========== Jankower Law Firm,L.L.C. www.Jankower.com 
January 2008 Newsletter 

Medicaid & Medicare:

They May Sound the Same But They Aren't

A Detailed Description of Government Health Programs in Terms 
You Can Understand 

Although the names sound the same, Medicare and Medicaid are entirely 
dif ferent programs providing distinct benefits to eligible 
recipients. The origins of both programs can be traced to 
legislation adopted during President Johnson's administration in 1965 
as Title XVIII and Title XIX of the Social Security Act. The 
legislation extended health coverage to Americans over the age of 
65. It also provided health care services to the elderly, the blind, 
and to individuals with disabilities, among others.

First, let's talk about Medicare:

There is one Medicare program in the United States and it is entirely 
funded and administered by the federal government. Medicare is a 
hospitalization insurance type of program and provides medical 
benefits to eligible recipients in lieu of private or group health 
insurance. Benefits provided under Medicare include hospitalization 
and physician care, among other services. Medicare does not cover 
long-term care at this time beyond up to 100 days of skilled nurs ing 
care. Given the financial constraints and political climate in the 
United States, it is highly unlikely that Medicare will ever cover 
long-term care costs for its recipients.

Medicare is not a "means-tested" program, i.e., eligible participants 
generally do not have to demonstrate a lack of financial means in 
order to achieve eligibility. In order to become eligible for 
Medicare, an individual must be age 65 or older and eligible to 
receive Social Security benefits. However, if an individual is under 
the age of 65 but is eligible to receive Social Security disability 
benefits, the recipient is entitled to receive Medicare on the 25th 
month following a determination of disability.

How Many Medicaid Programs are there in the United States?
As opposed to Medicare, there are fifty (50) different Medicaid 
programs in the United States, one for each state. Medicaid is 
partially funded by the federal government and is subject to federal 
guidelines, but it is 100% administered by the states. In other 
words, each state has its own "version" of Medicaid and offers 
different programs and services to its constituents. For individuals 
receiving Medicaid through a state waiver program, this is critical 
because if they establish residency in another state, they can lose 
their waiver slot and Medicaid eligibility until they are able to re-
establish eligibility in the state in which th ey now reside.

Medicaid was created as a joint system of the Federal government and 
the various state governments to assist in furnishing health care and 
medical assistance to eligible needy individuals. Currently, 
Medicaid serves as the primary source of funding for medical and 
health-related services for the poor in America.

Medicaid is a means-tested health care program. Persons qualifying 
for Supplemental Security Income (SSI) are entitled to receive a 
Medicaid card by virtue of eligibility for SSI. Medically qualified 
applicants are permitted to have only limited "countable resources" 
and "countable income" in order to maintain eligibility.

The income and resource limitations under Medicaid are only a part of 
the requirements for eligibility. Potential recipients must fall 
within one of the classifications of individuals designated 
as "categorically needy", such as the aged, blind, and disabled, or 
the "medically needy". States are also given the opportunity to 
create "waiver" programs to provide managed care and services to 
certain groups with more liberal eligibility criteria.

Medicaid provides a broad range of health related services to 
eligible recipients, including, but not limited to:

· Inpatient and outpatient hospital services.
· Prenatal care and vaccines for children.
· Physician services.
· Nursing facility services for persons aged 21 or older.
· Home health care for persons eligible for skilled-nursing 
services.
· Laboratory and x-ray services. 
· Pediatric and family nurse practitioner services.
· Early and periodic screening, diagnostic, and treatment 
(EPSDT) services for children under age 21.

Medicaid Planning is Critical to Families with Special Needs Members

Families with special needs members face many unique problems in 
providing for their disabled loved ones. Among the most difficult of 
these problems involves finding affordable health coverage.

Health insurance for persons with special needs, where available to 
them at all, can be extremely costly. Many disabled persons have no 
health coverage and are otherwise uninsurable. Furthermore, disabled 
individuals face a much greater prospect of needing long-term care 
than do most other citizens. Unfortunately, families with disabled 
members face many expenses that may not be covered by governmental 
programs. As a result, governmental programs such as Medicaid are a 
lifeline for these individuals and continued eligibility for Medicaid 
is critical.

Finding a reasonable way to become eligible for Medicaid is another 
question. Medicaid rules and guidelines place strict income and 
asset limitations on eligibility. These rules can cause individuals 
to suddenly become ineligible if proper steps are not taken to plan 
for unexpected contingencies.

Individuals vulnerable to the possibility of disqualification from 
public programs include families with disabled children, families 
with elderly disabled members facing long-term care problems, and 
victims of personal injury claims. It is extremely important for 
these individuals that care is taken to properly plan their estates 
and/or handle personal injury settlements. 

The issues involving Medic are and Medicaid eligibility and planning 
are extremely complex and there are numerous pitfalls if such 
planning is not done in a careful and prudent manner. You should 
only consider such planning after consulting with an attorney 
experienced and qualified in Medicaid planning.