 | | | | |  | |  | | | | | | Medicaid | | 2009
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- What is Medicaid?
- Who can get Medicaid?
- How does Medicaid work?
- What services are covered on Medicaid?
- Do I have to be a U.S. Citizen to get Medicaid?
- Does it matter how long I have lived in Montana?
- What are resources? What resources are counted for Medicaid?
- Are there any resource limits for Medicaid?
- How is Medicaid different for pregnant women?
- Do I have to cooperate with the child support office to get Medicaid?
- How do I get an application?
- What is the application like?
- Do I have to go in person to apply?
- What do I have to do to stay on the program?
- How often do I need to renew coverage for Medicaid?
- What is a premium?
- Are there premiums?
- What is a co-pay?
- Are there co-payments (co-pays)?
2. Who can get Medicaid?
Children (18 or younger), families with dependent children, pregnant women, women diagnosed with breast or cervical cancer or pre-cancer, the aged (65 or older), and people who are blind or disabled (based on Social Security criteria) can all get Medicaid. (But adults who do not have children living in their household cannot get Medicaid unless they are aged, blind or disabled.) You have to live in Montana. You also have to be a U.S. Citizen or a legal immigrant (with an acceptable immigration status) to get Medicaid. Most people also have to have income and assets below the limits to get Medicaid.
NOTE: The rest of this document is written for children (up to age 18), parents (or caretaker relatives [adults who are related within the fifth degree of kinship such as a grandparent]), with children under age 19 living with them, and pregnant women who want to get help from Medicaid. It does not talk about how Medicaid works for other people, such as those who are aged, blind or disabled. |
3. How does Medicaid work?
Medicaid in Montana is broken into two coverage types: basic and full coverage. Individuals who are aged, blind, disabled, pregnant and under age 21 receive full Medicaid coverage; everyone else receives basic coverage. Medicaid looks at every family member individually to see who can get help. Some people in your family may be able to get Medicaid, but others may not. Once you have been accepted for Medicaid, you will receive a Montana Access to Health card with your name, member number, and date of birth on it in the mail. You will need to bring this card with you whenever you go to the doctor, pharmacy, or get any health service. You may also have to sign up for Passport to Health, a managed care plan for Montanans with Medicaid. Passport helps people get good health care because each person has a Passport provider that manages his or her health care. You will choose a primary care provider (PCP)--this can be a doctor, nurse practitioner, physician assistant, or medical clinic--to be your Passport provider. You will see your PCP for most services and get your PCP's okay before seeing another provider or going to the hospital for non-emergency services. If you do not have Passport you can get health care from any provider who is a Medicaid provider. Be sure to ask if the provider is a Medicaid provider before you make an appointment. |
4. What services are covered on Medicaid?
Medicaid pays for most health care services, but not everything. All Medicaid services must be medically necessary. These things are covered: doctor and clinic visits, family planning, immunizations, prenatal care and delivery, inpatient (hospital) and outpatient surgery, most prescription drugs, eye exams and eyeglasses (with some limits), dental work and exams (exams are only for full coverage Medicaid recipients), child and teen check-ups, podiatry (foot) services, chiropractic care (for children only or individuals with QMB co-insurance), medical equipment and supplies, rehabilitative therapies (PT, OT and speech), lab and x-ray services, alcohol and drug treatment (residential and outpatient), and mental health services. Dental care for adults is limited based on the type of coverage (basic versus full). Basic Medicaid covers dental services if the service is essential for employment or in emergency situations. |
5. Do I have to be a U.S. Citizen to get Medicaid?
No. Legal immigrants with an acceptable immigration status can also get Medicaid. Proof of alien status and identity must be provided to be eligible for Montana Medicaid. Undocumented immigrants cannot get Medicaid, unless they are pregnant (however, pregnant aliens only receive emergency alien coverage, and this only covers the delivery of the baby).
- A new federal law requires some MA applicants and enrollees to prove that they are U.S. citizens and give proof of their identity when they apply for or renew their coverage. This includes U.S. nationals from American Samoa and Swains Island.
- You do not have to show proof if you are getting Medicare benefits or getting or have previously received Supplemental Security Income (SSI).
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6. Does it matter how long I have lived in Montana?
No. But you must be a Montana resident and plan to stay in Montana to get Medicaid. |
7. What are resources? What resources are counted for Medicaid?
Resources are monies or other things of value that you or your family own. Medicaid will count up some of your resources to see if you are over the limit. You do not have to count the home you live in and may exclude one vehicle with the highest equity value and all income-producing vehicles as resources. The equity values of any other vehicles are counted. Personal items such as clothes, furniture, jewelry and appliances are not counted. Some examples of resources that are counted are cash, money in a checking or savings account at a bank, recreational vehicles like 4-wheelers, property that you do not live on, and stocks and bonds, trusts and annuities.
Note: Certain Montana Medicaid programs do not have resource limits (Family-Extended, Family-Transitional, Pregnancy-Extended, and Breast and Cervical Cancer Treatment).
Depending on the type of Medicaid you are eligible for, resource limits are set at either $3,000 for families or $15,000 for children (regardless of household size) depending on the program. For aged, blind or disabled households, the limits are $2,000 for an individual and $3,000 for a couple.
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8. Are there any resource limits for Medicaid?
Yes. Depending on the type of Medicaid you are eligible for, resource limits are set at either $3,000 for families or $15,000 for children (regardless of household size) depending on the program. For aged, blind or disabled households, the limits are $2,000 for an individual and $3,000 for a couple. |
9. How is Medicaid different for pregnant women?
There are four different Medicaid programs for pregnant women in Montana: Medicaid for Pregnant Women(Pregnancy), Medicaid for Qualified Pregnant Women, Medicaid Pregnant Women-Extended (Pregnancy-Extended), and Pregnancy-Continued. Of the four, Medicaid for Pregnancy, Pregnancy-Continued and Qualified Pregnant Women have income and resource limits; Pregnancy-Extended does not. However, a woman can only get into the program Pregnancy-Extended if she was first receiving Pregnancy program coverage. |
10. Do I have to cooperate with the child support office to get Medicaid?
For some programs, yes. If you do not cooperate, you will not be able to get Medicaid. But your children can get Medicaid even if you do not cooperate with the child support office. However, if you have a good reason for not wanting to cooperate (for example, if you fear physical or emotional harm to you or your child), you may not have to cooperate. If this applies to you, you have to tell your worker that you want to claim “good cause.” You will have to fill out a form to explain your situation. |
11. How do I get an application?
You can get an application at your county Office of Public Assistance (OPA). You can access your local OPA number and address by calling the Montana Citizens' Advocate office at 1-800-332-2272. You may also get applications by clicking here and visiting this website. |
12. What is the application like?
The application is 17 pages long, plus directions. It is available in English and Spanish. The application will ask you about everyone who lives with you, how much money they make and what they own (resources). You will also have to provide copies of “documents of proof” that show your income (such as pay stubs or tax returns) and assets. You can fill it out yourself or you can get help filling it out from a county worker or other groups. You can use the Quick Program Lookup on this website to find places that help in your county. |
13. Do I have to go in person to apply?
No. You can apply for Medicaid by sending your application and documents of proof in the mail to your county Office of Public Assistance and have your Medicaid interview conducted by telephone. You can also take them to your county Office of Public Assistance to turn them in. |
14. What do I have to do to stay on the program?
You have to tell your Medicaid worker any changes in your household within 10 days of them happening. Things you must report include births, deaths, moving, obtaining or losing insurance coverage, income or job changes, and people moving in or out of your household. You also have to renew your coverage by mail. This means telling your worker updated information about you and your family to make sure that you can still get Medicaid. |
15. How often do I need to renew coverage for Medicaid?
Every twelve months, you will have to renew your coverage. You will get a “Redetermination Form” in the mail that asks you questions. Fill it out and mail it back right away so that you can keep getting your Medicaid. If you move, be sure to let a Medicaid worker know your new address so that you will get this letter. |
16. What is a premium?
It is the amount of money you must pay every month to get some health insurance programs. |
17. Are there premiums?
Yes and no. You do not need to pay money every month to get Medicaid. Some people with Medicaid pay a "cost share" to the provider when they get medical care, if they are:
- 21 years old or older
- not living in a nursing home
- not pregnant
Cost share is paid at the time a service is received, unless your provider lets you pay later.
Cost share amounts:
- $1 to $5 for each prescription, but not more than $25 added together in a month
- $1 to $9 for each visit to a provider
- $100 for each overnight hospital stay
Be sure to get a receipt for all cost shares you pay. There is no cap on how much cost share each person pays. |
18. What is a co-pay?
It is a small amount of the total bill that you have to pay when you get some services (get a prescription, get eyeglasses, etc.). |
19. Are there co-payments (co-pays)?
Some people have to pay a "cost share" to the provider when they receive medical care if they are:
- 21 years old or older
- not living in a nursing home
- not pregnant
Cost share amount vary from:
- $1 to $5 for each prescription, but not to total more than $25 added together in one month
- $1 to $9 for each visit to a provider
- $100 for each overnight hospital stay
Some Medicaid services do not have a cost share. |
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