What is Medicaid?
The federal government and states jointly fund Medicaid. States administer Medicaid within federal guidelinesand set the rules that say who is eligible, what benefits are covered, and how the provider is paid. States receivefederal financial support, but also put up some state funds. South Carolina gets about $3 from the Washingtonfor every dollar we put up for Medicaid.
Medicaid in SC is called South Carolina Healthy Connections Medicaid. It provides health care coverage tolow-income individuals and families and the disabled. Medicaid does this by paying health care providers fortheir services given to eligible people.
Who does Medicaid serve?
South Carolina’s Medicaid program covers almost 1 million South Carolinians each year. To get Medicaid aperson must be either pregnant, totally and permanently disabled, under the age of 19, or a caretaker relativeliving with a child under age 18 and also have a low income. Children and adults who are neither elderly nordisabled make up more than 3/4 of people getting help from Medicaid.
Elderly and disabled individuals make up less than 1/4 of Medicaid enrollment. Services for the elderly anddisabled mostly fill the gaps left by Medicare.
Who is eligible for Medicaid?Eligibility is determined by family income. Children who live in a household under 200% of poverty ($37,060for a family of three) can get Medicaid.
Different types of Medicaid programs have different income limits for adults. For example, adults havedifferent income limits that depend on the type of program. Those in need of long term care or nursing homecan get help if they are at or below 300% of poverty.
What services are covered?
There are certain services that Medicaid must cover. States can choose to cover more services. The federal lawhas not required states to provide these additional services under Medicaid, so they are technically optional.In South Carolina, some of the services covered by Medicaid are: inpatient and outpatient hospital services,12 doctor visits a year, periodic screenings, therapy, and ambulance transportation and prescription drugs.Prescription drug benefits for adults are optional and are limited to four prescriptions a month.
Children get unlimited doctor visits and prescriptions. In addition, if a child is diagnosed with a medicalcondition, she has the right to treatment under the Medicaid EPSDT program.
What would happen if Medicaid funding were cut?
Medicaid is the foundation of our healthcare system. Currently the state is lookingat cutting $125 million from the program.
If this happens South Carolina would lose $504,000,000 in business activity, 4,881 people would lose their jobs and $181,000, 000 in salaries and wages would belost around the state.
Most importantly, services once covered by Medicaid will be reduced or eliminated.
If someone has Medicaid and they have a low income job making $17,000 per year or less and their employer offers group coverage and is only paying 50% do they have to take the group coverage?
Thanks for commenting, Maria. Would you please email SC Appleseed’s director Sue Berkowitz at sberk@scjustice.org? She will need to get some more information about your situation in order to advise you.
What do you do when you originally received Medicaid for yourself and your children because you were jobless, then found a job so you then got “Transitional Medicaid,” but now THAT period has ended, you have a job that pays barely above minimum wage, but THAT income puts you over the limit for the “Low Income Families” Medicaid? It seems the whole purpose of assistance to get people back on their feet. But once they do, you yank the medical assistance. It makes no sense to me at all!
I had to have open heart surgery 3 years ago, and cannot be without medical care! I DEFINATELY cannot afford insurance through my job…that would take half of my check each week! My oldest son , who is now in college, was terminated when he turned 19. I still have a 16 year old and a 15 year old that I’m in the process of re-applying for. But What do I DO FOR ME? I don’t have breast cancer or cervical, and I’m not disabled, mentally retarded, pregnant, or blind. But I AM a single mother of three teenagers with a serious heart condition that requires daily medication that I just can’t stop taking….which will end up happening because I cannot afford to pay for it out of my pocket. So, PLEASE!!! Any advice on what to do would be GREATLY APPRECIATED!!
Melissa,unfortunately Transitional Medicaid is only for two years. All Medicaid eligibility is based on categorical eligibility. You could still be eligible for Low Income Family Medicaid if you have children in your home still on Medicaid. Your income as a family must be 50% of the poverty level or below. That would mean you cannot make more than $813.75 a month. Your son who has aged off of the Children’s Medicaid program is not eligible any longer. If we were able to expand the Medicaid program both you and your son may have been eligible January 2014. Our elected officials have chosen not to expand Medicaid.
In October you can apply for health insurance through the Federal Marketplace. You can apply through http://www.healthcare.gov. By applying you can purchase a much less expensive plan and you will probably be eligible for tax credit subsidies to make the insurance affordable.
I wish that the state of SC was more helpful through Medicaid Expansion and assisting its citizens with getting health insurance through the Federal Market Place. Unfortunately our state has turned its back on helping people in our state get health insurance. We promise here at SC Appleseed to continue the fight for quality, affordable healthcare for all.