Q: I understand the need for a higher Cost–of–Living Adjustment (COLA), but I’m wondering how it will affect people who get both Medicare and Medicaid. I live in Florida where Medicaid income eligibility requirements were recently lowered. Because my income was “too high” to be eligible for the new requirements, I was kicked into the “Medically Needy Program.” I lost my eligibility to Medicaid covered dental, visual, and hearing benefits. If a way can be found to help seniors with higher COLAs and still help them keep their eligibility for Medicaid that would be positive. — C.P. Orange Park, FL
A: Medicaid is the federal and state government program that pays medical expenses for lower-income persons. It’s an extraordinarily complex program and unfortunately there’s no simple answer to your question. A COLA that is more fair is likely to provide you with a somewhat higher income, but whether it would make you ineligible for Medicaid can only be determined by your state.
Medicaid’s flexibility has resulted in wide differences among states in income eligibility rules. What one state allows you to have in income may be different than others. Further complicating things are federal rules. Although states are allowed to add an optional category of seniors, defined as “Medically Needy,” the federal government has set income limitations that may make you ineligible for some of those benefits.
In addition, state Medicaid programs are changing rapidly, sometimes annually. In recent years most states have repeatedly squeezed programs to control spiraling costs by scaling back eligibility, cutting benefits, and increasing copayments. This is likely to continue as more persons come onto Medicaid rolls and health care costs continue to grow many times faster than state revenues.
Finally, Medicaid is under pressure to be overhauled from a “means-tested entitlement” to a “capped-cost” program. Currently, states can enroll anyone that qualifies for Medicaid if their income and assets are low enough (as set by your state) and they meet all other eligibility criteria. There are no limits to the number of persons a state may enroll. The federal government pays about 60% of all Medicaid costs and, according to the Congressional Budget Office, those outlays grew by more than 13% in 2002 and 9% in 2003. The Bush Administration, however, is pushing to cap what the federal government pays. That could mean more cuts in benefits to Medicaid recipients. State governors and Congress rejected the Bush plan in 2003, but it’s likely to be considered again in the near future.
One way you can ensure better Medicaid coverage in your state is to contact your local state representative, state Senators and governor as well as your federal Members of Congress. Tell them how high health care costs are affecting you and the continued need to provide more affordable health care. We also encourage you to make sure you are properly registered to vote and that you learn where your candidates stand on affordable health care.
April 2004
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