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MEDICAID CHANGES - Some Good. Some Not So
Good.
THE GOOD
As a result of a change in state Law, there has been an increase
in the AABD MANG income standard. EFFECTIVE JULY 1, 2002, the
new standards are:
|
Number
in Standard
|
New
Income Standard
|
|
1
|
$ 738
|
|
2
|
995
|
|
3
|
1252
|
|
4
|
1508
|
|
5
|
1765
|
|
6
|
2022
|
|
7
|
2278
|
|
8
|
2535
|
|
each additional
|
+257
|
THE NOT SO GOOD
Starting July 1, 2002, some copayments for medical services for
ADULTS have changed.
- $ 2.00 for each doctor visit
- $ 3.00 for each brand name prescription
- $ 1.00 for each generic prescription
Adults do not have to pay any copayment for:
- hospice care
- family planning
- emergency services
- Medicare services
- certain medications (including insulin, AIDS drugs, chemotherapy
drugs, hemophilia drugs, and certain cardiovascular drugs)
Adults do not have to pay any copayment if they:
- are pregnant (including 60 days postpartum)
- under age 19
- in a DCFS case
- are enrolled in managed care
- living in an institution (i.e., hospital, nursing home, ICF/MR)
- living in a state certified-licensed or contracted residential
setting (i.e., supportive living facility, shelter care or CILA)
Do you
wish spend-down would
just go away?
If you receive Social Security Disability AND are employed and
pay FICA, you may be eligible for a new program from the Illinois
Department of Public Aid.
As an example, there is an individual who was on Social Security
Disability and who worked in a workshop. He was on a spend-down
case with a $287 per month spend-down. With this new program he
pays $56 per month and receives regular Medicaid coverage.
This new program (called Health Benefits for Workers with Disabilities
- HBWD) is for persons with disabilities who wish to go to work
or to increase their earnings without the fear of losing medical
benefits.
QUALIFICATIONS:
- must be disabled
- must meet all other AABD(D) nonfinancial
eligibility requirements
- must be employed or self-employed
- must be ages 16-64
- must pay a premium to IDPA based upon income
INCOME AND ASSETS: The income guidelines and asset guidelines
for HBWB differ from the AABD program and there is no spend-down
(if an applicant's income and/or assets exceed the program's guidelines,
they are not eligible).
INCOME: the income standard is 200% of the Federal Poverty
Level.
Family Size & Monthly Countable Income
Family of 1 - $1432
Family of 2 - $1935
Family of 3 - $2438
Family of 4 - $2942
Family of 5 - $3445
Family of 6 - $3948
Family of 7 - $4452
Family of 8 - $4955
If family size is more than 8, add $503 for each additional person.
ASSETS - Disregard up to $10,000 of nonexempt assets, regardless
of family size.
PROGRAM COST: All HBWD participants must pay a monthly premium
based upon their gross unearned income and countable earned income.
These premiums vary from $19-$100 monthly.
HBWD UNIT - located in Springfield and will use local office
#250. Regular local offices CANNOT process these applications.
FOR FURTHER INFORMATION PLEASE CONTACT US BY EMAIL AT INFO@TSNN.ORG
OR CALL 847.522.7546
2002 Illinois Benefit Updates &
Budget Cuts
Governor Ryan recently announced $485 million in budget
cuts. The programs that serve low-income people bear the brunt of
these cuts. A full list can be found in the Governor's press releases
dated November 26,27 and 28 at WWW.STATE.IL.US. Below, please find
some significant cuts in Governor Ryan's proposals.
$1.00 Copayment for Medicaid Recipients for Prescriptions
and Dr. Visits
For the first time, Illinois will impose $1 copayment for each prescription
and doctor visit on Medicaid recipients. This is expected to cut
$5.5 million from the budget since the state will reduce the payments
it makes to the providers of these services by the amount of the
copay. It is the providers' responsibility to collect these copayments
from their patients.
Medicaid Payments to Hospitals
Unspecified adjustments of managed care contracts in Medicaid would
cut $30 million. The elimination of extra tertiary care payments
would cut $35 million.The elimination of extra outpatient payments
would cut $55 million. Unspecified cuts to high-volume Medicaid
hospitals would cut $13 million.
Cuts for Mental Health & Substance Abuse Programs
Grants for Women & Youth Programs - $14 million is being cut
from these programs- These appear to be funding reductions and not
program eliminations.
Non-governmental Human Service Agencies
Effective April 1, 2002, a 2% cost-of-doing-business increase was
supposed to be initiated for these agencies. Governor Ryan's proposal
will rescind this increase a total of $16 million.
2002 MEDICARE UPDATES
1) Part A - Coverage for Acute Care Hospital Days
2002
2003
Deductible $812.00 $840.00
Co-Insurance $203.00 a day $210
a day
Lifetime Days $406 a day $420
a day
2) Part A - Coverage for Skilled Care Days
For the first 20 days in a skilled care facility, Medicare will
pay this bill in full - as long as this stay follows a 3-day inpatient
stay in an acute care hospital.
2002
2003
Days 21-100 $101.50 $105.00
3) Part B
2002
2003
Deductible $100 $100
4) Medicare Part A Cost
2001
2002
Monthly Cost $54 $58.70
2002 MEDICAID UPDATE
MEDICAID- LONG TERM CARE COMMUNITY SPOUSE
ASSET ALLOWANCE
2002
2003
$89,280 $90,660
MEDICAID LONG TERM CARE COMMUNITY SPOUSE MAINTENANCE
NEEDS
2002
2003
$2,232 $2,267
Effective January, 2002, the income standard for community AABD
medical cases is increased to the amounts given below. There is
no change in the long term care (LTC) standard or the standard use
for TANF or MANG cases. There is also no change in the determination
of countable income to compare to the standard. The new standards
are:
|
Number in Family
|
Monthly Countable Income
|
|
1
|
$ 628
|
|
2
|
$ 846
|
|
3
|
$1,064
|
|
4
|
$1,282
|
|
5
|
$1,500
|
|
6
|
$1,718
|
|
7
|
$1,937
|
|
8
|
$2,155
|
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