MEDICAID - GENERAL INFORMATION

PROGRAM ADMINISTRATION: Conn. State Department of Social Services (DSS), http://www.ct.gov/dss/site/default.asp.

PROGRAM DESCRIPTION:

State/Federal program provides coverage of medical expenses for eligible participants. Recipients of Temporary Family Assistance (TFA) and State Supplement for the Aged, Blind or Disabled are categorically eligible for Medicaid. Other groups such as pregnant women, very low income adults without dependent children, people with exceptionally high medical expenses, and refugees may also be eligible. Waiver programs including the Katie Beckett Waiver, Medicaid for the Employed Disabled Program, and the PCA (Personal Care Assistance) Waiver allow Medicaid coverage without regard to the usual income or asset limits. Most Medicaid programs have asset limitations, but not all do.

WHAT TYPE OF ASSISTANCE IS PROVIDED?

DSS issues a medical card containing a program identification number to eligible participants. Recipients who are covered by a managed care plan must use that plan's health care providers. Recipients covered under "fee-for-service" must find providers that accept Medicaid. Recipients present their card to health providers who then request reimbursement for their services from DSS. Payments are made according to DSS's stated reimbursement schedules, and providers are required to accept this amount as payment in full. Medicaid provides coverage for a comprehensive array of health services and medical needs, including some of the items not covered by Medicare. Some services require prior authorization from DSS.

EXCLUDED HEALTH CARE SERVICES

As of 12/1/02 the following services for adults which are PROVIDED BY INDEPENDENT PROVIDERS will not be covered: psychologists, physical therapists, occupational therapists, speech therapists, naturopaths, chiropractors, and podiatrists.  These services WILL BE PROVIDED to adults on Medicaid if the service is provided at a hospital or outpatient clinic.

Children on Medicaid will continue to be able to receive these services from independent practitioners or from hospitals and clinics.

HOW TO FIND HEALTH CARE PROVIDERS WHO ACCEPT MEDICAID

• Managed Care Plan enrollees: Individuals covered by a managed care plan must use the providers who are enrolled in that particular plan. Call the plan for referrals.
• Fee-for-Service enrollees: Individuals covered by a "fee-for-service" plan can call the Provider Relations Unit at DSS or can visit the Connecticut Medical Assistance Program's web site (http://www.ctdssmap.com) and clicking on the Provider Search button.

WHO IS ELIGIBLE?

• People who receive Temporary Family Assistance (TFA)
• People receiving State Supplement for the Aged, Blind or Disabled (State Supplement)
• Adults without dependent children and who are very low income can apply for SAGA Medical.
• People with income over the limit who have exceptionally high medical bills can become eligible by "spending down" their income and assets to DSS's Medically Needy Income limit.
• Refugees
• Children whose family income is at or below 185% of the Federal Poverty Level: HUSKY A (http://www.huskyhealth.com/). There is no asset limit for this group.
• Pregnant women whose family income is at or below 185% of the Federal Poverty Level. There is no asset limit for this group.
• Parents and caretaker relatives with income at or below 100% FPL and whose child is covered under HUSKY A. There is no asset limit for this group.
• People who are disabled and who are employed. There is a higher asset limit than usual for this group. Also, impairment related work expenses can be used to bring income down.
• Severely disabled individuals who can be cared for at home and who would be eligible for Medicaid if the legally liable relative's income is not counted when determining eligibility.

DOCUMENTS NEEDED

Identification; Proof of address; Proof of income; Proof of all assets; Proof of citizenship or green card; Proof of age 65+ or age under 21; Proof of disability if over age 21 and under age 65; Social Security number.

WHERE DO PEOPLE APPLY?

Call or visit the nearest regional Department of Social Services (DSS) office to apply. Applications are usually processed within 45 to 60 days.

DOWNLOAD AN ELECTRONIC APPLICATION:

http://www.ct.gov/dss/lib/dss/pdfs/w-1e.pdf

APPEAL PROCESS

To request an appeal if coverage is denied, write to the DSS Fair Hearing Division in Meriden to request a Fair Hearing within 60 days of the notice of denial. For information or assistance in preparing for the Fair Hearing, contact a local Legal Services office through the Statewide Legal Services program.

TO FIND PROVIDERS IN CONNECTICUT'S COMMUNITY RESOURCES DATABASE:
Search by service name: Medicaid

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SOURCES:  CT Dept. of Social Services
PREPARED BY: 211/rj
CONTENT LAST REVIEWED: April2007