Applying for Medicaid

Silver Tips is written by the Senior Citizens’ Law Office in Albuquerque.

Medicaid is much in the news these days, due largely to proposals by the federal and state governments to reduce funding for it. Medicaid is an important health coverage program that pays for a broad range of health care services needed by lower income people. Most New Mexicans have heard about Medicaid, but they may not know much about it, and may often confuse it with Medicare.

Medicaid is funded by federal and state tax dollars, but run by the states. Each state has its own Medicaid program, and people are eligible only for their own state's program. Medicaid and Medicare are easy to confuse, because both are health coverage programs with similar-sounding names, and many people have both! The easiest way to distinguish between them is that Medicaid eligibility always involves satisfying very low income and asset tests. Most Medicaid beneficiaries get a blue plastic ID card; Medicare card-made of stiff paper-are white, with one red and one blue stripe across the top.

Understanding Medicaid can be complicated. Many different eligibility "groups" exist, and some groups qualify only for a limited type of help, many unfamiliar terms are used, and application procedures for different groups can vary. It may help to remember that, with one big exception, all Medicaid applications are handled by local offices of the state Human Services Department's "Income Support Division" (ISD)-the same offices that handle applications for Food Stamps, LIHEAP heating/cooling help, and other benefits (check the government pages of your phone directory for contact information).

Groups potentially eligible for Medicaid include children under 19, pregnant women, seniors (age 65 and older), persons with disabilities, "New Mexico Works" beneficiaries, nursing facility and ICF-MR residents, and some women with breast or cervical cancer. Applicants also must satisfy other requirements, especially, as noted, low income and (usually) assets tests. While most eligibles qualify for "full-scope" coverage (i.e., for all the many services that Medicaid can cover), people eligible only for "QMB," "SLMB," or "QI" coverage get very limited coverage-payment for Medicare premiums (and, with QMB, coverage of Medicare deductibles and co-pays).

As noted, most people apply for Medicaid through state "ISD" offices. Seniors and persons with disabilities whose income and assets are low nough to qualify for federal "SSI" benefits, however, do not! They must apply for SSI, through the Social Security Administration; and, if they qualify for SSI, they get full-scope Medicaid automatically.

The piecemeal evolution of Medicaid coverage, and bureaucratic developments, have spawned the use of many unfamiliar terms-e.g. in addition to those already noted; SCHIP, waiver services, deeming, and EPSDT-and additional application procedures-e.g. out-stationing of eligibility workers, presumptive eligibility options, and waiting lists (known as "central registries") for long-term care waiver services. Such terms and varying application procedures contribute to a Medicaid maze that can understandably confuse applicants and others members of the public alike.

The Aging and Long Term Services Department and others are available to help you penetrate the maze. Additional information about Medicaid eligibility can be obtained from many sources, including: state Human Services Department Income Support Division offices (check your phone directory for contact information); and the New Mexico Aging and Long-Term Services Department's "resource center," which includes the Department's statewide Benefits Counseling Program (statewide toll-free, 1-800-432-2080; for Bernalillo County residents, also 265-1244). Information about SSI also is available from the federal Social Security Administration (toll-free nationwide, 1-800-772-1213).