Thomas J. Neagle
An Introduction to Medicaid
Medicaid is a joint federal and state program for the medical care of those who cannot otherwise afford the benefits offered. While Medicaid was established by federal law, Medicaid is generally administered by the individual states, and financed with federal, state, and county funds.
In North Carolina, the Medicaid program is administered by the Human Resources, Division of Medical Assistance (DMA). Eligibility for Medicaid is determined by departments of social services (DSS) in each county.
The Social Security Act requires certain groups of individuals who must be covered by Medicaid. These mandatory groups include individuals who receive, or are deemed to be receiving, cash assistance. Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) are the major cash assistance programs. In addition, the State is mandated to cover certain Medicare beneficiaries and pregnant women and children. The Act also describes optional groups the state may elect to cover. Two of the optional groups North Carolina covers are individuals described as Medically Needy and individuals who receive Special Assistance
Once qualified as a Medicaid recipient, Medicaid is required by federal law to pay for inpatient and outpatient hospital stays, skilled nursing facilities, physician and dental services, home health care for those eligible.
Commencing in 1993, all states are required to have Medicaid estate recovery programs. North Carolina adopted its program effective October 1, 1994 pursuant to N.C. Gen Stat. § 108A-70.5.
By federal law, states are required to seek recovery of any medical assistance correctly paid on behalf of an individual under the State plan for individuals age fifty-five or older when receiving nursing facility care, or alternative home or community-based services (HCBS) and related hospital and prescription drug services (i.e. hospitalization or drugs provided while receiving nursing facility care or HCBS). 42 U.S.C. § 1396p(b)(1).
Qualification and Estate Recovery Topics will be covered are other blogs on this site.