Eligibility Insights: Accessing Multiple Medicaid Programs

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By: Renee Dain, Sr. VP, Communications and External Affairs 

Navigating Medicaid can be quite challenging due to its complexity. There are various programs, each with unique eligibility criteria and benefits, which can lead to confusion. Additionally, policies and regulations frequently change, making it difficult to stay updated on what options are available and what you qualify for. The application process can also be lengthy and complicated, often requiring extensive documentation and detailed information. This is where a case manager can be invaluable; they can guide you through the process, help you understand your options, and ensure you have the necessary support to access the benefits you need. 

 Here are some common questions answered to help you understand how to access these essential programs. 

1. What is Medicaid, and how does it help?

  • Medicaid is a joint federal and state program that provides healthcare coverage to low-income individuals and families. It covers a wide range of services, including doctor visits, hospital stays, long-term care, and preventive care. 
  • To learn more about eligibility and to apply, click HERE.  

 2. Can I be on multiple Medicaid programs? 

  • Yes! You can be enrolled in more than one Medicaid program at the same time.
  • This means you can receive benefits from various programs that may cater to different needs. 
  • For example:
    • Medicaid State Plan/Managed Care Organization (MCO) and a Waiver Program: You might be enrolled in your state’s Medicaid plan, which covers basic healthcare services, while also participating in a Home and Community-Based Services (HCBS) waiver that provides additional support like personal care assistance and respite services. 
    • Rare and Expensive Case Management (REM) and a Waiver Program: Since REM is part of HealthChoice, which is Medicaid’s Managed Care Program, you may receive your state plan services in REM and participate in a HCBS Waiver, except Model Waiver.
    • Dual Eligibility: If you qualify for both Medicaid and Medicare, you can access benefits from both programs. Medicare may cover hospital and medical services, while Medicaid can help with costs like co-payments, deductibles, and long-term care. 

3. What about Medicaid Waivers?

  • You can only be on one Medicaid Waiver at a time. 
  • Waivers offer additional services that are not typically covered by standard Medicaid, such as personal care or special equipment. 
  • The State of Maryland has multiple waivers: 
    • Waiver for Individuals with Brain Injury: The program, administered by Behavioral Health Administration (BHA), provides opportunities for community-based services to individuals who have experienced a traumatic brain injury after the age of 17. Brain Injury Waiver Fact Sheet. 
    • Community Options Waiver: Maryland’s Home and Community-Based Options Waiver provides community services and supports to enable older adults and people with physical disabilities to live in their own homes. 
    • Community Pathways: The Community Pathways waiver, administered by the Developmental Disabilities Administration (DDA), provides services and supports to individuals, of any age, living in the community, who meet the criteria for a developmental disability. 
    • Community Supports Waiver:  The Community Supports program, administered by the Developmental Disabilities Administration (DDA), will provide individual and family supports for people with developmental disabilities on the DDA Waiting List. 
    • Family Supports Waiver: The Family Supports program, administered by the Developmental Disabilities Administration (DDA), will provide individual and family supports for children birth to 21 with developmental disabilities on the DDA Waiting List. 
    • Medical Day Care Waiver: Medical Day Care is a structured group program that provides health, social, and related support services to functionally disabled adults, age 16 and older. Medical Day Care Waiver Fact Sheet. 
    • Model Waiver for Children with Disabilities: This waiver targets medically fragile individuals including technology dependent individuals who, before the age of 22, would otherwise be hospitalized and are certified as needing hospital or nursing home level of care.
    • Waiver for Children with Autism Spectrum Disorder: Administered by Maryland State Department of Education (MSDE). Autism Waiver Fact Sheet. 

Conclusion 

Understanding how to access and utilize Medicaid programs is crucial for individuals with disabilities and their caregivers. For more in-depth information and support, join our upcoming Community Enrichment Series Webinar on Tuesday, November 19th at Noon – 1:00 p.m., where we’ll dive deeper into Eligibility Insights: Accessing Multiple Medicaid Programs. Sharyn King, BSN, RN, CCM, Senior Vice President, Population Health will provide an overview where you can learn the differences in the various Medicaid programs, understand when you can and cannot be in more than one Medicaid program, and gain insight into the possible advantages and disadvantages of being a participant in more than one Medicaid program. Click HERE to register for the November Webinar.