Is it hard for you to find affordable Medicaid coverage? Have you been declined health insurance coverage because of a pre-existing condition? You can still apply for Medicaid to get the coverage you need.

If you qualify for Medicaid, you can get:

• Inpatient and outpatient hospital services
• Payment of physician services
• Surgical and medical dental services
• Nursing facility (NF) services for individuals aged 21 or older
• Home health care for persons that are eligible for nursing facility services
• Family planning services and supplies
• Nurse / midwife services
• Laboratory services and X-rays
• Pediatric and those services provided by a family nurse practitioner
• Federally-qualified health center services and ambulatory services that are otherwise covered under a state plan
• Rural health clinic services and other ambulatory services that are otherwise covered under a state plan

Arizona state hospital executives came up with a proposal that will restore Medicaid coverage to thousands of children. If approved, the proposal would most likely be implemented late January or early February 2012.

KidsCare

The main goal of the proposal is to allow up to 19,200 children on the Medicaid waiting list to enroll in KidsCare, a health insurance program catering to low-income families. However, this must be approved by the Centers for Medicare and Medicaid Services.

KidsCare provides health coverage to low-income families who still make “too much” to be eligible for Medicaid. They provide $10 to $70 a month per family, depending on the income. This covers doctors’ visits, prescriptions, surgery, emergency room visits, and vision and dental care.

Improving the Situation

This proposal was drafted when Arizona stopped enrollment in the children’s Medicaid program in January 2010 to cut costs. Because of the cost cutting, the number of children receiving assistance decreased from 45,820 to 14,200.

The Phoenix Children’s Hospital, the Maricopa Integrated Health System and the University of Arizona Health Network initiated this new plan and will allot $113 million in the next two years.

The money will be used to provide more Medicaid coverage to uninsured children and at the same time, get money from Washington in order to offset the non-compensated health care costs provided by hospitals.

“It isn’t a complete solution but it is an effort to try to improve our situation,” said Karen Mlawsky, CEO of the University of Arizona Medical Center in Tucson.

One of the services offered by Medicaid is the Assisted-Living Facilities program. ALF’s give Medicaid beneficiaries a safe environment that will cater to their medical needs at a reasonable cost. The facilities can be either a private home or a residential village.

These facilities offer different types of recreational activities and assistance that are required depending on age or disability. The rules in these ALF’s vary per state.

Different Services

Because many types of ALF services and sizes are available, costs vary. A small private home can cost less than $10,000 a year, while long-term care facilities with 24-hour medical services can cost more than $50,000 per year. The average cost of ALF’s in the United States is $1,800 a month.

In terms of payment, Medicaid can cover some health care services offered in assisted living facilities. However, they will not pay for the entire cost especially if it’s long-term.

Before choosing an ALF, you have to consider the needs, income and assets of the resident. These will be used as basis in determining the Medicaid eligibility of a resident.

Also, do consult with your hospital’s social worker or case manager because they can help you along the way. You might want to visit different ALF’s in your area to know which will cater to your medical needs. Make sure to get in touch with the administrator or social worker in every facility you visit and inform him or her about your medical concerns and other questions.

The Centers for Medicare and Medicaid Services (CMS) recently announced that obesity screening and behavioral counseling now be covered by Medicare.

CMS estimates that more than thirty per cent of all existing Medicare beneficiaries are categorized as obese. They are then qualified to receive benefits for obesity concerns.

Help for the Obese

With the new Medicare plan, qualified participants can receive six months of free dietary consultations and behavioral counseling. A patient who loses at least 6.6 during this time will be eligible for another six months worth of free sessions.

Living Large

Obesity is a medical condition where a person’s excess body fat accumulates to dangerous levels. Obesity can lead to a reduced life expectancy or increased health problems. The main causes of obesity are but not limited to a high food intake and low physical activity. Other factors include genetics, disorders, psychiatric illnesses or side effects of medication.

Obesity is measured using Body Mass Index (BMI), which compares weight and height. A healthy BMI is pegged between 18.5 and 25 kilograms per square meter. BMI’s between 25 and 30 are considered overweight, and 30 kg/m2 and above is categorized as obese.

Obesity contributes to the increased likelihood of many ailments, such as heart disease, diabetes, sleep apnea, osteoarthritis, and some kinds of cancer. It is the leading preventable cause of death worldwide. About one hundred thousand to four hundred thousand deaths in yearly U.S. are linked to obesity. The United States has one of, if not the, highest rates of obesity worldwide, with a statewide average of more than twenty-five per cent of all adults.

Fighting against obesity helps reduce the risk of many of the abovementioned medical conditions.

Have you been denied proper health insurance due to a pre-existing health condition? The new Pre-Existing Condition Insurance Plan, or PCIP, can help you.

What can the PCIP give me?

The PCIP can provide the following:

• Medical and doctors’ services
• Hospital care
• Prescription drugs

All insurance benefits will be available to you, including those for your pre-existing condition. Concerns about higher premiums due to your condition will be outdated, as is the worry that your income will be a factor.

However, do check if you have to pay a monthly premium, deductibles or other similar expenses. Your location, age and chosen insurance or health plan will affect the total cost.

How do I qualify?

You can qualify for the PCIP if:

• You’re a citizen of the United States of America, or have residential status
• You have a pre-existing condition
• You have been denied coverage because of your health condition
• You haven’t had health insurance coverage for the past six months or more

Each state will use its own ways of determining if you have a pre-existing health condition, and if you have been denied coverage because of it.

What is the PCIP?

The PCIP is a government program that is active in all American states and the District of Columbia. It helps children and adults who can’t get proper health insurance thanks to (or no thanks to! ) a pre-existing health condition. This program will help eligible American citizens while the country adapts to the new insurance marketplace in 2014.

Do you want to know more about the PCIP?

If you want more information on your state’s PCIP, do call the toll-free line at 1-866-717-5826. The lines will be open from 8 a.m. to 11 p.m. (Eastern time).

Looking for the right doctor involves research and thorough background checks. This may take time, but the benefits you’ll receive will make the process worth it.

Before starting your search, try to determine your main needs to help you find  the type of doctor or practitioner you must approach. Do consider asking for recommendations from other people for more insight.

Here are some things you should consider when meeting potential doctors:

He/she observes proper ethics and shares your values. A good doctor is respectable and capable of extending the same respect to you as a patient. He/she must be able to make patients feel comfortable and demonstrate excellent communication skills. For instance, a good doctor is able to explain situations or conditions clearly to a patient despite medical jargon and other technical phrases.

He/she specializes in the area targeting your medical needs. Many people commit the mistake of getting the wrong type of specialist. This is where your primary care physician can help you. He/she can help you find the specialist for you based on your current health needs.

He/she has commendable credentials. Check if your potential doctor specializes in the medical service you need and has earned credibility. You also have to find out if the doctor is licensed in your state. Knowing these things will make you feel more at ease with him/her.

His/her track record is clean. Knowing your doctor’s track record will give you an idea on how much experience he/she has had in the medical field. Do make sure that the doctor’s medical record is clean and unquestionable.

Do check if he/she honors insurance plans. This is a crucial step especially for those who hold either private or public (Medicaid/Medicare) insurance. Checkups and operations may be heavy on the budget, so having a doctor who honors insurance plans will definitely help you financially.

Find out which hospitals he/she is affiliated with. Doing this somehow places you a step ahead. If you suddenly need to be hospitalized and you have a strong preference for a certain hospital, it would help if the doctor you are considering were affiliated with that hospital. This way, you do not only get the hospital you want, you also get the doctor you need.

Senior citizens are encouraged to sign up for Medicaid to access quality health care upon retirement. Some opt for long-term and nursing home care but both can be expensive, especially for those who fall under the federal poverty line. Others are apprehensive about applying because they are worried about assets and other earnings they possess.

Do remember if you have assets and private income, you may have a hard time getting approval from Medicaid, regardless of your age or health status.

Here are tips on how you can get Medicaid without letting go of assets:

Transfer assets to your spouse.

Usually, Medicaid only allows a person to possess around $20,000 worth of assets (the limit varies for every state). Your Medicaid eligibility will depend on assets under your name. So if you want to protect your assets, you may want to transfer it to your spouse.

Transfer assets to your family.

Transfer your assets to your family within the five-year period of applying. This may seem a long time, but it’s better to start transferring assets early. Do not wait for the time you turn 70 or 75. It’s also important to do this while you’re in good shape.

If you are not able to transfer your assets within the given amount of time, Medicaid may disqualify you from membership for a certain period.

Do not fully depend on trust funds.

Do know that Medicaid considers trusts as assets. So if you have a relatively huge amount of money in your trust fund, it would be wise to transfer it to your family’s or spouse’s account/s. Transfer your assets immediately; otherwise, Medicaid might disregard your application if they find out.

Seek legal advice.

Medicaid laws vary in every state so it would help to have a lawyer assist you during the application process. Your lawyer can also help with your decisions regarding your assets and provide you with more options.

It may seem you have given up most of your assets just to get Medicaid. However, it is reassuring to have your assets and trust funds in safe hands as you secure yourself with the proper health care you need.

A new program launched by the North Carolina Medicaid aims to monitor the safety of children under prescribed antipsychotic medication. At the same time, it is projected to cut an estimated $30 million from the state’s Medicaid budget over the next five years.

The A+Kids Program, also known as the Antipsychotics-Keep It Documented For Safety, is a web-based tool that allows prescribing physicians to monitor the mental status of their patients.

The program was implemented due to the increasing number of children in need of clinical attention. According to Dr. Randall, Chief Medicinal Officer for N.C. Medicaid, the concern involving the frequent use of medications among children has spread nationwide.

Around 20,000 children residing in North Carolina benefit from these medications. However, many pediatric and mental-health professionals are questioning the possible overprescribing and the lack of follow-up monitoring from prescribing physicians.

These concerns were raised after medical reports showed increasing numbers in severe, long-lasting side effects experienced by children such as tremors, stiffness, rapid weight gain, high cholesterol levels and diabetes.

A+KIDS will make sure that physicians are well informed on the medications they distribute, its side effects and possible alternatives before writing the prescription.

Because of the program’s objectives, other states have started contacting North Carolina Medicaid, asking about the effectiveness of the A+KIDS program. This may be the key to increasing awareness and improved medical practice in more states.

With the anticipation of the results of the Medicaid reform, more families are worried about whether or not they will be able to get the financial and medical support they need by 2014.

Tony Keck, director of the South Carolina Medicaid agency has included a request for $35 million from the state in his 2012-13 proposal. This money will be used to pay for the medical needs of an estimated 70,000 children newly enrolled in the Medicaid program.

Keck believes this proposal will help South Carolina prepare for the results of the new federal health care law, which will be taking effect in 2014. Critics believe Medicaid expansion will withstand the decision made by the U.S. Supreme Court or whoever wins the 2012 elections. So this request is mainly being pursued to prepare for the “minimum expected scenario” where South Carolina will have enough money to reach out to the 70,000 uninsured children and provide them with proper Medicaid assistance.

Along with the budget proposal, Keck also proposed an “express lane eligibility” program. This will make the application faster, as more people are expected to apply for Medicaid.

Keck reported that around 89,000, up to 56,000 already-eligible adults without insurance also would sign up for Medicaid in 2014. If the state does not do anything, the increase will be felt, as Medicaid will not only have to pay for those newly eligible under the law, but also for those previously eligible.

The Medicaid program is the country’s principal health program for qualified low-income families and individuals. While the state and Federal government jointly fund it, the states manage their own Medicaid program.

As with other health insurance programs, Medicaid coverage has its own limits. This includes guidelines for dental coverage.

According to Title XIX of the Social Security Act, dental services under Medicaid are optional services for adult recipients (age 21 and older).

Most states provide some form of emergency dental services. However, the majority still do not include comprehensive dental care. If you are 21 or over, you must contact your State’s Medicaid office to check if they provide dental services.

For recipients under 21…

Medicaid’s comprehensive child health program is called the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Dental services are a required service under this benefit. Therefore, most Medicaid beneficiaries under the age of 21 will have access to dental services.

Under EPSDT, dental services must be given in intervals that meet the standard dental practice to ensure that your child receives adequate care. The state consults with recognized dental organizations experienced in children’s care so that it can come up with guidelines that meet industry requirements.

At the very least, the general dental services must include the following:

• Relief of pain and infections
• Restoration of teeth
• Maintenance of dental health

Other Notes

The oral screening isn’t a substitute for dental examinations performed by a dentist, although the oral screening may be part of a physical exam. Moreover, a direct dental referral is required for each child receiving EPSDT benefits.

The Centers for Medicare & Medicaid Services (CMS) does not specifically name the dental services that must be included in the program. But the EPSDT mandates that all services covered by Medicaid must be given to any EPSDT recipient if it is deemed a medical necessity. The state will determine medical necessity.