Medicaid - A Need-Based Program

Medicaid is a need-based program primarily designed to pay for the medical care for people with limited income and assets. The program contains both federal and state components. The federal government creates the laws and regulations that provide the framework for Medicaid, and the states implement those regulations through their own sets laws and regulations. Funding for Medicaid comes from both the federal and state governments.

Most people don’t realize that the federal government created over 50 different types of Medicaid programs. The State of Georgia has implemented 36 of those programs. Generally speaking, there are four different types of Medicaid in Georgia:

• Aged, Blind and Disabled.  These programs provide medical benefits to individuals who are over age 65, blind or disabled under the Social Security Administration regulations. The program most often seen in an Elder Law practice is Nursing Home Medicaid. In Nursing Home Medicaid, the Medicaid recipient pays her monthly income to the Nursing Home, and Medicaid pays the portion that she cannot afford. Once the recipient dies or no longer needs nursing home care, Medicaid recovers the money it spent on that person’s care through a process known as Estate Recovery.
• Qualified Medicare Beneficiary (QMB).  Individuals in this program are eligible to receive Medicare benefits but have such a low income that they have difficulty making the monthly Medicare premiums. The QMB program pays the individual’s monthly Medicare premium, giving these individuals additional access to medical care.
• Family Medicaid.  This program provides health care benefits for children and their families. The popular PeachCare for Kids program, a program that provides health insurance for children in Georgia, is a form of Family Medicaid.
• Waiver Programs.  In the past, Medicaid benefits favored individuals in institutions. For example, it provided benefits for people in hospitals, nursing homes and in hospice. But what about those individuals who needed the same level of care of someone in a hospital or nursing home but who could receive care at home or in a group facility? In recognition that not all care must be provided in an institution and that it can be less expensive to care for someone at home, Medicaid created a series of waiver programs. These programs frequently provide more than medical care. They also provide services that help individuals maintain their independence, such as housing services, home health care, respite care, and even home delivered meals.

Medicaid is a complex program, and what is required to be eligible for Medicaid changes from program to program. An Elder Law attorney can help determine which program may assist you and your family and guide you through the requirements of that program.