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Medicaid, Medicaid Waivers, Medicare, Supplemental Security Income (SSI), and Family Support Subsidy (FSS)

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Featured Resource

 

 

Covering Kids & Families - Covering Kids & Families works to reduce the number of uninsured children and adults who are eligible for public health care coverage programs but not enrolled.

 
Medicaid Information

MI Medicaid: $7 Billion Hidden in Small Type - So much commentary on government focuses on headline issues, the ones easily chewed and spun into bumper stickers and soundbites. Let us consider something else, something that those who know the newspaper industry know might be stuck in the agate columns. If one massed about 220,000 people in Michigan into one spot, it would be a pretty sizeable fondue of flesh. It would, in fact, qualify as the second largest city in the state...

 

FL Florida Medicaid Recipients Want Out of Nursing Homes - Charles Todd Lee spent a lifetime going backstage at concerts, following politicians on the campaign trail and capturing iconic shots of everyone from Martin Luther King Jr. to Mick Jagger to Mickey Mantle. Today, he enjoys such freedom only in his dreams.

 

Districts Face Medicaid Funding Cuts, Increased Compliance Requirements - What's ahead for school districts in terms of their ability to continue to access Medicaid? Schools may lose $635 million for the 2008-2009 school year. In addition, proposed rule changes will in many cases stop payments for services rendered in schools that Medicaid long has covered.

 

Proposed Medicaid Rule Would Allow Thousands To Choose Community Supports Instead of Institutional Care - A proposal by the U.S. Centers for Medicare and Medicaid Services would allow thousands of Americans, who previously could only receive Medicaid-funded services in nursing homes and other institutions, to be given the choice to receive them in their homes.
 

Medicaid Funding for Schools Cut - The new rule is expected to save the federal government $3.6 billion over 5 years but will affect a wide range of medical services such as speech, physical therapy.

 

New Medicaid Eligibility: Documentation of Citizenship Now Required - Health officials in many states warn that a federal law requiring Medicaid recipients to prove citizenship starting July 1 could lead to long lines, dropped coverage and general confusion for the program's participants. State officials are scrambling to implement the new rules, because the Department of health and Human Services told states only three weeks before the changes kick in what documents are acceptable as proof of citizenship. At least 46 million poor people on Medicaid for the first time will need to produce documents showing they were born in the United States or are here legally, the result of a budget-cutting measure signed by President Bush in February. The law targets illegal immigrants (who aren’t eligible for Medicaid), but administrators say it also will hurt American citizens.

 

Protecting Children's Health in Schools Act of 2006 (PDF) - Senator Edward Kennedy of Massachusetts has introduced a new bill in the U.S. Senate called the "Protecting Children's Health in Schools Act of 2006". This act sets forward clear guidelines in the statute for providing and receiving reimbursement for medical care in schools, rather than put schools, families, and their disabled children, and States in a situation where they are uncertain whether or not these medically-necessary services and related administrative and transportation costs will be covered under Medicaid.

 

MI Medicaid Fee Schedule Master Site
http://www.michigan.gov/mdch/0,1607,7-132-2945_5100-17165--,00.html

MI Manual and Bulletin Updates for Medicaid Program Policy: Order Form (Word Document)
http://www.michigan.gov/documents/Dch-1175(E)-Manual-Bulletin-Order_41609_7.doc

 

The Special Education & Medicaid KnowledgeBase is a project of the Region VII Comprehensive Center and Northrop Grumman Information Technology. The purpose of the Special Education & Medication KnowledgeBase is to support schools through the difficult process of claiming Medicaid dollars for eligible services by explaining in plain language the process of Medicaid claiming.

  

Medicaid Reform Information - Medicaid is the most valuable public resource for children and adults with disabilities to access health and long-term supports and services in the community. The nation's largest program serving the needs of low-income Americans with disabilities, Medicaid serves nearly 11 million people with disabilities, of whom 7 million are under age 65. With so many federal policy decisions being made related to Medicaid, AUCD has created this site to help network members and the public navigate all the information about new proposals to reform Medicaid and information about legislation and public policy changes related to Olmstead.
 

MI Michigan Medicaid Expanded To Relatives - Low-income grandparents and other relatives who live with and care for non-birth children may qualify for medical coverage under new rules from the Department of Community Health (DCH) and Department of Human Services (FIA).

 

MI Kinship Caregivers May Receive Medicaid - Low-income grandparents and other relatives living with and caring for non-birth children may be eligible to receive Medicaid benefits as the result of a federal court order in a case brought by kinship caregivers.

 

SSI Federal Benefit Calculator - click here.
 

Medicaid Fact Sheets Available: The National Association of Children's Hospitals and Related Institutions (NACHRI), together with the American Academy of Pediatrics (AAP), has produced a series of one-page, state -specific fact sheets about the issue of children and Medicaid. The fact sheets are written in simple, easy to understand language, and focus on why Medicaid is important to the health of so many of America's children. NACHRI and AAP have mailed copies of the fact sheets to every candidate for Congress or governor. All 51 fact sheets are now available on the NACHRI web site, www.childrenshospitals.net, however you must have Acrobat Reader, as they are in PDF format. NACHRI encourages you to share these fact sheets. If you have any questions about the fact sheets, please contact either Suzanne Hansen shansen@nachri.org or Sharon Ladin sladin@nachri.org at 703-684-1355.

 

MI Granholm Sees Both Good and Risk in Bush Medicaid Proposal

 

MI Michigan Medicaid Summit - Granholm is calling for broad participation by all stakeholders in shaping the future of the Medicaid program.

 

MI Medicaid '900-Lb Gorilla' State Must Wrestle With, Panel Told

 

Schools Decry New Guidance on Medicaid - A battery of district officials nationwide are alarmed by proposed Medicaid guidelines that they say could mean striking losses in aid for coordinating medical services for needy students, particularly those in special education.

 

COURT: Medicaid Rules Wrong on parent/Non-Parent Benefits
 

MI State Assesses Federal Rule on Medicaid for Emergency Services

 

MI Ruling won't force in-home Medicaid - Ingham County Circuit Judge Peter Houk has upheld a ruling saying Medicaid is not required to pay for medical services for people living in their own homes.

 

Gongwer 12-3-02 U.S. Supreme Court Allows Medicaid Suit

 

HHS Releases Spanish-Language Guide to Medicaid, CHIP Programs - HHS Secretary Tommy Thompson on July 23 released a new bilingual booklet to provide information to low-income Spanish-speaking parents whose children may qualify for CHIP or Medicaid. HHS will distribute the 13-page booklet, titled "Protect Your Family's Health ... With Confidence," to community health centers and other organizations and will work with states that "want to add information about their programs" to the booklet. The booklet includes four sections: one that explains the importance of health insurance in children's health care, one that explains the enrollment process and benefits for CHIP and Medicaid, one that provides answers to questions about eligibility requirements and other issues; and one that provides explanations of terms used in the enrollment process. Thompson said, "States have made the SCHIP program a dramatic success, and a key element of that is making sure families sign up their eligible children." He added, "The new booklet will help to expand health insurance coverage to eligible children in the Hispanic community by providing information to families about benefits available to their kids." - from Monday Morning in Washington, D.C.

 

Read the 29 page brief "Medicaid and School Billing" (pdf version)

 

MI Gongwer 9-5-02 State, Drug Companies Argue New Medicaid Drug Plan

 

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Medicaid Waivers
Children's Waiver Program

The Children's Waiver Program (CWP) is a federal entitlement program that provides Medicaid funded home and community-based services to children (under age 18) who are eligible for, and at risk of, out of home placement. Children with developmental disabilities and who have challenging behaviors and/or complex medical needs are served through this program.

 

The CWP enables children to remain in their parent's home or return to their parent's home from out-of-home placements, while receiving regular Medicaid State Plan services (i.e., case management, private duty nursing) and waiver services, regardless of their parent's income.

 

The waiver services include (see State of Michigan website for most up to date info):

  • family training

  • specialty services (e.g. music, recreation, art and message therapy)

  • community living supports

  • transportation

  • respite care

  • environmental accessibility adaptations, and

  • specialty medical equipment.

Although the program is at capacity, a waiting list is maintained, using a priority rating system to add new children to the program when openings occur. To request more information regarding eligibility or to submit a prescreen application for the program contact your local Community Mental Health Services Program.

 

Note: The CWP Manual dated 2004 is no longer valid even though it is easily found across the internet. Please only refer to the complete Medicaid Manual. Search through the subsections to find the information you need.

 

Michigan Medicaid Provider Manual: http://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidProviderManual.pdf

 

The National Association of State Medicaid Directors (NASMD) - A very informative website that contains different types of information, data, and statistics. It also contains data on children enrolled in 1915c waivers by state, age and program. Also includes information on 1915b and 1115 Waivers. This group is a bipartisan, professional, nonprofit organization of representatives of state Medicaid agencies. The primary purposes of NASMD are: to serve as a focal point of communication between the states and the federal government, and to provide an information network among the states on issues pertinent to the Medicaid program.
 

Understanding Medicaid Home and Community Services: A Primer, is an excellent resource manual available online from the U.S. Department of Health and Human Services. It can be downloaded in PDF format, but is 246 pages long and may take a long time to print it.
 

Overview of the Michigan Dept. of Community Health (MDCH) Children's Home and Community-Based Services (HCBS) Waiver Program - click here.

 

How to request a Medicaid Fair Waiver Hearing (Michigan): Instructions (PDF; size=89k) and Request Form (PDF; size=113k)

 

Medicaid Manual Chapter III (PDF; Michigan) has been updated to correct some errors and to add information regarding children's waiver.
 

Medicaid Waivers: Tips & Comments From Parents - click here.

 

MI Children's Waiver Program: The Children's Waiver Program is a federal entitlement program which enables Medicaid to fund necessary home and community-based services for children (under age 18) who are eligible for, and are at risk of, placement into an Intermediate Care Facility for the Mentally Retarded.

 

The Medicaid HCB Waiver: The Alternative to Institutionalization
 

State Freezes Waiver Slots, Litigation Filed - The Michigan Department of Community Mental Health handles the Medicaid Waivers. They have closed the waiver slots for all adults and children.  Michigan Protection and Advocacy has initiated action against the state for this.

  

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Medicare Information

Understanding Medicare & Medicaid: Fundamentals and Issues for the New Congress - This briefing book was distributed at an invitation-only seminar requested by congressional staff to provide an overview of the Medicare, Medicaid, and State Children’s Health Insurance programs. The sessions featured experts from the General Accounting Office, Medicare Payment Advisory Commission, Congressional Research Service, and Centers for Medicare and Medicaid Services, in addition to other public and private entities. This book contains links to the sessions’ presentations and handouts as well as to additional reports, Web sites, and other resources.

 

Low Income Americans on Medicare Receive Drug Discount Cards - The U.S. Health & Human Services reports that HHS Secretary Tommy G. Thompson announced on September 22 that nearly two million low-income Americans on Medicare will soon be automatically eligible for prescription discounts through the Medicare Drug Discount card and qualify for an additional $1,200 in savings over the next 14 months.

 

U.S. Doctors to see decrease in Medicare payments in 2003

 

Read the article "Bush's New Freedom Equals a 'little freedom' for Americans with Disabilities on Medicare"

 

HHS Urges States To Continue To Expand Home & Community Based Care For Disabled Residents - HHS Sec. Tommy G. Thompson yesterday urged America's governors to make continued efforts to overcome the institutional bias in Medicaid programs by providing benefits outside of nursing homes to Americans with disabilities. Secretary Thompson noted that states already have many affordable community-based options for serving people with disabilities, and he pointed to a new Web site identifying promising practices.

 

Medicare "Homebound" Rule Update

 

Medicare intends to cover use of Neuromuscular Electrical Stimulation - to Help People with Spinal Cord Injury Walk.

 

Read the article "OmniCare ills haunt health care: Debt grew under state's watch" from the Detroit News, July 14, 2002.

 

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Supplemental Security Income (SSI) Information

Social Security Disability Secrets

 

Legal Planning for Special Needs In Massachusetts: A Family Guide to SSI, Guardianship, and Estate Planning - Attorney Barbara Jackins' new book is a must have resource for parents of children with special needs and the professionals and advocates who assist parents. In an easy-to-read, conversational style, she covers the essential elements of SSI, guardianship, and estate planning when there is a child with a disability in the family. Although some of the materials are specific to Massachusetts, most of the strategies she discusses are valid in any state. Don't live in Massachusetts? Then you can simply ignore the fine points about that state's guardianship laws and procedures. The rest of the book--her practical estate planning strategies and SSI pointers-- will get you on track no matter where you live.

 

Social Security Revamps Disability Benefits - People seeking disability benefits from Social Security can expect to spend less time waiting for a decision under changes rolled out Tuesday on the anniversary of the Americans with Disabilities Act. Social Security Commissioner Jo Anne Barnhart said people who are clearly disabled could be approved for benefits in as little as 20 days under the new procedures, which the agency expects to start putting into action next spring.

 

What’s the Big Idea? - There’s more than one solution for Social Security. Here are nine ways to keep the system solvent.
 

Social Security Options Abound - As it stands now, by 2017 the system will begin paying out more in benefits than it collects in taxes. By 2041, it will have exhausted its reserves and be able to pay 74 percent of benefits, according to the program's trustees. Most options involve cutting benefits, raising taxes or a combination of both.

 
Social Security: What We Can Learn From Chile's Experiment
by Susan Q. Stranahan, AARP Bulletin, April 08, 2005
As the debate over President Bush's proposals for Social Security heats up, you can expect to hear a lot of talk about Chile-if you haven't already. Why Chile? In 1981 it became the first country to use private accounts as part of its retirement system, and since then more than a dozen nations in Latin America and Europe have followed suit. Bush has said that the United States could "take some lessons from Chile" and has called its system "a great example". The program's chief architect is Jose Pinera, a Harvard-educated economist who was Chile's minister of labor and social security from 1978 to 1980 in the government of Gen. Augusto Pinochet. He's now co-chairman of the Cato Institute's Project on Social Security Choice-an idea the free market think tank has been pushing since 1979. In Chile, workers can invest 10 to 20 percent of their pretax income in private retirement accounts, selecting stocks or bonds from half a dozen pension funds. Investments are tax free until retirement. Historically, the rate of return has exceeded 10 percent. But now, as the first wave of participants reaches retirement age, many of them are discovering that their private nest eggs are far smaller than they expected, partly because the fees and commissions paid to fund managers have typically ranged from 25 to 30 percent. Many retirees are learning they would have fared better in the government-run system, which provides pensions of $140 to $1,250 a month. Only about half of Chile's workers have private accounts. The rest stayed in the government system or have no retirement insurance at all. Consequently, Chile still spends 5 to 6 percent of its gross domestic product on retirement benefits; by comparison, Social Security costs in the United States total 4.2 percent of GDP.

 

The Other Side of the Social Security Debate: What Social Security Means to Children and Families: The National Center for Children in Poverty (NCCP) notes that over five million children benefit from Social Security, either directly as beneficiaries, as dependents of workers who have become disabled, or indirectly as family members in households where an adult relies on Social Security. Here are several documents from the NCCP on this matter: Why Social Security Matters to Children and Families: What Every Policymaker Should Know - Five page fact sheet loaded with information and statistics, with endnotes. Whose Security? What Social Security Means to Children and Families - Policy brief describes the role that Social Security plays in protecting America's children and argues that the current debate ignores how privatization and benefit cuts will impact our most vulnerable population's children.

 

Social Security Debate and Persons With Disabilities (PWD) - As the Administration begins to push to privatize Social Security, persons with disabilities have been virtually absent from the public discourse. The disability community should be asking their elected federal representatives some critical questions regarding the program.

 

Report Examines How The Federal Government Defines Disability in Different Ways - A report by the AARP examines how four national surveys conducted by the federal government in the U.S. define and measure a critical aspect of disability--whether the disability limits the person's ability to perform daily activities. Read Disability: Federal Survey Definitions, Measurements, and Estimates.

 

The long awaited Part 3 of 3 in the SSI Parent Brief Series, titled "Supplemental Security Income: Your Right to Appeal", is now available from the National Center on Secondary Education and Transition (NCSET) - click here.

 

FREE Social Security Resource: Sign up for the Social Security Administration's E-News - choose your topic of interest and receive a free monthly newsletter.

 

Parent-to-Parent Questions and Answers
(Across the state and country, parents communicate with each other sharing information and advice via the Internet. With their permission we are sharing some of those questions and answers.)

Question: My 18 year old was approved for SSI early this year. Two weeks ago he got his Medicaid card with a letter telling him that he must join a Medicaid health Plan to receive benefits. We are in Wayne County and I would like to ask for some input which plan would be a good choice. The choices are Botsford Health plan, Cape health plan, Great Lakes health plan, M-Care, Midwest, Molina healthcare of MI, The Wellness Plan and Total Health Care. I do not have any experience with any of these plans and would appreciate any input.

Answer:  I choose to stay with the Basic Plan (as opposed to the more traditional HMO you listed above) for my daughter who is 18 and happens to be CSHCS and Medicaid eligible. On the other hand I have used Wellness Plan and the Great Lakes Health Care Plan for myself and my other daughter. You may want to ask around about the plans you are considering. Try the hospital you would like to utilize for your son, the pharmacy, the doctors and specialist's office.

 

Social Security for Parents: Benefits for Disabled Children - A child who is disabled may depend on your help for the rest of their lives. Social Security has two programs that pay disability benefits to disabled children: Social Security Disability Insurance and Supplemental Security Income (SSI).

 

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Family Support Subsidy (FSS) Information

MICHIGAN Family Support Subsidy (FSS) Pamphlet & Information (PDF)
http://www.michigan.gov/documents/brochure03(english)_92625_7.pdf
If you have a child who is labeled (educationally) as AI, SXI, or SMI (see brochure for definitions) you may qualify for a subsidy of $222.11 per month. Comes in the form of a check made out to the parent/guardian each month. Taxable income MUST fall below $60,000 per year. In cases in which the child is not receiving special education services or if it is not known if the child is receiving special education services, parents may contact the director of special education at their local or intermediate school district. They can also call Early On/Project Find at 1-800-252-0052 to be connected with their local ISD, Early On Coordinator, or Project Find Coordinator. For information on Early On, visit https://www.bridges4kids.org. For information on Project Find, visit http://www.projectfindmichigan.org. Don't want to download the brochure? Here's another way to get info: CMHSPs (Michigan’s Community Mental Health Services Programs) can provide additional information on the Family Support Subsidy Program. Questions or requests for applications should be directed to your local CMHSP. If you are unable to find the name of the contact person and telephone number at your CMHSP, call the Michigan Department of Community Health Family Support Subsidy Program office in Lansing at 517-335-9480. The TTY number is 517-373-3573.

 

The Michigan Department of Community Health's section on the Family Support Subsidy can be found here: http://www.michigan.gov/mdch/0,1607,7-132-2941_4868_7145-14670--,00.html

 

Changes to the Administrative Rules for Special Education and Their Impact on the Family Support Subsidy (FSS) Program - Memo from Jim Haveman, Director of the Michigan Department of Community Health, to Tom Watkins, Superintendent of Public Instruction, July 8, 2002

 

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Children's Special Health Care Services

Children's Special Health Care Services (CSHCS) is a program within the Department of Community Health.  It is for children and some adults with special health care needs and their families.  It helps persons with chronic health problems by providing: Coverage and referral for specialty services, based on the child's health problems. Family centered services to support you in your primary role as caretaker of your child. Community-based services to help you care for your child at home and maintain normal routines. Culturally competent services which demonstrate awareness of cultural differences. Coordinated services to pull together the services of many different providers who work within different agencies.
 

Free Online Course: "What is Children's Special Health Care Services?" - This course covers the basics of Michigan's Children's Special Health Care Services (CSHCS) program. The course is designed to assure that all "relevant" professionals have sufficient knowledge to respond appropriately to potentially eligible families. It also may help families understand who may be eligible for the CSHCS program and get other information. Professionals and families who are in touch with persons with disabilities/special needs will gain straight-forward, useful information. The aim of offering this course is to boost understanding so that all who may be eligible will be referred to CSHCS. Course features: ten sections that cover a wide range of topics; links to resources for families; readily accessible and easy to use; take in one sitting or many; average completion time is 45 minutes or less. Visit http://healthcare.mivu.org, select the "Children's Special Health Care Services" course, create a FREE account and begin! It's that easy.

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NOTE: (ALL RESOURCES PRE-IDEA 2004 ARE FOR INFORMATIONAL/HISTORICAL RESEARCH PURPOSES ONLY)