generic medicaid

The commonwealth has launched a campaign to spread the message far and wide: An estimated 400,000 Virginians will be eligible for free health insurance under Medicaid beginning Jan. 1, and an estimated 14,000 of them live in Prince William County.

As a result of the state legislature’s action earlier this year to expand Medicaid under the federal Affordable Care Act,  the eligibility requirements for the state- and federally-funded health-care program for low-income residents have expanded, opening Medicaid coverage to many who may not have qualified before.

Under Virginia’s existing Medicaid program, even disabled adults could not qualify for Medicaid if they made more than $9,700 a year. Childless, non-disabled adults did not qualify for Medicaid at all, no matter how little they made.

Starting Jan. 1, all adults making up to $16,700 a year – whether or not they have children – will be eligible for Medicaid. In general, Medicaid is designed for the disabled; low- and no-income adults and children; and low-income elderly residents. (See table for new income limits based on family size.)

Everyone who currently does not have health insurance and thinks they might now qualify for Medicaid is encouraged to apply as soon as possible, said Holly Handy, a program manager with Prince William County’s Department of Social Services.

Handy explained the details for the expanded Medicaid program during an Oct. 10 meeting at the Prince William Chamber of Commerce.

“Up until now, we were offering limited Medicaid coverage based on income and age. But those guidelines have changed,” Handy said.

In September, every child enrolled in Virginia public schools was sent home with a flyer delivering information about this new opportunity to apply for Medicaid.

“We’re asking everyone to pass the word,” Handy said.

Medicaid is a health-insurance program that covers services such as doctor’s appointments, hospitalization, prescription medications, maternity care, newborn care, behavioral health care and more through the Commonwealth Coordinate Care Plus (CCC+) Medicaid programs.

Applying is easier and faster than ever before, Handy said.

Prince William County will have 18 newly hired and trained personnel – in full-time, permanent positions – who will work to process the county’s new enrollees, Handy said.

“Virginia is doing everything to make applying and on-boarding new Medicaid recipients a simple, straightforward process. They want to make sure they don’t have the technical problems Obamacare [the Affordable Care Act] experienced initially,” added Virginia Hospital Association’s Kelly Cannon.

More than 200,000 Virginians who are expected to be eligible for Medicaid based on their current enrollment in other programs for low-income residents – such as the Supplemental Nutrition Assistance Program, informally known as food stamps, or FAMIS, Virginia’s health-insurance program for low-income children -- will receive letters informing them of their new eligibility for Medicaid, Handy said.

Others can apply in person at any Virginia Department of Social services office or by calling Cover Virginia at 1-855-242-8282 or visiting: www.coverva.org

Anyone applying who needs assistance with their activities of daily living should answer “Yes” to question 9 on the new application. This helps to identify people with more complex healthcare needs.

Applications for Medicaid can now also be filed on the website commonly known as the “marketplace,” set up to help identify region-specific, low-cost insurance plans based on individual needs.

The Affordable Care Act “marketplace” is available at www.healthcare.gov/ and www.commonhelp.virginia.gov.

Those who qualify for Medicaid will receive a packet in the mail within six days. New enrollees must chose an HMO provider through which they will receive Medicaid-covered services. If no specific doctor is chosen, one will be assigned.

“This will lower the number of visits people make to the emergency room, when what they really need is a treating physician,” Handy said.

There is no dental or vision insurance offered with the expanded Medicaid program, “but there are other programs that might be available for the applicant. We would only know by their application,” Handy said.

Virginia lawmakers passed Medicaid expansion with a work or volunteer requirement for new, non-disabled adult enrollees and have filed for a waiver from the federal government to add the requirement, as it is not part of the federal program.

The state has not yet received its waiver, however, and therefore the work requirement will not immediately go into effect when the program is expanded Jan. 1. “Although that could change in the future” if the waiver is approved, Handy said.

As of now, there are also no co-pays for Medicaid recipients, although that could also change, especially for those earning near the income thresholds.

Undocumented immigrants are generally not eligible for Medicaid.

“We do look at citizenship status, but we do not report to any agency about that status. The applicant either qualifies for Medicaid based on the information they give us, or they don’t,” Handy said.

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