement
awards. Most but not all states cover all FDA-licensed prescription
medications. Copayments per prescription range from 25 cents to
$20 or more, rising with income level. Premiums and deductibles
are used in some states as well, particularly for those at higher
income ranges. For income levels---which range from $8590 yearly
in WY and $9,650 in MD to about $35,000 in NJ and NY--- formularies
and other program details on state general drug aid programs,
see the AARP's "State Pharmacy Assistance
Programs" at http://research.aarp.org,
the National Conference of State Legislature's "State Pharmacy
Programs" at http://www.ncsl.org/programs/health/drugaid.htm
(best site on income levels), the General Accounting Office's
Report GAO/HEHS-00-162, Sep. 6, 2000) at http://www.GAO.gov,
the National Governors' Association at http://www.nga.org/cda/files/STATEPHARM.pdf
and daily news reports. While all states have centralized statewide
application procedures, one can apply through city and county
aging offices everywhere ---even under-65 disabled persons applying
in those states which cover the disabled.
[For the separate income rules (income levels set at from 100% to over 400% of poverty, sometimes with sliding scale premiums and copayments for those in higher brackets) and formularies (which range from minimal to quite generously inclusive) for state AIDS Drug Assistance Programs (ADAPs) which all states operate with federal Ryan White Act appropriations and sometimes also with state supplemental funding see http://aidsinfonyc.org/adap/ap5.html.]
States With State-Funded Pharmacy Assistance Programs For
Aged and (sometimes) Disabled Who Are "Too Rich" For
Medicaid, 2001
*Also covers at least some disabled too.
Note 1. On 7/1/01 State also added 2 year temp. drug
aid program, only for aged & disabled Medicare patients, under
300% poverty ($25,770 for 1), operated
by MD Blue Cross of Baltimore, with $1,000 annual benefit cap,
$10/mo. premium & copays of $10 generic, $20 "preferred"
brands & $35 other drugs.
Note: Most recent (2001, 2000 or 1999) income levels at http://www.ncsl.org/programs/health/drugaid.htm
A SURVEY OF ELIGIBILITY
RULES OF PUBLIC AND SEMI-PUBLIC HEALTH COVERAGE PROGRAMS, STATE-BY-STATE,
PROGRAM-BY-PROGRAM AND CATEGORY-BY-CATEGORY
(See below for dollar amounts of poverty
levels.)
By Thomas P. McCormack DRAFT 12/07/01
The paths to state Medicaid and related health coverage have grown more numerous and wider as a result of legislation and policies adopted during the last few years.
We used to assume that the rule was that only those found disabled by the Social Security Administration (SSA) and who received Supplemental Security Income (SSI)---or whose medical bills forced them to "spend down" to the SSI level or below--- got Medicaid, plus small numbers of HIV-positive welfare mothers and children on Aid to Families with Dependent Children (AFDC, now called Temporary Assistance to Needy Families (TANF).
Since the SSI level is only $531 monthly in 2001 (but somewhat higher in about 19 states which add State Supplementary Payments [SSPs] to the basic federal SSI level) many disabled persons' incomes made them "too rich" and many "pre-disabled" HIV-positive poor persons didn't fit into any Medicaid category at all.
| State Supplementary Payment (SSP) Income Levels Above the $531 Basic Federal SSI Level Which Also Confer Medicaid Eligibility on Disabled, Apr., 2001 | |||
| Alaska | $893 (1) | ||
| California | $712 | New Jersey | $562.25 |
| Colorado | $568 (531) (1, 6) | New York City | $810 (1, 4) |
| Connecticut | $765 (1, 2) | New York State | $618 |
| Hawaii | $535.90 (1) | Oklahoma | $584 (1,5) |
| Idaho | $584 (1) | Oregon | $532.70 (1) |
| Illinois | $591 (1, 3) | Pennsylvania | $558.40 |
| Massachusetts | $645.39 | Rhode Island | $595.35 |
| Maine | $541 (1) | South Dakota | $546 |
| Michigan | $545 | Vermont | $590.04 |
| Minnesota | $612 (1) | Washington | $536.95 |
| Nebraska | $538 (1) | Wisconsin | $614.78 |
| New Hampshire | $558 (1) | Wyoming | $540.90 |
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1. Apply for SSI at the Social Security office, and for SSP and
Medicaid at welfare office. 2. Used only if one pays threshold of rent & utilities in own name; includes value of $183 disregard. 3. Used only if one pays threshold of rent & utilities in own name in Cook County; lower elsewhere. 4. City SSP, called "DASIS", is only for HIV+, including "pre-disabled", if rent is at least $480 (can pay more if rent higher); medical assistance for those childless who are not disabled is non-federally-funded. 5. In 1998, OK offered add'l $579 SSP to TB+ pts.; in 2001 that would equal total SSI/SSP of $1109(!). 6. $568 for those over age 60; $531 for disabled under age 60. For details, see latest "State Assistance Programs For SSI Recipients" at http://www.ssa.gov/policy |
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Where once state Medicaid programs could cover only persons who were over 65; under 21; blind; disabled (using Social Security rules); pregnant; or members of welfare-type poor families (which allowed a second parent only if he were incapacitated medically or had been laid off after long-time work), the reforms now allow more coverage:
1. States can pay COBRA premiums with Medicaid money for
anyone---even those who aren't (yet) disabled or members
of other Medicaid categories-to keep their health insurance in
force for 18 or even 29 months after leaving a job--- with income
under 100% of poverty ($715.83 monthly for unemployed singles,
at least $1,516.66 for those working), or, at state option, even
higher levels. But only a few states have taken this little-known
option so far, even though any state can tap essentially unlimited
federal Medicaid dollars to pay premiums.
| States Using Federal Medicaid Money To Pay COBRA Premiums for Those Under 100% of Poverty Who Are Not (yet) Disabled or in Other Medicaid Categories | ||||||||
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2. States can get waivers under federal law (as former Vice President Gore once promised) to cover needy, "pre-disabled" persons who are not in any Medicaid category in their Medicaid programs-but only if they can show that federal costs won't be increased. (This "budget neutrality" rule is tough to meet. Arizona [with an income level at 100% of poverty], Oregon [at 100%] and Tennessee [at 400%] did it by adding in budget figures from previous state health programs. Maine [100%] did so with optimistic hospital cost estimates and private drug subsidies. And Massachusetts [200%] got a "waiver" for federal funding of coverage it already offered using only state funds. But to do so, all had a helpful thumb on the "no new costs" fiscal scale from a cooperative Clinton-Gore Administration.)
| States Giving Medicaid To All Poor, Even Childless Persons or All Poor, Even Childless "Pre-disabled" HIV+ Persons Via Federal Waivers or State Programs | |
| Arizona (everyone in state under 100% of poverty) | Missouri (non-custod parents under 125%, if curr. in child suppt.) |
| Colorado (adults over 60 under $568) (12) | New Jersey (everyone under 100%) (3) |
| Delaware (adults not on Medicare under 100%) | New York City (all HIV+ to $810 or more) (5) |
| District of Columbia (most persons under 200%) (8) | New York (all adults on Medicare under 100%) (6) |
| Georgia (HIV+, incl. "pre-dis.", under 100% [?]) (9) | Oregon (everyone not on Medicare under 100%) (4) |
| Hawaii (everyone in state under 100%) | Pennsylvania (all adults not on Medicare under 200%) (11) |
| Maine ("pre-disabled" HIV-positive under 100%) (7) | Tennessee (all uninsurable persons under 400%) |
| Massachusetts (HIV+ 200%; others 133%) (1) | Vermont (all adults to 150/175%) (10) |
| Minnesota (childless adults not on Medicare to 175%) | Washington (adults not on Medicare under 200%) (2) |
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1. All HIV+ (including even "pre-disabled") persons
to 200%; other disabled and aged to 133% 2. State-subsid, "Basic Health" ins., not Medicaid waiver; mo. prem. $10-$50; not open to Medicare eligibles (but discount enrollment in state hlth ins. risk pool is open to Medicare eligibles under 300%). 3. State-only medical assistance, in HMO, for those under 100% of poverty; no new applicants after 9/1/01 4. Medicaid waiver for everyone, except Medicare eligibles, under 100%; but state subsid. 70%-90% of hlth ins. risk pool. prem. for everyone, including Medicare eligibles, under 170% 5. City SSP ("DASIS") to $810/mo. for one (can be more if rent higher) for HIV+, incl. even "pre-disabled"; also disregards $90 wages, $175 per child child care & $50 child support in computing eligibility 6. State waiver, approved 5/01, to cover all childless adults under 65 and who are not on Medicare to 100% 7. ME, as of 6/01, also seeks waiver to cover all childless adults under 125% & the self-employed & their families under 300%; but approved waiver for HIV+ under 100%, faces funding/implementation problems. 8. 200% for anyone in DC Health Care Alliance, except disabled Medicare eligibles; those over 65 only get drug coverage; DC also has as-yet-unfunded waiver for all HIV+ (incl. "pre-disabled" HIV+)under 100%. 9. GA waiver said to be approved as of 5/01; but yet to be announced by HHS as of 6/15/0; covers limited treatment services, but with HIV drugs provided by ADAP, not Medicaid. 10. FULL Medicaid for non-Medicare eligibles to 150%. For Medicare eligibles: only Medicaid drugs + QMB coverage to 100%; Medicaid drugs only to 150%; Medicaid "maintenance" drugs only to 175%. 11. State purchases medical insurance (without drug coverage) for all adults who are uninsured & not on Medicare; effective 2/02. Aged and disabled who are on Medicare get Medicaid if under 100%. 12. State gives up to $568/mo + state-only "Medicaid" to everyone over age 60, whether or not disabled. |
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| States Giving Medicaid to "Pre-disabled" Tuberculosis-Infected Persons, Using Income Rules Similar to (but not quite as generous as) Those For Disabled | ||
| California | New York | Virginia |
| District of Columbia | Oklahoma* | Wisconsin |
| Minnesota | Rhode Island | Wyoming |
| *In 1998, OK offered add'l $579 SSP to TB+ pts.; in 2001 that would equal total SSI/SSP of $1109(!). | ||
Most local cancer, leukemia and related organizations offer free counseling, peer support, transportation allowances and very limited medical cost help to needy patients under their own local rules. In addition, California offers free prostate cancer screening and comprehensive treatment to all men with incomes under 200% of poverty through state and local health departments and the UCLA Medical Center's Urology Department.
4. One little-noticed result of the 1996 welfare reform law
was that states now define a family for welfare and Medicaid
coverage purposes. Under the old AFDC welfare law, families
with second parents could only be eligible if he was "unemployed"
or "incapacitated" (temporary disability less strict
than SSA's). Non-parental related caretakers (stepparents, grandparents,
aunts, uncles, siblings, etc.) who pool income with the children
continue to get Medicaid (unless noted to the contrary below).
But since under the TANF reform law most states now cover all
poor families, including those with second parents who
aren't incapacitated or headed by income-pooling non-parental
relatives. The federal government allows them to do so for
Medicaid even if they don't do it for welfare---and also lets
them raise family Medicaid income levels higher than before.
| States Which Still Bar Two Parent Families From Medicaid Unless a Parent Is "Unemployed" (Working Less Than 100 Hours Monthly) | |
| Arkansas | North Dakota |
| California* | Tennessee |
| Kentucky* | Utah |
| Louisiana | West Virginia |
| New Hampshire | Wisconsin |
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For details, see "State Policy Documentation Project" tables at www.cbpp.org *Allows "unemployed parent" to work over 100 hour limit once on Medicaid; and CA exempts all parents, including new applicants, who earn under 100% of poverty from 100 hour work limit. |
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5. Under the state Child Health Insurance Program (CHIP) created by the 1997 Balanced Budget Act (BBA), all children under age 19, (and, at state option, all pregnant women), with family incomes under 200% of poverty [yearly, $22,500 for family of two, $28,300 for three, $34,100 for four, $39,900 for five, etc.] are eligible for Medicaid or similar CHIP health insurance in almost all states even if they aren't disabled. (A few states use income levels of 150% or 185% and a few use levels over 200%; most but not all state CHIP prorgams use the same income disregards as are shown for family Medicaid in Item # 5.)
CHIP allows states, in some cases, to give Medicaid to parents too. Connecticut, Florida, Minnesota, New York, Pennsylvania (unconfirmed), Tennessee and one or two other states even allow over-income families to enroll their uninsured children in CHIP at small (e.g. $50-$85 monthly) or no (TN) premiums.
In the early and mid-1990s, many local Blue Cross/Blue Shield plans offered free or very cheap health insurance to uninsured, modest-income children through what was then usually called the "Caring Program for Children". Some, but not all, local "Caring" programs even granted parents of such children health insurance at VERY cheap premiums (e.g., about $75 monthly in western Pennsylvania). While children's health coverage needs are now largely met by CHIP, the parental coverage portion of some local Blue Cross plans' "Caring" programs may still be available for uninsured parents.
| States With Extra- High Medicaid and/or Health Plan Income Levels For Parents | ||
| STATE | INCOME AMT. | COMMENT |
| AZ (1) | 100% | all adults, including Medicare eligibles |
| CA (7) | 100% (retain to 150%) | all adults (seeks federal approval to go to 150% as of 06/01) |
| CT | 150% | all parents |
| DE | 75% / 100% | 75% for parents on Medicare; 100% if childless & not on it |
| DC | 200% | all parents |
| GA | 100% | all HIV+ parents (9) |
| HI | 100% / 200% | parents 200%; other adults 100% |
| IN | 100% | parents (effective July 2002) |
| LA | 100% | parents working under 100 hrs./mo. & pregnant women |
| MA | 133% | all adults |
| ME (8) | 150% / 200% | all parents |
| MN (14) | 100%/175%/275% | parents 275% & other adults 175%, except Medicare eligibles |
| MO (10) | 100% | all parents except Medicare eligibles |
| NJ (12) | 100%/200%/400% | parents 200%/400% except Medicare eligible; other adults 100% |
| NY (2) | 100% / 150% | parents 150%; other non-Medicare adults under age 65, 100% |
| OH (11) | 100% | all parents, including Medicare eligibles |
| OR (1, 3) | 100% / 170% | all persons not on Medicare |
| PA (15) | 200% / 100% | all persons not on Medicare |
| RI | 185% | all parents |
| TN (1, 5) | 400% | all uninsurable persons, including Medicare eligibles |
| VT (13) | 150%/175%/185% | parents 185%; other adults 150%/175% |
| WA (1, 6) | 200% | all persons |
| WI (7) | 185% (retain to 200%) | all parents, including Medicare eligibles |
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Notes: For listed states, effective income level is somewhat
higher (and may be far, far higher) due to income disregards--which
all states have and which some states have greatly liberalized;
see next table for disregard amounts. which can effectively raise
an otherwise-lower eligibility level. Eileen Sweeney's "Recent
Studies..." at http://www.cbpp.org/12-29-00wel.pdf
strongly suggests that at least 20% of low-income parents are
also disabled (see note with * in next table). Some additional
(but often outdated or unusably vague) detail on state Medicaid
income levels and income-counting rules may be available for
some states through http://www.geocities.com/CapitolHill/5974/.
In almost all states, kinship caretakers are considered "parents"
and enjoy these higher income levels; but in some states (noted
here), they are covered only under the lower income level used
for non-waiver, basic "TANF-related" coverage. 1.AZ' includes and OR excludes those on Medicare; they otherwise cover everyone under 100%. Uninsured children can also get CHIP up to 200% income in AZ, OR & WA (no limit in TN). 2. NY parent/ childless adult waiver approved 5/01; implementation 09/01;elig. budgeting quirks allow slightly higher income level for some NYC families w/ HIV+ members via City "DASIS" budget (pp.1&2). 3. But OR does pay 70% to 95% of premiums for risk pool health ins. for persons below 170% of poverty, including Medicare eligibles (any of whom can join the risk pool for secondary-to-Medicare coverage); Medicare-elig. also can get Medicaid via regular SSI, TANF or medically needy eligibility categories. 4. Deleted. 5.TN waiver covers everyone --parents, children & even childless adults who are "uninsurable". 6.WA subsidizes "Basic Health" insurance, not Medicaid; mo.prem.costs $10 to $50 per person & plan is not open to Medicare eligibles---but subsid enroll.in state hlth ins. risk pool is open to Medicare eligibles. 7. CA and WI do (or will) cover even two parent families with one working over 100 hours monthly, even though they didn't under their previous "regular" (and lower) Medicaid income levels. At this writing, it's unclear whether WI excludes non-parental relative caretakers from this higher family Medicaid level. 8. A 6/01 state law allows coverage of families and parents up to 200% to the extent funds allow. 9. GA waiver, approved 5/01, still awaits HHS announcement as of 6/15/01; will cover limited treatment services, with HIV drugs to be provided via ADAP, not Medicaid. 10. Even covers non-custodial parents up to 125%, if they're current in child support. 11. Limited to 24 months in any 30 month period. 12. But parents on Medicare can only get Medicaid via SSI, TANF, medically needy or 100% of poverty .aged/disabled. eligibility category; parents 200% to 400% also get Medicaid-type benefits via state-only funds, but must pay small premiums & copayments . 13. Parents and caretakers get FULL Medicaid if under 185%, even if they're on Medicare. 14. Medicare eligibles must be under 100% of poverty to get Medicaid. 15. State purchases medical insurance (without drug coverage) for adults who are uninsured and not on Medicare, effective 2/02. Aged and disabled under 100% get Medicaid, even if on Medicare. |
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| Family Of 3 Monthly Medicaid Income Levels & Wage, Childcare & Child Support Disregards | |||
| STATE | LEVEL | WAGE DISREGARDS | CHILDCARE DISREGARDS |
| AL | $164 | $90 | * |
| AK | $1,092 | $90 | * |
| AZ | (1) | $90+30% rest | * |
| AR | $204 | 20% wages | 0 |
| CA | (1) | $90 | * |
| CO | $421 | $90 | * |
| CT | (1) | $90+rest to poverty level | * |
| DE | (1) | $90 | * |
| DC | (1) | 0 | all costs |
| FL | $303 | $90 | * |
| GA | $424 | $90 | * |
| HI | (1) | $90 | 0 |
| ID | $317 | $90 | * |
| IL | $377 | $90 | * |
| IN | $259 | $90 | * |
| IA | $426 | 20% + 50% rest | * |
| KS | $404 | $90 + 40% rest | * |
| KY | $526 | $90 | * |
| LA | (1) | $90 | * |
| ME | (1) | $90 | * |
| MD | $418 | 20% wages | $200 |
| MA | (1) | 0 | 0 |
| MI | $459 | $90 | * |
| MN | (1) | $120 + 33% rest | * |
| MS | $368 | $90 | * |
| MO | (1) | $90 | * |
| MT | $476 | $200 + 25% rest | $200 |
| NE | $393 | 20% | all costs |
| NV | $828 | $90 or 20% | all costs |
| NH | $575 | 20% | * |
| NJ | (1) | $90 | * |
| NM | $389 | $120 + 33% rest | * |
| NY | (1) | $90 | * |
| NC | $544 | $90 | * |
| ND | $447 | (2) | "reasonable" costs |
| OH | (1) | $250 + 50% rest | * |
| OK | $471 | $120 | * |
| OR | (1) | (3) | * |
| PA | $421 | $90 | * (4) |
| RI | (1) | $90 | * |
| SC | $568 | $90 | $200 |
| SD | $796 | 0 | 0 |
| TN | (1) | $90 | * |
| TX | $275 | $90 | * |
| UT | $583 | $90 | * |
| VT | (1) | $150 + 25% rest | * |
| WA | $546 | 50% | all costs |
| WV | $253 | $90 | * |
| WI | (1) | $90+$30 + 33% rest | * |
| WY | $590 | $200 | 0 |
|
Note: States first count total, gross income, then
subtract earned income disregard, childcare disregard
and child support disregard amounts from that to get
net, countable income---only the net is what is
then compared to eligibility level. Most states disregard up
to $50 monthly of actually-received child support income
per case; AR, DC, HI, MD, MA, MO, NE, NH, OK, TN and WA have
no child support disregards; DE, GA and ME's $50 disregards
can sometimes be a bit higher due to quirks in eligibility budgeting;
CT disregards up to $100, KS $40, and NV $75; and CA also
disregards even all paid-out child support. Some additional
detail on state income levels or income-counting rules (but often
outdated or unusably vague) may be available through http://www.geocities.com/CapitolHill/5974/.
In all states without footnote 1, "parents" includes
kinship caretakers; in footnote 1 states, they may or may not
be covered too (see previous chart). 1. See previous chart for state's special, extra high income
level against which net, countable income is compared in determining
eligibility for families with children. State may use lower income
level for non-parental kinship caretakers. |
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7. On a demonstration project basis, states can give Medicaid to "pre-disabled" workers at risk of full disability, also using generous income rules. They could even get extra federal money for doing so. No "waiver" is needed. But as of September, 2001 only Mississippi and the District of Columbia (for HIV+ persons); Rhode Island (for multiple sclerosis patients); and Texas (for schizophrenia and bipolar patients) had successfully applied for such funding, leaving well over $100 million authorized and available for such patients but unclaimed and unused by the states. The extra planning money can be used for this too.
8. States that cover the working disabled can also give Medicaid to those workers who recover from their disabilities while eligible for basic working disabled coverage but still have a potentially serious conditions. AZ, CO, CT, IN, KS, PA and WA do this, and OK and TX are considering doing so..
| States Offering or Considering Medicaid For Working Disabled With Earnings Income Eligibility Level of $43,000 Yearly or Higher, 11/20/01 State Leg. Enacted and/or Approved by HCFA | ||
| Alaska | Louisiana | Oklahoma |
| Arizona | Maine (1) | Oregon |
| Arkansas | Minnesota | Pennsylvania |
| Colorado | Mississippi | Texas |
| Connecticut | Missouri | Utah |
| Florida | Nebraska | Vermont |
| Iowa | New Hampshire | Washington |
| Indiana | New Jersey | Wisconsin |
| Kansas | New Mexico | |
| 1.Also passed law 6/01 for Medicaid buy-in at up to 300% poverty for all self-employed and their families. | ||
|
States Which Already Have Higher-Than-SSI, 100% (Or More) of Poverty Medicaid Income Levels For Aged & Disabled, 2001 Alaska ($893, actually, $1.17 below state's own separate poverty
level) 1. Only if not on Medicare; if childless & on Medicare,
one only gets QMB benefits & Medicaid drugs if under 100%,
Medicaid drugs only to 150% and Medicaid "maintenance"
drugs only to 175%.; but all parents on Medicare get full Medicaid
to 185%. |
10. States can offer home and community based (HCB) services (wider services like case management & enhanced home health-type care) to frail disabled persons (or smaller groups, like PWAs) at medical risk of going into hospitals or nursing homes. Federal HCB regulations say that only persons who are in actual need of hospital or nursing home care AT THE EXACT TIME they apply can enter the HCB program. But some states are more flexible in practice & permit those in early disease stages----who'd only later be at risk of institutionalization if their disease stayed untreated----to enter the HCB program to prevent ACTUALLY NEEDING HOSPITAL OR NURSING HOME CARE. States can use extra -high Medicaid income levels (up to 300% of the SSI level, or $1590 monthly) for this group---but not all opt to do so.
| States With Home & Community Based Services Programs For All Frail Disabled or Frail PWAs & Whether 300% of SSI ($1590) Is the Income Eligibility Level | |||
| California | No | Missouri | No |
| Colorado | Yes | New Mexico | Yes |
| District of Columbia | No | New Jersey | Unknown* |
| Delaware | No | North Carolina | Unknown* |
| Florida | Yes | Pennsylvania | Yes |
| Hawaii | No | South Carolina | Unknown* |
| Illinois | No | Texas | Yes |
| Iowa | Yes | Virginia | No |
| Maine | Unknown* | Washington | Yes |
| Montana | Unknown* | ||
| *Contact state Medicaid agency about use of 300% rule | |||
| Other States With Home and Community Based Services Programs for Other Targeted Classes of the Physically Disabled (Which May or May Not Include PWAs or Use 300%) 1 | |||
| Alaska | Kansas | Nebraska | South Dakota (2) |
| Alabama | Kentucky (2) | New Hampshire | Utah |
| Arkansas (2) | Louisiana | Nevada | Vermont |
| Connecticut (2) | Maryland (2) | Ohio | Wyoming |
| Georgia (2) | Michigan | Oklahoma (2) | |
| Idaho (2) | Minnesota | Oregon | |
| Indiana | Mississippi (2) | Rhode Island (2) | |
|
1. Call state Medicaid agency to see who/how program covers 2. Uses 300% of SSI eligibility level |
|||
11. Most states offer Medicaid to disabled persons and members
of families with children through the medically needy or
"209(b)" spend down options.
Those with countable income over the Medicaid spend down income
level (which can be, and often is, even lower then the SSI level)
can deduct their incurred
(but not necessarily paid) medical bills from their income to
lower it to the level and become eligible for the state's spend
down time period (one, three or six months, depending on the state).
| States With No Medicaid Spend Down For Anyone or Only Limited Spend Downs For Some But Not All Medicaid Categories, 2001 | |
| Alabama | Missouri (only aged & disabled spend down) (1) |
| Alaska | Nevada |
| Arizona | New Mexico |
| Colorado | Ohio (only aged & disabled spend down) |
| Delaware | South Carolina |
| Florida (2) | South Dakota |
| Idaho | Texas (only families & children spend down) |
| Indiana (only aged & disabled spend down) | Wyoming |
| Mississippi | |
|
1. 09/01 bill adds add med. needy spend down for families &
children eff. 7/02, if funding is avail. 2. 12/01 bill restricts med. needy spend down to families & children eff. 7/02, unless new funding is avail. |
|
|
2001 Poverty Level is $8590 yearly ($715.83 monthly); add $3020 yearly ($251.66 monthly) for each add'l family member. To be updated in late February, 2002 at http://aspe.hhs/gov/poverty. (Bill signed 10/05/01 gradually phases out "209(b)" income level , income disregards & asset restrictions in Missouri by 7/01/04.) Income Disregards: For disabled, subtract $20 monthly of any income---and $65, half the rest of wages and out-of-pocket medical expenses from earnings---before income is counted. (But "209(b)" states--CT, HI, IL, IN, MN, MO, NH, ND, OH, OK & VA-can & do have stricter income counting rules.) For working disabled category (see above), most states offer more disregards than for the regular disabled category and, while "209(b)" states can be stricter here too, most also give extra-generous disregards to the working disabled category. For families, all states have their own differing, modest-to- generous earnings and childcare disregards; see table above for amounts, state-by-state. |
|
Allowable Assets For Disabled, Working
Disabled and Families and Children For special working disabled category (see previous page): Some states also allow extra liquid assets, 2nd cars and/or IRAs, 401(k)'s etc. While here, too, the "209(b)" states can allow less, not all use their strict "209(b)" rules for this favored group & some are even extra-generous to them. For families and children: $1,000 liquid assets (some states allow more), a lived-in home of any value and a car worth under $4500 (many but not all states allow costlier cars). CT, DC, IL, MA, MS, MO, OH, OK, PA, RI & WI drop asset tests for family & children Medicaid & CHIP but not welfare. |
12. Twenty nine states operate or sponsor state health insurance risk pools, which offer health insurance (subsidized by state taxes or assessments) similar to that offered by major employer group plans at higher-than-market-range premiums for those who cannot get insurance at all, at reasonable rates or without prohibitive preexisting condition limitations. At least 7 states further subsidize premiums for those who meet state low-income guidelines. Many state risk pools offer several plans, including fee-for-service, PPO and HMO options, as well as variations for location or amount of desired deductible. Most, but not all, ban enrollment of Medicare eligibles. Of those that do allow them, some but not all offer premium discounts because Medicare is primary payer. But a few states that cover Medicare eligibles offer them only a standard Medigap plan (with no meaningful drug coverage) rather than full, comprehensive secondary coverage in the risk pool. Many risk pools have laws or regulations prohibiting the use of public monies to pay premiums (e.g., from the Medicaid, Ryan White, maternal and child health, mental illness, mental retardation or developmental disability programs). One or two only exist for portability purposes under HIPPA, while at least two are continually or often closed to new applicants due to funding shortages.
Contact state insurance commissioners for further risk pool details. Also see Comprehensive Health Insurance For High-Risk Individuals, 2000 (hard copy only; Communicating For Agriculture at http://www.selfemployedcountry.org, [218] 739-3241), contact the National Association of State Comprehensive Insurance Plans (NASCHIP) [email protected] (225) 926-6245 and see "Insuring the Uninsurable: An Overview of State High Risk Insurance Pools" (August, 2001) at www.cmwf.org .
| State Health Insurance Risk Pools: Access, Characteristics and Typical Premiums | ||
| State | Characteristics | Typical Premium |
| AL | 1, 6, 9 | $206 |
| AK | 2, 3, 4 | $445 |
| AR | 1, 6, 7 | |
| CA | 1, 6, 10 | $319 |
| CO | 5, 6, 8 | $229 |
| CT | 2, 6, 7, 8 | |
| FL | 2, 3, 4, 6, 7, 10 | |
| IL | 2, 3, 6, 10 | $307 |
| IN | 2 | $225 |
| IA | 2, 3, 6 | $425 |
| KS | 1, 6 | $371 |
| KY | 5, 6, 7 | |
| LA | 1, 6, 7 | |
| MN | 2, 3, 6 | $411 |
| MS | 5, 6, 7, 11 | |
| MO | 5, 6, 7 | |
| MT | 2, 3, 4, 6 | $233 |
| NE | 2, 6, 7 | |
| NM | 2, 6, 7 | $237 |
| ND | 2, 3, 4, 6 | $224 |
| OK | 1, 6 | $218 |
| OR | 2, 6, 8 | $313 |
| SC | 5, 6 | $280 |
| TN | 2, 6, 8 | $0 - $155 |
| TX | 5, 6 | $230 |
| UT | 5, 6 | $238 |
| WA | 2, 3, 4, 6, 8 | $298 |
| WI | 2, 3, 6, 8 | $186 |
| WY | 2, 3, 4, 6 | 239 |
|
Note: All risk pools require previous minimum time of immediately
prior creditable coverage in other state risk pools, group or
individual health insurance, Medicaid or (sometimes) Medicare
to exempt one from pre-existing condition coverage waiting periods
of 6-12 months. (Each month of prior coverage earns a month's
credit toward the waiting period, if any.) Premium shown is the
1999 or 2000 rate for a 35 year-old male non-smoker in the state's
largest city for the option with the lowest deductible and fewest
managed care restrictions, but does not reflect any low income
or Medicare discounts offered. State insurance commissioners
and risk pool staffs have details. 1. Bans Medicare eligibles 2. Allows Medicare eligibles 3. Gives Medicare eligibles discount when the risk pool is the secondary coverage 4. May only offer Medicare eligibles one of the federally defined (options A through J) "Medigap" plans, which lack meaningful drug benefits; clarify with insurance commissioner & risk pool agency 5. Policy on Medicare eligibles unknown (contact state insurance commissioner & risk pool agency) 6. May have statute/rule banning use of public funds to pay premium (e.g., Medicaid, Ryan White, MCH , mental health, mental retardation, developmental disabilities or substance abuse program funds) 7. Call state insurance comr. & risk pool staff for premium by sex, age, city, plan type & deductible 8. Premium reduction for those considered "poor" under state guidelines (CO under $30,000; CT under 200% poverty; NM 200%; OR 170%; TN 400%; WA 300%; WI $24,000) 9. Only for federal HIPPA portability eligibles 10. Enrollment either closed continually (FL, IL) or has waiting list (CA); however, Ca does offer more expensive, "look-alike" health plan to those on risk pool waiting list. 11. While banning Medicare eligibles from joining risk pool, MS allows them to keep pool coverage if they first become Medicare-eligible after enrolling in the pool. |
||
13. A growing number (at least 20) of states now use their own funds to run state pharmacy assistance programs for the aged and (sometimes) disabled who are "too rich" for Medicaid. Programs are funded by state general revenues, dedicated gambling and lottery taxes and, increasingly, state tobacco settlement awards. Most but not all states cover all FDA-licensed prescription medications. Copayments per prescription range from 25 cents to $20 or more, rising with income level. Premiums and deductibles are used in some states as well, particularly for those at higher income ranges. For income levels---which range from $8590 yearly in WY and $9,650 in MD to about $35,000 in NJ and NY--- formularies and other program details on state general drug aid programs, see the AARP's "State Pharmacy Assistance Programs: 2001" at http://research.aarp.org, the National Conference of State Legislature's "State Pharmacy Programs" at http://www.ncsl.org/programs/health/drugaid.htm (best site on income levels) , the General Accounting Office's Report GAO/HEHS-00-162, Sep. 6, 2000) at http://www.GAO.gov, the National Governors' Association at http://www.nga.org/cda/files/STATEPHARM.pdf and daily news reports.
[For the separate income rules (income levels set at from 100% to over 400% of poverty, sometimes with sliding scale premiums and copayments for those in higher brackets) and formularies (which range from minimal to quite generously inclusive) for state AIDS Drug Assistance Programs (ADAPs) which all states operate with federal Ryan White Act appropriations and sometimes also with state supplemental funding see http://aidsinfonyc.org/adap/ap5.html.]
|
States With State-Funded Pharmacy Assistance
Programs For Aged and (sometimes) Disabled Who Are "Too
Rich" For Medicaid, 2001 1. On 7/01 State also added 2 year temp. drug aid program,
only for aged & disabled Medicare patients, under 300% poverty
($25,770 for 1), operated by MD Blue Cross of Baltimore, with
$1,000 annual benefit cap, $10/mo. premium & copays of $10
generic, $20 "preferred" brands & $35 other drugs.
Note: Most recent (2001, 2000 or 1999) income levels at http://www.ncsl.org/programs/health/drugaid.htm |
14. Most pharmaceutical manufacturers operate their own corporate patient assistance programs (PAPs) for those who, under company guidelines, cannot afford medications and aren't eligible for any private or public health coverage. Each company with such programs (and not all have them) establishes its own income and asset standards for free drugs, which sometimes can even vary from one company drug to another. Firms only rarely reveal what their income and asset levels are---and, indeed, some don't really have any coherent, hard-and-fast income levels, relying instead upon ad hoc, "common sense" decisions by their PAP staffs.
PAP drugs almost always must be applied for, on a needy patient's behalf, by his or her physician calling corporate 800 numbers to secure patient application forms (which must then be submitted with proof of income like paycheck stubs, etc.). Quite often, delivery of vouchers for drugstore use or drug shipments is then made to the doctor at his office by drug companies' salesmen. Naturally, they use the visit to try to sell other company products---but also give doctors free drug samples to pass out to other needy patients. Many doctors dislike having to deal with all this---even if they have desperate, needy patients who need drugs. Yet, while PAPs do provide drug makers with good public relations, the fact is that PAP distribution via doctor sales calls may be the reason that some manufacturers even consider PAPs worthwhile at all.
Manufacturers' drug assistance programs are listed at www.volunteersinhealthcare.org or http://rxassist.org and http://PhRMA.org/patients/index.html [for general, non-HIV-specific drugs] and http://www.aidsinfonyc,org/network/access/pa.html [for HIV-specific drugs].
15. All veterans with honorable or general discharges who have served at least 180 days of active duty can receive care at VA medical centers -- even if they aren't disabled under VA or Social Security rules or have not served in a war zone or during wartime. (But those who first enlisted after September 7, 1980 must also have served at least two years as well----unless they were activated Reservists or National Guardsmen who fully served out a shorter call-up or were discharged early for disability or hardship.) Care available through the VA includes inpatient hospital stays, outpatient hospital services, clinic and physician services, and outpatient prescriptions. Veterans who are former prisoners of war and fully or even partially disabled from service-connected causes get priority, free care. Other non-service-connected veterans who are poor get free care, except for a $2 per prescription copay. Richer, non-service-connected veterans get space-available care with very low copays. Dependents such as spouses, widow(er)s and minor (or grown, children first disabled before age 22) of service-connected (100% or more) disabled veterans get premium-free CHAMPVA health insurance (similar to major employer plans), whether rich or poor, on Medicare or not or over 65 or not. See www.VA.gov. Dependents of active-duty service members, "lifer" retirees and their dependents and survivors (including grown children disabled before age 22) not only get free, "space available" care at military medical facilities (which is, in fact, usually unavailable due to priority active duty patient caseloads); they also get premium-free Tricare health insurance (also similar to major employer plans); see www.Tricare.gov .
| Income Levels, Free VA Health Care, 2001 | Copays for Higher Income Veterans, 2001 | ||||||||
|
|
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16. Native Americans---members of, or those eligible for membership in, federally-recognized Indian tribes and Alaska Natives' Corporations---get free health care from the Indian Health Service (IHS), tribal health facilities on reservations and reduced, sliding scale-fee care at 34 urban Indian clinics funded by the IHS. This non-means-tested (or sliding scale fee, in urban clinics) health coverage is available to those with at least some partial Indian descent who are eligible for membership in tribes---most of which do not require one to be "full-blooded". Reservation-based health facilities are open only to members of that tribe (and their spouses from other tribes) who live on the reservation or in adjacent counties. (Emergency care only is given to those from other tribes, for free, or to non-Indians, who must pay.) But urban clinics are open to members of any recognized tribe, subject to limited space and funding. IHS care, while open to rich or poor, is last payer, and patents must first seek out, apply for and use any other potential or available insurance or entitlement. To locate IHS reservation health facilities and urban clinics, visit http://www.dhhs.gov; to find out how to confirm one's Native American ancestry and contact tribal leaders to enroll, visit http://www.doi.gov/bureau-indian-affairs.html. For details on urban clinic programs see http://www.kff.org/content/2001/6006
17. All states, through county and city health departments, operate Maternal and Child Health (MCH) Block Grant (also called "Title V") and Children with Special Needs (formerly called "Crippled Children's") programs for mothers and children, using wholly state-set income levels of, typically, 200% of poverty. Many (but not all) states choose not to impose an asset test. These programs provide health screening, immunizations, well-child care, outpatient clinic care, rehabilitation and therapy---and, often, inpatient hospital care and outpatient prescriptions. Visit www.amchp.org to locate state programs and get their detailed rules.
18. The federal government's Health Resources and Services Administration (HRSA) funds at least 330 low-income community health clinics across the country; there are at least 125 similar "Federally-Qualified 'Look Alike'" clinics; and hundreds of other private non-profit clinics serving the poor (e.g., doctors volunteering evenings to see the poor in church basements and so on.)
HRSA-funded clinics provide free or very low co-payment care to those with income under 100% of poverty, sliding scale fee care to those between 100% and 200% and charge full costs of care for those above 200% (but some clinics in the high-cost Northeast allow sliding scale fees to those up to 250% or 300%.) About half of HRSA clinics offer their own in-house pharmacy services (again, with appropriate copays based on income level). The half or so of clinics that can't afford in-house pharmacy services sometimes arrange for partial discounts for their patients at area drug stores. The so-called "'look alike' clinics" and the private non-profit ones typically have similar fee arrangements---but are far, far less likely to offer in-house pharmacy services. To locate HRSA-funded clinics, visit www.bphc.hrsa.gov. Almost all of the "look alike", other private non-profit and HRSA-funded clinics are listed at www.NACHC.com and in the annual directory of the Primary Health Care Clearinghouse; call (800) 444-7773 for a copy.
19. Most----but not all---states (or their counties) have General Medical Assistance (GMA) or State-Only Medical Assistance (MA/SO) programs to provide medical care to needy uninsured persons who aren't eligible for federally-funded Medicaid. Where offered, GMA or MA/SO is usually limited to those who get cash General Assistance (GA) welfare. GA, in almost all states except New York and California, now requires one to meet state definitions of medical incapacity and to be actively seeking SSI disability benefits. Thus---except for several Northeastern, Great Lakes and West Coast states which also offer this medical coverage to those who are not on cash GA welfare (e.g., those who "spend down" to the income level)---meeting state medical incapacity standards now serves as an eligibility requirement. These state programs have very low asset eligibility levels---and many bar those with cars, even modest homes and minimal cash savings. Income levels for one person vary from about $100 monthly in the strictest states to about $450 or more in the most liberal states.
While in a few states GMA or MA/SO operates like Medicaid, with the same providers and benefits package, in most areas recipients' choice of medical providers is restricted to public hospitals, low income clinics and the like. Especially in local-option states, all but the most routine, cheapest care must be pre-authorized. Southern, Plains and Rocky Mountain states' programs all exist only at county option (so coverage is only available in liberal, urban counties), and some don't offer it at all. In many states, the hospital and clinic "coverage" really offered by these programs amounts to no more than an unpaid-for state mandate to admit and treat the poor uninsured ---which can and does leave unpaid bills subject to later collection action against whatever few resources the poor may have. For state-by-state eligibility and coverage details, see especially "State General Assistance Programs, 1998" [99-01] by Gallegher et.al. at http://www.newfederalism.urban.org/html/ga_programs/ga_main.pdf (pp. 85-104); for details on the Denver, Houston and Los Angeles systems, see http://newfederalism.urban.org/html/op49/occa49.html
Alabama 1 , 10 Montana 3
| States With No, Only County-Option or Limited General Medical Assistance(GMA) | ||
| Alabama 1, 10 | Iowa 1 | North Dakota 2 |
| Arizona 2 | Kentucky 1 | Oklahoma 1 |
| Arkansas 1 | Louisiana 5 | South Carolina 1 |
| Colorado 2, 10 | Maryland 6 | South Dakota 3 |
| Florida 2, 10 | Mississippi 1 | Texas 2, 9, 10 |
| Georgia 1, 10 | Montana 3 | Virginia 3, 10 |
| Idaho 3 | Nebraska 8 | West Virginia 1 |
| Indiana 4 | New Mexico 1 | Wyoming 7 |
| North Carolina 2 | ||
|
Note: Everywhere, public & other non-profit hospitals---especially
"teaching hospitals" tied to medical schools---almost
always offer free or sliding fee scale discounted inpatient &
outpatient care to the poor under their own rules. Access to
hospital care-where accomplished via mandate and not publicly-paid-can
and does leave resulting unpaid bills subject to later collection
against indigents' meager incomes and assets, particularly for
non-public hospitals. 1. No state or even county GMA or MA/SO program. 2. GMA or MA/SO at county option only (e.g., likely available only in urban, liberal counties). 3. GMA or MA/SO at county option only (so far, only confirmed as available in largest/most urban county). 4. GMA or MA/SO at township option only (available, at least in theory, in Marion County/Indianapolis). 5. No GMA or MA/SO, but state still has Charity Hospital system providing free/discounted care to all indigents. 6. GMA or MA/SO is free outpatient care at chain of state-subsidized low income clinics; but inpatient hospital care delivered via state mandate to admit indigent without immunity against later debt collection; not tied to cash GA. 7. No GMA or MA/SO, per one 1998 survey, but other surveys report that state's Minimum Medical Program offers drugs and some medical care to everyone under 100% of poverty. 8. GMA or MA/SO supposedly offered by 56 of 93 counties which adhere to optional state GMA-MA/SO system. 9. A more detailed report on Texas' indigent care is available at http://www.accessproject.org. 10. County & teaching hospitals offer free & sliding-fee inpatient, outpatient and outpatient pharmacy services care in Atlanta, Austin, Birmingham, Charlottesville, Dallas, Denver, Houston, Lincoln, Miami and Richmond. |
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20. State, county and municipal public hospitals (especially "teaching hospitals" affiliated with state medical schools), as well as most private, non-profit "teaching hospitals" tied to medical schools, offer free or sliding scale-fees for inpatient, outpatient clinic and even outpatient pharmacy services to indigent residents. Virtually all offer free or reduced-fee care for inpatient and outpatient care, and over two-thirds also offer free or sliding scale outpatient prescriptions at their own in-house pharmacies. Income levels vary, with free care or only nominal copays offered to those below 100% or even 200% of poverty, sliding scale fees for those at slightly higher levels and full fees for those above the institution's maximum income threshold.
Full fees are always charged to those failing to cooperate with the indigent financial counseling process (including those who fail to follow through in applying for other public coverage or who later become delinquent on agreed reduced-fee payment plans), and such accounts are sent to collection agencies. For emergency care, and even sometimes for elective inpatient admissions and outpatient care, actually paying in advance one's reduced-fee copayments can often be waived; however, waiver of cash payment of reduced copays for issuance of outpatient prescriptions is far less often granted. Outpatient pharmacy copays vary from about $2.00 to $10.00 (and, in a few hospitals, even more); slightly over half of these institutions waive copays after patients reach a monthly "stop loss" cap of pharmacy copays. Often, cash-short hospital pharmacies help patients use industry patient assistance programs (PAPs; see above).
Visit www.NAPH.org for a list of
member public hospitals and call (202) 585-0100 for the hard copy
pamphlet, Cost-Sharing and the Uninsured; consult AA
for a member list of medical schools associated with teaching
hospitals; contact area public and teaching hospitals; visit www.cmwf.org to see "A Shared Responsibility:
Academic Health Centers and the Provision of Care to the Poor
and Uninsured" and "Safety Net Hospitals"; for
details on Denver, Houston and Los Angeles' systems, see http://newfederalism.urban.org/html/op49/occa49.html;
finally, see http://www.kff.org/content/2001/2250
and http://www.kff.org/content/2001/2251.
21. Several states and a number of counties use specially dedicated Medicare and Medicaid Disproportionate Share Hospital (DSH) funds, state and local taxes, private and foundation donations, Medicaid Section 1115 project funds, existing GMA/MA/SO programs and/or employer contributions to provide subsidized health insurance for modest-income, uninsured employees, their families and, sometimes, other uninsured residents. Usually, but not always, subsidized health insurance for modest-income employees and their families depends upon employer cooperation and at least partial contribution toward premiums; but a few health coverage subsidies are also open to the non-employed as well. Details---including income eligibility criteria, at-work status requirements, employer participation mandates, recipient costs not met by subsidies and contact information---is available in "State and Local Initiatives To Enhance Health Coverage for the Working Uninsured" (November, 2000) at www.cmwf.org. The following chart gives a brief overview of those programs not listed elsewhere in this paper:
| State/Local Health Coverage Subsidy Programs for Modest Income Workers & Other Uninsured | |||
| State/Locality | Income Elig. Level | Only Employees? | Comment |
| Bay Area, CA 5 | 250% poverty | Anyone uninsured | Free minor surgery, incl. hosp. & necessary drugs |
| Boston | 200% poverty | Anyone uninsured | Free care + nominal copays |
| Cumberland, Kennebec & Lincoln Cos., ME 2 | None (?) | Anyone uninsured | Free care after $10 enrollment fee |
| Denver | Income under $50 K | Only workers & dependents | Partial city subsidy of premium & copays |
| Kansas | 200% poverty | Only workers & dependents | Partial state subsidy of premium & copays |
| Lansing, MI | 250% poverty | Anyone uninsured | Free care + nominal copays |
| Marion Co., IN | 200% poverty | Anyone uninsured | Free care & rising copays over 150% |
| Massachusetts | 200% poverty | Only workers & dependents | Premium subsidy to $10/$50 + sm. copays |
| Muskegon, MI | Earn under $10/hour | Only workers & dependents | 70% city subsidy of premium & copays |
| New Jersey 3 | 400% poverty | Any uninsured family w/children | Very small premiums & copays |
| New York | 250% poverty | Anyone unins. 12 mos. | Partial state subsid. of prem + copays |
| Pima Co. AZ 4 | 150% poverty | Uninsured workers & dependents | $40/yr premium + outpatient copays/ inpatient discount |
| San Diego | 300% poverty | Only workers & dependents | Partial city subsidy of premium & copays |
| Washington, DC 1 | 200% poverty | Any resident | Free care + nominal copays (care only at city clinics/designated hospitals) |
| Wayne Co., MI | Earn under $10/hr | Only workers & dependents | 66% Co. subsidy of premium & copays |
|
Note: A study of public and some blended public/private safety
net care in Denver, Houston and Los Angeles is at http://newfederalism.urban.org/html/op49/occa49.html.
Programs open only to workers can and do also cover their unemployed
disabled dependents. 1. DC Health Care Alliance. (202) 842-2410; Medicare eligibles under 64 excluded; and persons over 64 only get drug coverage. 2. Reported in Kaiser Daily Health Policy Report, 06/13/01. Contact state or counties' health depts. 3. State-only program for fam. to 400%.. See NJ website thru http://www.geocities.com/CapitolHill/5974/. 4. Uninsured workers and their families earning under 150%; Pima Comm. Access Prog. (520) 694-0418. 5.Uninsured under 250% in Alameda, Marin, San Francisco, San Mateo or Sonoma Co. areas; Operation Access (415) 931-3866; minor/outpt surgery only, incl. hosp .costs & related prescriptions. |
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Many persons who acquire Medicaid through "spend downs" later extinguish even those liabilities by successfully applying for Hill-Burton. While Hill-Burton programs can't (and don't) offer forgiveness or bill-reduction for accompanying, separate bills form doctors and other independent practitioners, being accepted for Hill-Burton on the facility bill often can and does persuade such practitioners to grant voluntary, free charity care or bill-reductions on their own.
Hill-Burton's health access benefits are perpetual obligations of the facility (continuing even after free care obligations are "paid off") and include: the right to a medically necessary treatment and admission, even if one doesn't have a doctor with staff privileges; the right to have one's Medicare or Medicaid accepted as payment in full, even from doctors practicing at the hospital who don't accept such programs off-premises; the right to emergency room and emergency inpatient treatment, without regard to Medicare/Medicaid status, lack of insurance, current means to pay or even an agreed-upon installment plan for later payment; and the right to "no upfront cash deposit" elective admissions---even for those without insurance or current ability to pay---for patients who do agree to make later installment payments.
23. At least 27 states provide at least some publicly-financed medical care to those with permanent kidney failure or End Stage Renal Disease (ESRD) or who need or have had kidney transplants through state kidney programs. Most, but not all, have means-tested eligibility rules, and all require use of all other available resources (Medicare, Medicaid, CHIP, private health insurance, etc.) before state funds. A few of those with income tests also have asset tests as well. Covered expenses/benefits packages vary enormously.
| State With Kidney Program | Income Eligibility Test? | Telephone Contact Number |
| Alabama | "poverty level income" | 205-934-2111 |
| Arizona | Criteria unknown | Unknown (reported in 2001) |
| Arkansas | "financial need" | 501-296-1629 |
| Delaware | None noted | 302-422-1393 |
| Illinois | "last resort" | 217-782-3303 |
| Indiana | 250% of poverty | 317-383-6543 |
| Iowa | 250% | 515-281-4960 |
| Louisiana | None noted | Unknown (reported in 1998) |
| Maine | None noted | Unknown (proposed 1998) |
| Maryland | "no income limit" | 410-764-5000 |
| Massachusetts | None noted | Unknown (pending in 1998) |
| Missouri | income in lowest 25% of state median | 573-882-2506 |
| Montana | None noted | 406-444-4349 |
| Nebraska | "ability to pay" | 402-471-2638 |
| New Hampshire | $13,000 for 1; $14,500 for 2 | 603-271-4526 |
| New Jersey | 300% | 609-984-6137 |
| North Carolina | "no third party payer" | 919-715-3113 |
| Oklahoma | None noted | Unknown (enacted in 1997) |
| Pennsylvania | 300% | 717-787-9772 |
| Puerto Rico | "medically indigent" | 787-764-2254 |
| South Dakota | 133% of poverty | 605-773-3495 |
| Tennessee | "sliding scale" | 615-741-5359 |
| Texas | income under $60,000 | 512-458-7796 |
| Vermont | "any Vermont citizen" | Unknown (funded 1998) |
| Washington | 300% | 360-753-5742 |
| Wisconsin | None noted | 608-266-2469 |
| Wyoming | No new applicants accepted | 307-777-6296 |
| Details available (in hard copy only) in the "Directory of State Kidney Programs" ($5.00) , National Organization of State Kidney Programs (NOSKP), c/o Missouri Kidney Program, 112 Lewis Hall, University of Missouri, Columbia, MO 65211 [email protected] or [email protected] Also see www.kidney.org. Note that anyone experiencing permanent kidney failure who himself, whose parents or whose spouse is Social Security-insured is eligible for Medicare with only a 3 month waiting period. Details are available at www.HCFA.gov. | ||
24. The federal government, through the Health Resources and Services Administration (HRSA, [email protected] [301] 443-5698), helps fund dozens of Hemophilia Treatment Centers (HTCs) which provide free or reduced-price care to the indigent and which can be located at www.hemophilia.org. In addition, state hemophilia assistance programs are funded by Florida ([email protected] [727] 856-7057), Michigan ([email protected] [734] 975-2838), New Jersey ([email protected] [732] 238-5250; state association, which helps with health insurance premiums) and Texas ([email protected] [512] 685-3159).
25. Florida ( [email protected] ) and Texas ( [email protected] [512] 685-3159) have state epilepsy assistance programs for those with limited resources.
26. ALS (Lou Gehrig's disease) patients can get Medicare as soon as their Social Security Disability Insurance (SSDI) begins and don't have a 24 month wait for Medicare. See www.HCFA.gov for details.
Detailed 1998 reports on eligibility rules for Medicaid,
ADAP and (some but not all) related health programs are available
on Colorado, Connecticut, Florida, Illinois, Missouri, Nebraska,
Nevada (hard copy only) , New Mexico (hard copy only), Oklahoma,
Texas and Utah from the author at [email protected]
.
Thomas McCormack wrote the AIDS Benefits Handbook (Yale University Press), did policy on SSI, Medicare and Medicaid at HHS and several AIDS and disability groups and now consults for the Title II Community AIDS National Network (T2CANN). Email him at [email protected].
Revised December 8, 2001