Medicaid, Medicare Savings Programs, and Institutional Care

MEDICAID MEDICARE SAVINGS PROGRAMS, INSTITUTIONAL CARE AND WAIVERS, AND AFFORDABLE CARE MEDICAID PROGRAMS

MEDICARE SAVINGS PROGRAMS (MSP) You may be able to get help paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance and copayments if you meet certain conditions. There are 3 Medicare Savings Programs Qualified Medicare Beneficiary (QMB) Specified Low-Income Medicare Beneficiary (SLIMB) Qualified Individual (QI-1)

INCOME AND RESOURCE STANDARDS FOR MSP Federal Poverty Levels

INSTITUTIONAL CARE, PACE AND WAIVER MEDICAID SPECIALIZED MEDICAID

An applicant who is institutionalized in the following types of facilities may apply for IC Medicaid Hospital Intermediate Care Facilities for People with Intellectual disability (ICF/ID) Nursing Facility (NF) Inpatient Psychiatric Services for Individuals Under Age 21 Services for individuals age 65 or older in an institution for mental diseases Nursing and related services INSTITUTIONAL CARE MEDICAID (IC) Institutional Care Services cover, but are not limited to: Specialized rehabilitative services (treatment and services required by residents with mental illness or intellectual disability, not provided or arranged for by the state) Medically-related social services Pharmaceutical services (with assurance of accurate acquiring, receiving, dispensing, and administering of drugs and biologicals) Dietary services individualized to the needs of each resident Professionally directed program of activities to meet the interests and needs for the well-being of each resident Emergency dental services (and routine dental services to the extent covered under the state plan) Room and bed maintenance services Routine personal hygiene items and services

INSTITUTIONAL CARE PROGRAM REQUIREMENTS There are income and resource standards for IC Medicaid 2019 Income Standard: $2,313 if stay is 30 days or longer $771 if stay is less than 30 days (Federal Benefit Rate) 2019 Resource Standard: $2,000 Dollars Resources include, but are not limited to, vehicles, bank accounts, life insurance, property, mineral rights/royalties, burial contracts, CDs, etc. If an applicant is married, it is possible to protect a portion of income and resources for the spouse in the community.

PACE (PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY) InnovAge PACE is an alternative to nursing facilities. It provides customized healthcare and social engagement to older adults to help them stay independent. PACE allows seniors to age in place, meaning to grow older in their own homes and communities. InnovAge PACE helps you do just that! Care is coordinated at an InnovAge PACE center. Coordinated healthcare services include: Clinical exercise Physical, occupational and speech therapy Emergency care Respite care End-of-life care Social engagement In-home assistance Specialty care Medication management Transportation Nutrition Preventive and primary care is provided at the PACE center. Also included is hospitalization and post-hospital care. For those who are enrolled, PACE becomes the sole source of services for Medicare and Medicaid eligible enrollees. Individuals can withdraw from the program at any time.

PACE ELIGIBILITY To be eligible for PACE, individuals must meet the following conditions: Be age 55 or older Live in the service area of a PACE organization Valencia, Sandoval and Bernalillo County Be eligible for nursing home care Able to live safely in the community Contact Innovage at 505-924-2650 and follow the intake process. Once accepted into the PACE program, an application can be submitted with income and resource verifications. Once financial eligibility is determined, PACE will be contacted for an enrollment start date. Eligibility will not begin until an enrollment start date has been given to the department.

Home and community-based services waivers (HCBS Waivers) meet the needs of people who prefer to get long-term care services and support in their home or community, rather than in an institutional setting. A variety of unlimited services are offered under an HCBS Waiver program.Programs can provide a combination of standard medical services and non-medical services.Standard services include, but are not limited to: Case management (i.e. supports and service coordination) Homemaker Home health aide Personal care Adult day health services Habilitation (both day and residential) Respite care HOME AND COMMUNITY BASED SERVICES WAIVER MEDICAID

There are income and resource standards for Waiver Medicaid: 2019 Income Standard: $2,313 Dollars 2019 Resource Standard: $2,000 Dollars Resources include, but are not limited to, vehicles, bank accounts, life insurance, property, mineral rights/royalties, burial contracts, CDs, etc. WAIVER MEDICAID PROGRAM REQUIREMENTS If an applicant is married, it is possible to protect resources for the spouse in the community.

For the DISABLED & ELDERLY Waiver, please contact the Aging & Long Term Services Department at 1-800-432-2080 or 505-476-4846 IF YOU ARE INTERESTED IN WAIVER SERVICES, YOU MUST FIRST BE ALLOCATED. For the DEVELOPMENTAL DISABILITIES program, please contact the Department of Health: TO BEGIN THE ALLOCATION PROCESS YOU MUST CALL THE APPROPRIATE AGENCY TO BE PLACED ON A REGISTRY. NW Region (Gallup) 866-862-0448 NE Region (Taos) 866-315-7123 Metro Region (Albuquerque) 800-283-5548 ONCE FUNDING BECOMES AVAILABLE, THE APPLICANT WILL BE SENT AN ALLOCATION LETTER. THIS ALLOCATION LETTER IS NEEDED TO BE ELIGIBLE FOR WAIVER MEDICAID. SW Region (Las Cruces) 866-742-5226 SE Region (Roswell) 866-895-9138 For the MEDICALLY FRAGILE program, please contact the Medically Fragile Central office at 1-800-283-8415 or 505-841- 2913

AFFORDABLE CARE MEDICAID PROGRAMS Medicaid and the Children's Health Insurance Program (CHIP) offer low-cost or free health insurance including, but not limited to: Children and teens up to age 19 Parents and other adults Pregnant women People with disabilities U.S. citizens and certain lawfully present immigrants may be eligible Eligibility depends on income and the number of people in the household. Benefits may include, but are not limited to: Doctor visits Hospital stays Preventive care, such as immunizations, mammograms and colonoscopy Prenatal and maternity care Mental health care Needed medications Children get vision and dental care

MEDICAID FOR ADULTS

MEDICAID FOR CHILDREN

WORKING DISABLED INDIVIDUAL (WDI) Federal Poverty Levels

EMERGENCY MEDICAL SERVICES FOR ALIENS (EMSA) Certain non-citizens who are undocumented or who do not meet the qualifying immigration criteria but meet all eligibility criteria for other MAGI programs can receive coverage for emergency services hearing aids; The following are not covered as EMSA emergency services: outpatient prescriptions podiatry services The service must meet the EMSA definition of emergency medical services which includes labor and delivery, inductions, and cesarean sections, as well as other medical conditions manifesting with acute symptoms of sufficient severity such that the absence of immediate emergency medical attention could reasonably be expected to result in one of the following: long-term care prenatal and postpartum care organ transplants rehabilitation services well child care elective surgical procedures routine dental care the individual s death routine dialysis services placement of the individual s health in serious jeopardy psychiatric or psychological services non-emergency transportation serious impairment of bodily functions durable medical equipment or supplies serious dysfunction of any bodily organ or part preventive care

HOW TO APPLY Complete an application your local office or utilize kiosk Apply through www.yes.state.nm.us Fax in an application to 855-804-8960 Mail an application to PO Box 830 Bernalillo, NM 87004 Case worker/social worker may help file/complete an application at a hospital or homeless shelter

FOR QUESTIONS, PLEASE STOP BY THE ISD TABLE IN BALLROOM/SALON SPACE C