The Medicaid Buy-In Program

The State of New York’s expenditure on health insurance is higher than other states because of its wider range of benefits and flexible terms of eligibility on New York medical buy-in program, foremost of which is coverage of disabled people who are employed to get Medicaid eligibility, or maintain it, in spite of receiving more income or having more resources which was formerly allowed only for Medicaid card holders.Residents of the Empire State can qualify for a medicaid buy-in program if they:
· are between 16 and 64 years old;
· are full-time or part-time employees;
· have disabilities, either physical or mental, that have lasted or expected to continue for more than a year or result in deaths;
· have passed the medical criteria for eligibility set forth by the Supplemental Security Income (SSI) program; and
· receive not more than $53,028 in gross income as an individual or not more than $71,028 as a couple.Available through local Medicaid offices, Elder Law attorney may file the application, particularly for those who are looking into how they may qualify for benefits and what specific benefits they may avail of. Errors in filing the form, filling out information, and non-submission of required documents may lead to delays in or denials of benefits.In cases wherein a spouse applies for Medicaid but the other declines support, Medicaid will provide the benefits to the spouse who is sick but it can also ask contributions from the spouse who is called as “community spouse,” and entitled to some income and resources which have immunity from any claims made by Medicaid. A community spouse may have up to $109,560 in resources and $2,739 from monthly income received from employment wages.However, applicants should take note that the coverage of NY Medicaid does not include children or other members of the family because this program is exclusive and limited to disabled individuals or couples who both have disabilities. A review for disability is conducted by a Disability Review Team of the State of New York to certify that the person applying for the program is actually disabled or has not been certified as such by the Social Security Administration.An individual who doesn’t own assets which are more than $13,050 (or $19,200 for a family consisting of parents and two children) of “nonexempt resources” such as the residence of the applicant, motor vehicle or funds earmarked for burial expenses, any properties other than your existing home and your regular bank account savings is still eligible for enrollment in the medicaid buy-in program.For seniors who were already eligible before the filing of the Medicaid application, they can get reimbursement for out-of-pocket expenditures for health care for up to ninety days. Coverage for seniors start off on a pending basis upon filing the application. In effect, the home care facility or nursing home has to wait to be paid in arrears by Medicaid after the application has been approved (this usually takes several months).If you get right down to it, though, the main beneficiaries of New York’s medicaid buy-in program are disabled people who don’t receive any form of SSI because they:
· Are already recipients of Social Security Disability Insurance (SSDI);
· Had SSDI but lost their right to it since they got employed;
· Are disabled and qualified to receive SSI but never received SSI; and
· Received SSI previously but have been disqualified for having more resources allowable for SSI.The expanded coverage of NY Medicaid now allows those who are in the SSI program but lost the right to it when they got employment to maintain their eligibility for Medicaid, but under a different work-incentive program called Section 1619 (b) program.New York’s social services counselors can discuss with you the conditions regarding whether or not you are required to pay a premium, but generally, these are the following guidelines required by an application for the medicaid NY program:
· A monthly income of $1,300 or less doesn’t entail payment of a premium.
· A monthly income between $1,300 and $2,167 for an individual and for families with only one child necessitates payment of a premium, the sum of which is 3% of earned income from employment wages and 7% of unearned income that comes from sources like pension of any kind, unemployment benefits, etc.
· For an individual, the maximum total premium payable is pegged at $1,026 for a year.Pregnant women who decide to get an abortion may get Medicaid coverage with Presumptive Eligibility, which gives women coverage easily and begins the same day that the application is made. Individual enrollees who want to quit smoking can avail of Medicaid’s smoking cessation counseling (SCC) coverage, effective April 1st of 2011, of six counseling sessions in twelve continuous months.These sessions will all have to be face-to-face and may use prescription as well as non-prescription products made specifically for smoking cessation (these products are part of Medicaid’s coverage). 48% of smokers, according to the New York Adult Tobacco Survey of 2009, are enrolled with Medicaid or do not carry health insurance. According to University Health Services specialist Wendi Hamm, a nurse, counseling and medication combined could be more effective in enforcing smoking cessation than used either or alone. Medicaid’s expanded coverage of smoking cessation services can be of significant help to New Yorkers in this.”Excelsior,” the Latin word for “Ever Upward” is the state motto of New York, and rightly so, as the state maintains a lower rate of uninsured residents, and consistently at that, in comparison to the rest of the country. New York has extended efforts in streamlining renewals to encourage eligible applicants not to drop out of the program unnecessarily, as well as offering opportunities in facilitated enrollment in the medicaid NY program and spreading eligibility to provide health insurance to all individuals, couples, childless couples and families with children.Those found to be eligible for the medicaid buy-in program are entitled to retroactive eligibility for up to three months. And should you be ill or laid off from your job while in the program, you won’t lose your eligibility because of a “grace period” granted to you for as long as a six month duration period, and you are allowed to have more than one of said grace period for as long as these periods don’t come up to more than six months over a year or 12 month time period (exceeding the grace period as set will negate your eligibility for the New York medicaid buy-in program accordingly).And as if those weren’t enough, a New Yorker who has an employee’s health insurance may be reimbursed by the New York medicaid buy-in program for any amount that he or she paid in maintaining that insurance. The state wherein The Sons of Liberty were organized in the 1760s fulfills the significant role of safety net in the absence of either a state or federal solution regarding universal health insurance coverage.In October 2007, Healthcare Association of New York State (HANYS) President, Daniel Sisto, cited a HANYS report showing medicaid buy-in program cost increases were the result of enrollment increases over the recent years and not the outcome of increases in the reimbursements of providers or costs of services. And while New York Medicaid spending increased by 54% between the years 2000 and 2005, its enrollment also increased by a near 54.5% during the same duration period.New York’s medicaid buy-in program is considered to be the largest Medicaid program in the country, providing comprehensive health insurance coverage to around 4.9 million New Yorkers. Prescription drugs, nursing home long-term care, facilities that are community-based, vision healthcare, dental care and long-term care in private homes are provided for by NY Medicaid even as the program extends coverage for those largely ignored by other states in the provision of additional benefits.In a study published by The New England Journal of Medicine in July 2012, it showed the states of New York, Maine and Arizona have been expanding the range of their eligibility requisites since 2000. In 2001, New York’s eligibility level rose to 150% off the poverty level, and by all indications, Governor Andrew Cuomo will raise that level up again in 2014 with the Affordable Health Care Act.Delivery of healthcare services in this state is a key factor in the overall healthcare system of New York and its policies have long influenced the progression of that delivery system. Such a delivery is New York’s review of program applications for community-based Medicaid wherein transferred assets prior to application for benefits will not incur any penalties.
And for as long as a senior citizen is qualified in needing long-term care in either a nursing home or private residence, New York’s medicaid buy-in program will cover the payment until the patient’s demise. Quite a throwback to the New York Police Department motto, “Fidelis Ad Mortem,” (Faithful Unto Death), don’t you think?

This entry was posted in Uncategorized and tagged . Bookmark the permalink.