Navigating Medicaid can be quite challenging. There are various programs, each with its own rules and benefits. This can lead to confusion. These rules frequently change, making it hard to stay updated on what options are available.
The application process can also be difficult. You might need to provide a lot of documentation and detailed information. A case manager can give you a lot of support during this process. They can help you understand your options and offer guidance. Most importantly, they can help make sure you can access the benefits you need.
Here are answers to some common questions to help you understand how to access Medicaid programs that you need.
What is Medicaid, and how does it help?
Medicaid is a joint federal and state healthcare coverage program. It helps low-income individuals and families, as well as individuals with disabilities access a wide range of services, including:
- Traditional Medicaid, which covers doctor visits, hospital care, medications, long-term care;
- Medicaid programs: State run programs that fund health and long-term care services for specific populations who meet income requirements; and,
- Medicaid waivers programs: States are granted federal permission to “waive” (ignore) the normal Medicaid rules to help a specific group of people.
To learn more about eligibility and to apply, click HERE.
Can I be in multiple Medicaid programs?
- Yes! You can be enrolled in more than one Medicaid program at the same time.
- This means you can get services to support your different needs from different programs. Let’s look at some examples:
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- Medicaid State Plan/Managed Care Organization (MCO) and a Medicaid waiver program:
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- You might be enrolled in your state’s Medicaid plan, which covers basic healthcare services including an MCO; and, at the same time,
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- You could also participate in a Medicaid waiver program, which provides you with access to home and community-based care.
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- Examples of Medicaid waivers programs include the Autism Waiver, Home and Community-Based Options Waiver, and Community Pathways Waiver.
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- Rare and Expensive Case Management (REM) Program and a Medicaid Waiver Program:
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- REM is a Maryland Medicaid program for people with certain complex medical conditions who need specialized care coordination and access to medically necessary services.
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- Since the REM Program is part of HealthChoice (Medicaid’s Managed Care Program), you may receive your traditional Medicaid state plan services through the REM Program.
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- If you are enrolled in the REM program, you can also choose to participate in a Medicaid waiver, except for Model Waiver.
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DID YOU KNOW? The Coordinating Center recently developed a tool to help you understand which programs you may qualify for. To explore your options, click HERE.
What is a Medicaid waiver?
Medicaid waivers have different eligibility requirements than Medicaid programs. Waivers offer additional services that are not typically covered by traditional Medicaid. These include things such as personal care or special equipment.
You can only be on one Medicaid waiver at a time.
The State of Maryland has multiple waivers:
- Brain Injury Waiver: This waiver provides community-based services for adults who are living with brain injuries and need a high level of care. These services can include:
- Day programs
- Supported employment services
- Housing support
- Home and Community-Based Options Waiver: The Home and Community-Based Options Waiver provides community services and support that helps older adults and people with physical disabilities to live in their own homes.
- Community Pathways Waiver: This waiver provides services and support to people of all ages in in the community who meet the criteria for a developmental disability.
- Medical Day Care Services Waiver: This is a waiver for people who need a nursing facility level of care. The waiver allows you to get Medical Day Care services within your community. These services can include:
- Activity programs
- Meals and nutrition services
- Medication monitoring
- Skilled nursing and nursing assessments
- Social work services, therapy, and more
- Model Waiver for Fragile Children: Model Waiver provides home care services to children who are 21 or younger at the time of application. It helps kids who would not qualify for community Medicaid, and who would otherwise be hospitalized in an acute or long-term care setting. Most Model Waiver participants need skilled nursing care and depend on life-sustaining technology.
- Autism Waiver: This waiver helps children and caregivers of children with Autism Spectrum Disorder thrive in their homes and communities.
Click HERE to access Fact Sheets for each Medicaid Waiver available in the State of Maryland.
Interested in learning more about accessing multiple Medicaid services? Learn more in our Community Enrichment series! These webinars provide information to help you achieve your goals for a meaningful life. Click here to discover our upcoming sessions.
