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The McCormack Report
State Eligibility Policies that Discriminate
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States with Less Than 100%-of-Poverty Aged/Disabled Medicaid Income Levels
Alabama Kansas Oklahoma 2 Alaska (about 90%) 1 Louisiana Oregon 6 Arkansas Maryland 9 South Dakota Colorado Mississippi 2 Tennessee 7 Connecticut (about 90%) 1 Missouri (85%) 2 Texas Delaware Montana Virginia (80%) Florida 2 Nevada Washington Georgia New Hampshire West Virginia Idaho New Mexico Wisconsin 1, 8 Indiana New York (100% & 150%) 4 Wyoming Iowa (200%) 3 Ohio 5
1. Uses its SSI Sate Supplementary Payment level as its highest aged/disabled Medicaid level too. 2. Aged/disabled Medicaid level was formerly over, at--or nearly at--100%, then state cut it to lower SSI level (or 85% in MO). 3. Waiver Medicaid coverage only if not on Medicare; but uses lower SSI level for those on Medicare. 4.100% for childless if not on Medicare; 150% for parents/caretakers even if on it; but lower SSI/SSP Medicaid level for others. 5. 90% for parents/caretakers even if on Medicare; but only $504/mo (even less than SSI level!) for childless aged & disabled. 6. Was 100%, then state cut it to lower SSI level except for HIV patients & certain other diagnoses. 7. Was 400%, then state cut it to lower SSI level but offers limited Rx’s & discounted clinic fees & risk pool premiums to poor. 8. 185% for parents/caretakers even if on Medicare; lower SSI/SSP level for childless, but discounts risk pool premium for poor. 9. All adults (including disabled) under 116% qualify for waiver-funded outpatient clinic care, but only if not on Medicare.
States With No Medicaid Spend Down for Aged and Disabled With “Excess” Incomes
Alabama Delaware New Mexico South Dakota Alaska Idaho Oregon Texas Colorado Nevada South Carolina Wyoming
“209(b)” States Where Aged & Disabled Face Stricter-Than-SSI Medicaid Rules and Must Apply Separately, All Over Again for Medicaid at Welfare Offices Even If They’re On SSI
Connecticut Indiana New Hampshire Oklahoma Hawaii Minnesota North Dakota Virginia Illinois Missouri Ohio
“Title XVI” States That Do Accept SSI Rules For Aged & Disabled But Still Make Aged & Disabled (Even If They’re On SSI) Apply Separately, All Over Again for Medicaid at Welfare Offices
Alaska Kansas Oregon Idaho Nebraska Utah Kansas Nevada
State Pharmacy Assistance Programs (SPAPs) That Discriminate Against the Disabled
State Prescription Assistance Programs State Prescription Assistance Programs Which Exclude the Disabled Under Age 65 Which Cover the Disabled Under Age 65
Connecticut +(includes dis in 2 year wait) Alaska Delaware+(caps benefit) Indiana Illinois*+(lesser formlry for dis than aged) New York Maryland*+(include dis under116% in 2yr wait)1 Pennsylvania Massachusetts +(includes dis in 2 yr wait) South Carolina New Jersey +(includes dis in 2 yr wait) Wisconsin Missouri +(includes dis in 2 yr wait) Maine +(includes dis in 2 yr wait) Rhode Island* +(only dis over 55; limtd formlry) Nevada +(includes dis in 2 yr wait) Montana (excludes dis in 2 yr wait) Hawaii (excludes dis in 2 yr wait) Vermont +(includes dis in 2 yr wait)
* Gives lesser SPAP benefits/coverage to disabled under age 65 than to aged over 65. + Includes disabled in two year Medicare waiting period. 1. Lower income band SPAP covers any uninsured adult (aged, disabled or not) under 116% who is not eligible for Medicare, and was just re-packaged, together with a previous state low income clinic & HMO care program (which does not cover hospital, ER, specialty or long term care), as a Medicaid waiver. The higher income band SPAP (300%), technically run by a non-profit on behalf of the state, excludes the disabled and now covers only Part D premiums, but not drugs, deductibles or co-payments.
States Excluding or Using Lower Income Levels For Disabled (and Often Aged) on Medicare in Medicaid & CHIP Section 1115 Waiver Income Eligibility Expansions
Arizona---waiver Medicaid covers parents and caretakers up to 200% FPL, but excludes childless aged and disabled on Medicare, who must meet lower 100% level to get Medicaid.
Arkansas—a Medicaid waiver funds subsidized health insurance for small-firm workers & spopuses earning under 200%, (300% for some) but excludes Medicare patients; unemployable aged & disabled must meet lower SSI level ($603 monthly in 2006) to get Medicaid.
California---parents and caretakers, even if on Medicare, enjoy 150% Medicaid income level, but childless aged & disabled must meet lower 135% income level to get Medicaid.
Connecticut---parents and caretakers, even if on Medicare, enjoy 150% Medicaid income level, but childless aged & disabled must meet lower SSI/SSP level (about 90% FPL) to get Medicaid.
Delaware---parents and caretakers, even if on Medicare, enjoy 100% Medicaid income level, but childless aged & disabled must meet lower SSI level ($603) to get Medicaid.
District of Columbia---parents & caretakers, even if on Medicare, enjoy 200% Medicaid income level but childless aged & disabled must meet lower 100% income level to get Medicaid.
Hawaii---gives Medicaid to all uninsured adults not on Medicare under 200%, but all aged & disabled (even parents, and caretakers) must meet lower 100% level to get Medicaid.
Illinois----parents & caretakers, even if on Medicare, enjoy Medicaid level of 185%, but childless aged & disabled must meet lower 100% level to get Medicaid.
Indiana---state keeps in force an even stricter-than-SSI “209(b)” Medicaid disability rule that one be fatally or incurably incapacitated to get Medicaid.
Iowa---a Medicaid waiver covers uninsured adults under 200% but excludes Medicare patients; aged & disabled on Medicare must meet lower SSI level ($603) to get Medicaid.
Maine---parents & caretakers, even if on Medicare, enjoy Medicaid level of 200%, but childless aged & disabled must meet lower 125% level to get Medicaid.
Maryland—a just-revised Medicaid waiver offers outpatient low income clinic and HMO primary care, including prescriptions--but no inpatient hospital, ER, long term or specialty care--to all uninsured adults under 116%, except aged and disabled Medicare eligibles, who must meet lower SSI income level ($603) to get (full) Medicaid.
Massachusetts---pays $14.43 higher SSI state supplement to the aged than it pays to the disabled; but, conversely, gives Medicaid to disabled up to 133%, but only up to 100% for aged; will offer Medicaid and/or subsidized health insurance to workers & dependents under 300%, but retain lower 133% & 100% levels for non-working disabled & aged.
Montana---its proposed Medicaid HIFA waiver will cover uninsured workers (including parents & caretakers) not on Medicare using income level of 200% or more, but childless, non-working & Medicare-eligible aged & disabled must meet lower SSI income level ($603) to get Medicaid.
Nevada---gives Medicaid to aged over age 65 using $36.40 higher-than-SSI State Supplementary Payment (SSP) income level, but younger disabled must meet lower, un-supplemented $603 basic SSI monthly income level to get Medicaid. Proposed Medicaid HIFA waiver will fund health insurance for uninsured workers and dependents under 200% if not on Medicare, but disabled and aged must meet lower SSI ($603) and SSI/SSP levels to get Medicaid.
New Hampshire—keeps in force an even-stricter-than-SSI “209(b)” Medicaid disability rule that one’s disability must last at least 4 years (versus only one year for SSI).
New Jersey---offers waivered Medicaid/CHIP to parents and caretakers, even if on Medicare, under 133% but childless aged & disabled must meet lower 100% level to get Medicaid.
New Mexico---gives (watered-down) Medicaid to certain qualified working adults under 200% except Medicare eligibles, who must meet lower SSI income level ($603) to get Medicaid.
New York---gives Medicaid to parents and caretakers, even if on Medicare, under 150% income level and to all uninsured childless adults under 100% except childless Medicare eligibles, who must meet lower $690 SSI/SSP level to get Medicaid.
Ohio---gives Medicaid to parents & caretakers, even if on Medicare, under 90% but childless aged & disabled must meet far lower $504 (!) monthly “209(b)” income level to get Medicaid.
Oklahoma---gives HIFA Medicaid waiver-funded health insurance to uninsured small firm workers (including parents & caretakers) with incomes under 185% who are not on Medicare, but aged & disabled, on Medicare or not, must meet lower SSI/SSP level to get Medicaid.
Oregon---gives Medicaid to only some aged and disabled adults under 100% , but not Medicare eligibles, most of whom must meet lower $603 SSI income level to get Medicaid.
Rhode Island---gives Medicaid to parents & caretakers, even if on Medicare, under 185% income level, but childless aged & disabled must meet lower 100% level to get Medicaid.
Utah---gives watered-down Medicaid (no inpt hosp care) with high co-pays ($50 prem; $10 gen drug copay; 25% brand drug co-pay) to all uninsured adults under 150% except aged & disabled on Medicare who must meet lower 100% level to get (full) Medicaid
Vermont---gives Medicaid to uninsured, childless adults and parents & caretakers (the latter even if they’re on Medicare) under 175% , but childless aged & disabled must meet lower 125% income level to get full Medicaid.
Wisconsin---gives Medicaid to parents & caretakers, even if on Medicare, under 185%---it may rise to 200%-- but childless aged & disabled must meet lower SSI/SSP level to get Medicaid.
Wyoming—proposed HIFA Medicaid waiver would fund health insurance for small firm uninsured workers (and dependents) not on Medicare under 200%, but aged & disabled would still have to meet lower SSI level ($603) to get Medicaid.
States Still Not Yet Offering Medicaid (via Sliding Scale “Buy-In” Premiums) to the Working Disabled Using Income Levels Above “Regular” Medicaid Income Levels
AL DC 2 HI MT TN VA CO 1 FL KY NC TX WI DE GA MD 3 SD UT
1. But offers Medicaid to the working “recovered”, “ex-disabled”, as do AZ, CT, IN, KS, PA and WA also. 2. But offers Medicaid only to the working “pre-disabled” with HIV, as does MS (RI covers the working “pre-disabled” with multiple sclerosis, while TX covers only the working “pre-disabled” with schizophrenia & bipolar disorder). 3. The state authorized a program, but it still hadn’t yet been implemented as of late 2005.
States That Cover the Working Disabled But Have Extra “Unearned Income” Thresholds That Bar Coverage for Anyone with SSDI Over the SSI, 100% FPL or Medicaid Levels
AK ME MO 1 NM VT AR MI NE SC WY
1. Discontinued its previous, generous working disabled coverage in 2005; legislative leaders are now seeking to revive it---but only with this kind of crippling, and much-too- low, unearned income threshold that denies coverage to most disabled.
States Excluding or Using Lower Income Levels For Disabled (and Aged) on Medicare In Other State-Only-Funded Health Care Programs
Alaska---has state-funded “Senior Assistance Program” benefit (either $120 cash monthly, or up to $1600 a year in drugs at Medicaid discount prices) to aged under 135% , but not to the disabled; these benefits are given to these aged whether or not they can also get the regular aged/disabled State Supplementary Payment (SSP) to SSI, which has an income level of over $900 monthly (and only actual receipt of the regular SSP or SSI confers full Medicaid coverage).
Colorado---offers a fully state-funded “Medicaid” to disabled (or anyone) over age 60 using $37 higher-than-SSI SSP level, but uses only lower, regular $603 SSI level for disabled under 60.
Delaware---offers state-funded medical assistance to any (even if not a parent, aged or disabled) uninsured person under 200% (650% for cancer patients), except aged & disabled on Medicare, who must meet lower SSI level ($603) to get Medicaid.
District of Columbia---offers city-funded medical assistance to anyone (even if not a parent, child, aged or disabled) under 200% except childless aged and disabled, who must meet lower 100% level to get Medicaid.
Massachusetts---will offer state-subsidized health insurance to any uninsured person under 300%, except the aged & disabled on Medicare, who will have to continue to meet lower 100% and 133% levels to get Medicaid.
Michigan---Governor proposes subsidized health insurance for any uninsured person under 200%, except aged & disabled on Medicare, who must meet lower 100% level to get Medicaid.
New York----the state-subsidized Healthy NY health insurance plan for those under 250% excludes those working under 20 hours weekly and aged and disabled Medicare patients (even if working) and caps Rx coverage at only $3,000 yearly; state-funded “Medicaid” covers those uninsured with colon & prostate cancer under 250% (reportedly, even if they’re on Medicare), but other disabled & aged must be under lower 150% or SSI/SSP levels to get Medicaid..
Pennsylvania---offers state-subsidized AdultBasic health insurance (with no drug benefit) to any uninsured adult under 200% except aged & disabled Medicare eligibles, who must meet lower 100% level to get Medicaid. AdultBasic new enrollments are suspended due to funding shortage.
Tennessee---will offer health insurance subsidies to uninsured workers & spouses under 250%, but aged & disabled on Medicare (even if working) must meet lower SSI level ($603) to get Medicaid.
Vermont---will offer subsidized health insurance to uninsured workers and spouses under 300%, but aged and disabled (even if working) must meet lower 125% level to get Medicaid.
Washington---offers state-funded “Basic” health insurance to uninsured adults under 200% except for aged and disabled Medicare eligibles, who must meet lower SSI/SSP level to get Medicaid. State funding shortages often limit enrollment in the Basic plan.
West Virginia---will offer subsidized health insurance to uninsured small firm workers and spouses under an income level of about 200%, but aged and disabled Medicare eligibles (even if working) must continue to meet lower SSI level ($603) to get Medicaid.
States With State-Funded Health Insurance Risk Pools Which Deny Enrollment to Disabled and Aged Medicare Eligibles or Deny Them Fair Premium Discounts
Twenty nine states sponsor state health insurance risk pools, which offer subsidized health insurance to 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 them premium discounts for having Medicare as their primary payer. (And a few states that do cover Medicare eligibles give them only a Medigap plan rather than full secondary coverage in the pool.) See Comprehensive Health Insurance For High-Risk Individuals, 2006 (Communicating For Agriculture at http://www.selfemployedcountry.org, [218] 739-3241); contact Natl Assoc of State Comprehensive Insur Plans (NASCHIP) www.naschip.org ; and see “Insuring the Uninsurable: An Overview of State High Risk Insurance Pools” at www.cmwf.org and http://www.insure.com/health/highriskpool.html and “Expanding Individual Health Insurance: Are High Risk Pools the Answer?” in Health Affairs (10/23/02) www.healthaffairs.org [subscription].
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