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Medicaid

Medicaid is a joint federal and state program that provides health insurance and long-term care to low-income children, parents, elders, and people with disabilities. While Congress and the Centers for Medicare and Medicaid Services (CMS) set out the main rules that govern Medicaid, each state runs its own program. As a result, the eligibility rules differ significantly from state to state, although all states must follow the same basic framework.

Elders with extremely limited income and assets often qualify for both Medicare and Medicaid, and they are referred to as "dual eligible." Most of their health care and long-term care costs are covered.

Medicaid eligibility is extremely complicated. The types of programs, income limits, and definitions vary by state, and they are adjusted annually. State programs are also called by different names, such as "Medical Assistance," "Medi-Cal," or "MassHealth." It is important to understand the impact of the Medicaid rules in your state on your personal situation.

Many states offer Medicaid managed care programs. Under managed care, Medicaid recipients are enrolled in a private health plan based on a fixed monthly premium paid by the state. Today, all but a few states use managed care to provide coverage for a significant proportion of poor children and parents, while the aged and disabled eligibility groups more often remain in traditional "fee for service" Medicaid. PACE (Program of All-inclusive Care for the Elderly) is a managed care model program that enables frail elders to remain independent in the community and in their own homes. It may be available in your area.

To learn more about an elder's eligibility for Medicaid, visit the Web site of the National Association of State Medicaid Directors, which offers links to each state agency or call 800-Medicare (800-633-4227) toll free and ask for Medicaid counseling for your area. The Eldercare Locator can also connect you with Medicaid counseling. Visit the Web site or call 800-677-1116 toll free.

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