Beneficiaries may encounter many new phrases when navigating Medicaid, and “managed care” may seem confusing at first. However, the underlying concepts are quite simple – and it may only take a few minutes to become confident about how managed care works. Simply put, managed care refers to the manner in which your loved one receives healthcare services. The government refers to this as a “health care delivery system” that involves budgeting, quality control, and other organizational steps. The type of managed care depends on your home state, and it may be difficult to create a targeted strategy without help from an experienced elder law attorney.
What Exactly is Managed Care, Anyway?
Managed care is the method by which states provide eligible people with Medicaid benefits. The process involves contracting a private insurance company to provide health care services, and the company receives a certain amount of money each month in return.
Although this might seem pretty simple, the Commonwealth Fund notes that managed care can be “extraordinarily complicated” in many areas of the country. Managed care is now the most common way in which beneficiaries receive healthcare benefits. In 1990, only 10% of eligible recipients enrolled in managed care – but now that number has risen to well over 50%.
Managed Care vs. Fee-for-Service
Fee-for-Service (FFS) is the alternative to managed care. Under FFS, the state compensates the healthcare provider for each service you receive. Many beneficiaries are not aware that there are two different systems when it comes to Medicaid. The differences between these systems are somewhat controversial, with many arguing that one is superior to the other. For example, some point out that under FFS, beneficiaries can choose their own specialists. On the other hand, they could be charged for visiting the ER if it was not a true emergency. While the pros and cons of FFS and managed care represent a completely different topic, beneficiaries should know that they at least know that they may have a choice.
Understand the Costs Involved
It may help to sit down and discuss the various costs involved with managed care. Typically, managed care plans are cheaper compared to FFS – especially if you choose a Health Maintenance Organization (HMO). These organizations help limit costs while ensuring high-quality care – a difficult balancing act that does not always turn out well.
In the end, each beneficiary has unique priorities and needs when it comes to healthcare – and it will be difficult to navigate managed care effectively without a solid understanding of your own needs. Remember, part of this planning process involves treatment that you may need at some point in the future.
It may be helpful to discuss these potential future needs alongside your doctors. Pay close attention to genetic conditions that your family members may have. Consider your current health limitations and how they might degrade or improve in the future. After this discussion, you can take what you’ve learned to your elder law attorney. Your lawyer can then help you determine the most appropriate path forward.
Understand the Focus on Preventative Care
If you choose managed care, you should understand that this system focuses considerably on preventative care. This is part of the cost-limiting strategy, but it can also help you avoid preventable health concerns. It might seem like this is simply to lower costs for the insurance companies, but all doctors understand that preventing illnesses makes much more sense compared to treating them after they appear.
As a result, you may be encouraged to get annual check-ups. You might also be encouraged to take vaccines. Screenings may also become more frequent as you age, and this is something you should probably make time for.
Consider Your Health Network
If you choose managed care, you might want to consider your health network and the quality of healthcare in your specific state. It is no secret that some states have better healthcare systems than others, and it may make sense to relocate in order to take advantage of this. Each state has its own specific Medicaid network and program, and you may need to research these differences before your move.
You can also target specific states for other benefits, including homestead exemptions and lower tax rates. An elder law attorney may be able to help you choose the most optimal state based on your unique retirement needs. Finally, it is worth noting that not every state offers managed care plans. If you live in a state that does not offer managed care plans, you might need to relocate before you even consider this option.
Dual Eligibility and the Danger of “Fragmented Care”
If you are eligible for both Medicaid and Medicare, it might be more challenging for you to navigate this process compared to others. There is a real danger of receiving “fragmented care” due to the lack of integration between these two programs. However, various states and insurance providers are attempting to address these issues for dual-eligible seniors.
You might be able to find an “integrated care plan” that serves only dual-eligible people in your community. Often, these plans cater to people in nursing homes. Because these organizations focus on dual-eligible individuals, they can integrate and coordinate their treatment with greater efficiency. Speak with your elder care lawyer to learn more about integrated care plans.
Contact The Elderly Care Law Firm Today
Medicaid planning can be challenging if you are working alone. You may feel intense pressure to provide your loved one with effective healthcare services, and it may feel like this task has become a full-time job. Fortunately, you can delegate many aspects of Medicaid planning to an experienced elder law attorney. During your first consultation with one of these legal professionals, you can discuss how your specific state handles managed care. You might also discuss your senior’s unique challenges and priorities. From there, you can ensure your loved one receives the best health care possible. To get started, consider a consultation with The Elderly Care Law Firm today.
One of the most confusing aspects of Medicaid is its varied nature. Depending on your state of residence, you might have to approach Medicaid with all kinds of different considerations. One of the most controversial and complex aspects of this is “Medicaid expansion.” While this might be a difficult concept to understand, the most important thing to remember is simple: Some states have expanded Medicaid, while others have not. The impact of this could affect seniors and low-income individuals in various ways. Read on to learn more.
What is Medicaid Expansion, Anyway?
To understand Medicaid expansion, you first have to understand the “eligibility requirements” for this federal program. Different States may determine eligibility in different ways. Some consider multiple factors, including income, the number of people in your family, your disability status, and others. Other states take a simpler approach, and they only consider your income.
The states that only consider your income level when determining eligibility are said to have “expanded Medicaid coverage.” By enforcing fewer eligibility requirements, more people qualify for Medicaid. In other words, Medicaid is expanded to include more people.
If your state has expanded Medicaid coverage, you only need to consider one metric: The federal poverty level. As long as your household income is below 138% of this number, you automatically qualify for Medicaid with no further steps required.
What is the Impact of Medicaid Expansion?
According to the Center on Budget and Policy Priorities, expanding Medicaid has had various effects. Statistics show that when states expand Medicaid, adults are more likely to seek insurance coverage. States also see a rise in mental health outcomes and a reduction in opioid overdose deaths. Some studies indicate a reduction in overall depression rates for states that expand Medicaid. Some say that hospitals have become more financially sound in States that have expanded Medicaid.
That being said, Medicaid expansion has its fair share of critics. One study found that in states with expanded Medicaid, low-income women had fewer live births. Other studies suggest that expanded Medicaid may be correlated with poor infant and maternal health.
Some say that Medicaid expansion has forced some Americans off their private insurance policies. These critics claim that if Medicaid expansion spreads to other states, some may have no choice but to go on welfare. They also note that welfare pays less than Medicaid. There is some indication that States that expand Medicaid later could face increased negative effects.
In 2022, Forbespointed out that providers may be less willing to accept new Medicaid patients compared to privately insured patients. In some states, wait times for Medicaid patients are longer. Forbes also points to a study that found Medicaid patients were 50% more likely to die from throat cancer compared to privately insured patients.
How Does Florida Approach Medicaid Expansion?
Florida is one of the many states that has not expanded Medicaid. This is a hot-button issue for many residents, especially those who want to benefit from increased eligibility seen in other states. Others are wary about the potential negative effects of expansion – particularly residents with private insurance.
So far, Governor DeSantis has been less than enthusiastic about Medicaid expansion. However, he has justified this stance on relatively few occasions. The cost could be considerable. Florida is famous for its high population of seniors, and Medicaid expansion could affect the Sunshine State in ways not seen in other jurisdictions.
The Paragon Health Institute argues that 30% of Florida residents would be on Medicaid, stretching an overwhelmed healthcare system. Taxpayers would reportedly have to pay a $2 billion bill for Medicaid expansion over the following decade, and this may cause the State to raise its taxes or cut other programs in order to compensate.
That being said, many argue that voters in Florida should at least get a chance to decide on Medicaid expansion. There is a growing legal battle to put Medicaid expansion on the ballot, and this could happen sooner than many realize. If Medicaid expansion goes on the ballot, there is a high chance of it being approved in Florida. In every other state, Medicaid expansion has been greenlit after reaching the ballot. People tend to vote for Medicaid expansion if they get a chance.
Currently, seniors may qualify for Medicaid in Florida if their income is below approximately $3,000 per month. They must also have assets below $2,000, and they must need nursing home services.
Can a Medicaid Lawyer Help?
If you are living in Florida or another state that has yet to expand Medicaid, legal assistance may help you qualify. Even if you do not quite meet the requirements for Medicaid, you might be able to adjust your financial affairs slightly and re-apply.
The best strategy depends on your unique circumstances. In some situations, the most appropriate course of action might be to take advantage of the Florida Medicaid home exemption. In other situations, you might want to explore strategies involving your spouse.
It may be easier to qualify for Medicaid than you realize. Alternatively, there may be other sources of financial support to explore. For example, you might pursue compensation for medical treatments under VA benefits if you are a veteran. Lawyers are familiar with these various programs, and they can help you pursue fair compensation based on your unique circumstances.
Contact The Elderly Care Law Firm Today
If you are ready to have a more detailed discussion about Medicaid expansion, why not schedule a consultation with The Elderly Care Law Firm? Our experienced Medicaid attorneys can help you assess your next steps, depending on your state’s approach to Medicaid expansion. If there is one thing you should take away from this article, it is that the best Medicaid strategy in Florida depends entirely on your unique circumstances. Reach out today to discuss these circumstances in more detail – and get started with an action plan.
Many veterans learn all kinds of tips, tricks, and “life hacks” thanks to their military service. During a deployment, a soldier might learn various mechanical skills. They might learn how to defend themselves in a dangerous situation. For many veterans, a general sense of discipline is one of the most valuable rewards of service. When it comes time to apply for VA benefits, you may benefit from additional tips and tricks during the application process. Once you learn about these tips and tricks, it might be easier to get the most out of your VA benefits. For more guidance on VA benefits, consider a consultation with an elder law attorney.
Review Your Discharge Papers Before Applying
Before you begin, you might want to review your discharge papers. Look for something called a “DD-214,” which details the circumstances of your discharge. If you do not have your DD-214, you can request a copy from the National Archives. This might be something that a lawyer can assist with if you are not sure how to proceed.
Why is your DD-214 necessary if you want to apply for VA benefits? The truth is that not all servicemembers get access to VA benefits. If you received a “dishonorable discharge,” you might not be eligible to pursue these benefits at all. That being said, you might still gain access to these benefits even if you were dishonorably discharged. If you review your DD-214 and determine that your discharge was not honorable, speak with an experienced lawyer. Pursuing VA benefits may be possible – but it makes sense to review your situation in more detail before moving forward with your application.
Gather Additional Documents
Before you get started with your application, you might want to gather as many relevant documents as possible. It makes more sense to gather these documents together before starting on your application. Otherwise, you will have to stop filling out your application as you periodically search for the information you need. Other than your DD-214, necessary documents might include marriage certificates, divorce decrees, income statements, tax returns, and healthcare provider info.
If you’re not sure what kind of documents you need before starting your application, speak with an experienced lawyer. The necessary documents may vary depending on your unique situation – especially if you are applying for a widow’s pension.
Consider Keeping a Journal
As you approach your new application, you might want to write a journal. This could be a positive move if you are applying for VA medical benefits. A journal can help you document some of the less obvious psychological effects of a serious injury. Don’t be afraid to express your feelings in these journal entries. As long as you make your entries at the same time as your treatment, they can support your application – and they might increase the chances of positive outcomes.
A journal could be particularly useful if you’re applying for PTSD-related benefits. In addition, journal entries could help you recover benefits for mental health issues caused by head injuries.
Review Your Medical Records
As a general rule, it makes sense to carefully review your medical records before starting your VA benefits application. It may be difficult to apply for the appropriate benefits if you are not totally confident about your medical condition(s). Consider requesting copies of your medical records and have them at your side as you fill out your application.
It is all too easy to write incorrect information when filling out these applications. Be as specific as possible – and write down the official medical term for your injuries. For example, you should write “femur fracture” rather than “broken leg.” You might also want to spell out acronyms. For example, you would write post-traumatic stress disorder rather than “PTSD.”
Be Prepared to Reveal Family Information
Although it might seem awkward, these applications require you to reveal considerable details about your family information and history. The VA needs to know about all of your previous marriages, and you will need to list the names and relevant information of prior spouses. If you have a current spouse, they might also need to list their own prior marriages. This section alone can take hours to complete if both spouses have had numerous previous marriages.
You might also need to reveal the names and information of your children. Rest assured that the VA is a reputable organization, and they will not share this sensitive information with others.
Take Your Time
Although it might seem tempting to rush through your VA benefits application, it makes more sense to take your time. A single mistake could cause your application to be denied – and this may cause needless delays. If you urgently need VA benefits, it makes even more sense to slow down and double-check your application before sending it. Rushing will not get you anywhere, and it may push you several steps backward. If you are worried about potential mistakes on your application, have a lawyer check it over first.
Consider Expediting Your Application It is possible to expedite a VA benefits application in certain circumstances. Generally speaking, expedited applications are reserved for those who need them most. These might include terminally ill people or those who desperately need life-saving treatment. If you think that you might fall into one of these categories, discuss the possibility of an expedited application with your lawyer.
Consider Adding Supporting Statements
According to the VA, supporting statements can help your application. These statements should come from reliable third parties, such as friends, family, or the military servicemembers you served alongside. Supporting statements can shed further light on your claimed condition(s), and they can improve the chances of an approved application.
Contact the Elderly Care Law Firm Today
If you are serious about getting the most out of your VA benefits, contact the Elderly Care Law Firm today. Located in Miami, our law firm has been helping seniors and veterans for years. We know how crucial VA benefits can be, and we can guide you through the application process with confidence and efficiency. Remember, online research is only the first step – and you can continue this important discussion during a meeting with us. Book your consultation today to get started.
If you are serious about applying for Medicaid, one of your first steps should be to determine your eligibility. Only certain people are eligible for Medicaid, and these requirements can be quite complex. Fortunately, you may be able to make a few adjustments to become eligible. A Medicaid lawyer can guide you through these steps, helping you achieve financial stability and reliable healthcare throughout the rest of your life. A lawyer can also help you determine whether you qualify for Medicaid based on your unique circumstances. The best way to discuss these circumstances is during a consultation.
Medicaid Eligibility Differs by State
The first thing you need to know about Medicaid is that eligibility requirements may vary by state. Although some of the requirements are universal, others vary depending on where you live. You may need to discuss your State’s unique requirements alongside your Medicaid lawyer for best results.
One of the most important factors to consider is whether your state has expanded Medicaid coverage. It may be easier to qualify if your State has expanded Medicaid. If you live in one of these States, you can qualify based on your income alone. As long as your income is below 138% of the “federal poverty level,” you automatically qualify with no other requirements to consider. In 2024, the federal poverty level for a single individual was about $15,000. This poverty level increases by about $5,000 for each additional person in the family. For example, a family of four is associated with a poverty level of $30,000.
Speak with your lawyer to learn more about the federal poverty income level. It changes from year to year, and calculations can be deceptively complex. Remember, you do not necessarily need to be below the federal poverty level – you only need to be within 138% of the number.
Basic Medicaid Eligibility Requirements
There are a few other basic, universal requirements to consider when it comes to Medicaid in the United States. Generally speaking, only US citizens are eligible to receive Medicaid. You must also be a legal resident of the State in which you file your application. This second requirement is much easier to meet than citizenship, as you only need to live in the State for six months to become a resident. Some “qualified non-citizens” may also qualify for Medicaid, such as lawful permanent residents.
Eligibility Requirements That Most States Enforce
Although requirements vary depending on your state, you probably will not qualify if you are under 65 with more than $2,000 in cash. If you are over the age of 65, you may qualify based on more complex requirements. All States have strict rules against some of the most popular qualification strategies. Medicaid officials pay especially close attention to strategies involving asset transfers and gifts.
California Medicaid Eligibility Requirements
California’s version of Medicaid is called “Medi-Cal.” California is one of the many States that have expanded Medicaid, allowing you to qualify based on your income alone. California also offers Medicaid to various other individuals, including those who are over the age of 65. In addition, people who are blind or disabled may qualify regardless of their age. Pregnant individuals may also qualify, and some youths under the age of 21 could be eligible. If you are a refugee, you might also receive Medicaid in California. Certain cancer patients could qualify as well.
Texas Medicaid Eligibility Requirements
In Texas, you must have a low income or “very low income” to qualify for Medicaid. You must also fall into one of the following categories:
You’re pregnant
You’re caring for a child
You’re blind
You’re disabled or caring for someone who is disabled
You’re over the age of 65
In other words, Texas is one of the states that has not expanded Medicaid eligibility. That being said, Texas defines “low-income” in relatively generous terms – as anyone with an income under about $30,000 per year generally qualifies.
Florida Medicaid Eligibility Requirements
Florida’s Medicaid eligibility requirements are very similar to those of Texas. The Sunshine State has not expanded eligibility, which means you cannot qualify on the basis of income alone. You must be characterized as “low-income” while also falling into one of the following categories:
Pregnant
Blind
Caring for a child
Caring for a disabled person
Disabled
65 or older
With that said, the income requirements for Florida are considerably more strict compared to Texas. A single individual can only qualify for Medicaid if their annual income is less than about $20,000 per year.
New York Medicaid Eligibility Requirements
Like California, New York expanded Medicaid eligibility requirements. This means you can qualify based on your income alone – as long as it falls below the 138% threshold of the federal income poverty level. Aside from this requirement, you can also qualify based on pregnancy, disability, blindness, parenthood, or age (65 and older).
New York also offers Medicaid based on immigration status. This makes New York one of the few states in which non-citizens and permanent residents can get access to Medicaid. If you are an undocumented migrant living in New York, you might want to speak with a Medicaid lawyer to learn more about this opportunity.
Strategies for Becoming Eligible for Medicaid
There are various strategies that can help you become eligible for Medicaid. These strategies may depend on the unique requirements of your home state. They could include gifting, transfers, trusts, and homestead exemptions. Speak with your lawyer to learn more about your options if you do not yet qualify for Medicaid.
Find an Experienced Medicaid Lawyer
Contact The Elderly Care Law Firm if you would like to learn more about Medicaid eligibility. With our help, you can review these requirements in more detail and determine whether you qualify. From there, you can explore various steps and strategies to help you qualify. Even if you are not currently eligible to pursue Medicaid, it may be easier than you think to meet the necessary requirements. To discuss your next steps in more detail, feel free to book a consultation today with our experienced Medicaid lawyers.
If you have protected the United States by serving in its military, the country owes you a serious debt. Although this debt may never truly be repaid, you should consider the advantages of VA benefits. This is one of the main ways in which the country shows its appreciation for veterans, and it can help with various aspects of your life. It may also benefit your family in various ways. Even if you’re not too enthusiastic about claiming these benefits, it makes sense to consider how they may help your loved ones. An elderly care lawyer can help you review these benefits and take full advantage of them.
VA Benefits May Vary Based on Your Home State
The first thing to understand about VA benefits is that they tend to vary based on your home state. While some VA benefits apply to all veterans, others may only apply to certain states. For example, Texas is considered one of the best states for veterans because of its property tax exemptions for disabled veterans. Texas also offers veterans exemptions from income tax and free college tuition. You can also pursue free college tuition for your children and spouse as a Texas veteran. Some of the more obscure benefits include free fishing/hunting licenses, free vehicle registration fees, and much more. Speak with a lawyer to learn more about the VA benefits in your home state.
Mortgage Assistance
VA can help veterans struggling to pay their mortgages. They can also help those who are trying to obtain a mortgage. The VA home loan program may help you purchase a home with no down payment. There is also no need to pay mortgage insurance premiums in some cases. The loans are generally “favorable,” meaning that you may pay a lower interest rate compared to other Americans. The VA guarantees certain loans, allowing you to purchase houses, apartments, trailers, and other residences with few barriers.
If you are struggling to pay your mortgage, the VA can also help. One option is to refinance your loan with VA’s assistance. You could qualify for a specialized repayment plan, and you might receive free counseling to create an action plan. In addition, the VA could help with loan forbearance or loan modification. Foreclosure assistance is possible, and you could receive a special grant to cover the cost of home ownership if you are severely disabled.
Disability Benefits
If you have suffered a disability while serving with the armed forces, the VA should cover the cost of your medical treatment. As long as your disability is related to your service in some way, you can receive compensation. However, this process is relatively complex. You might want to speak with a lawyer to gain a more concrete understanding of the “disability rating” system. Note that you might also qualify for disability benefits if you have suffered a mental health issue.
Even if you did not suffer a service-related disability, you may still qualify for VA health care. This is one of the most important benefits for veterans in the United States, and it can also cover your family. Various health costs are covered under VA health care, including:
Hospital care
Dental care
Pharmaceutical services
Nursing homes
Counseling
Addiction treatment
Women’s health
College Tuition
Many people specifically join the American military to access free education. The VA covers approved education programs, including tuition, books, and supplies. You might also receive a monthly housing allowance to cover your shelter costs while you study. One of the most important things to understand about this benefit is that it also applies to your dependents. This might include your spouse or children.
College tuition is covered by “The GI Bill,” one of the oldest VA benefits. First established in 1944, it covers up to 26 months of your educational costs. This might not be enough time to earn a degree or certification, but it can certainly make the cost of education much cheaper. Note that this benefit also covers non-college training, such as trades school.
Housing
Although VA may help with mortgages, it can also provide shelter if you’re struggling with homelessness. If you become homeless and you have served in the military, you may be eligible for specialized healthcare services. You might also get access to the VA’s housing assistance program, which is specifically geared toward homeless veterans. This type of assistance comes in the form of rental assistance vouchers. In other words, you will receive financial assistance to help cover your rental costs. If you’re homeless, you can use these vouchers to pay for a new home.
Burials
Finally, the VA helps cover the cost of a veteran’s burial. This benefit can be helpful for families of veterans, as the cost of a funeral can easily surpass $8,000 in the modern era. The VA provides each family with an inscribed headstone at any cemetery. If you purchase your own headstone, the VA will provide a special medallion that you can attach to the headstone.
The VA also provides a “burial allowance” that covers the cost of funeral costs. Unfortunately, this allowance is relatively low, and it is unlikely to cover the full cost of a funeral in the United States. That said, it still makes sense to take full advantage of this financial assistance. That said, the VA allows all veterans to be buried in a VA national cemetery for no additional cost. Finally, the VA will provide each family with an American flag to drape over the casket.
Contact The Elderly Care Law Firm Today
If you have been searching for a VA benefits lawyer, look no further than The Elderly Care Law Firm. With our help, you can review the various VA benefits – and how they might help your family. From education and shelter to mental health and loans, VA benefits can be surprisingly generous. These benefits may be especially critical for seniors facing medical costs, less mobility, and other issues associated with old age. Contact us today to learn more about your options during a consultation.
