MEDICAID - GENERAL INFORMATION

PROGRAM DESCRIPTION:

Medicaid (often called Title 19) is a state/federal health insurance program administered by the Connecticut Dept. of Social Services (DSS) http://www.ct.gov/dss/site/default.asp. The program helps pay for medical and long term care for low income elderly, blind or disabled individuals and families with dependent children. Payments are made according to DSS's stated reimbursement schedules, and providers are required to accept this amount as payment in full.

SERVICES COVERED:

Medicaid provides coverage for many health services and medical needs, including some items not covered by Medicare. Covered services include:

• inpatient and outpatient hospitalization
• physician care
• nursing facility care
• home health care
• family planning
• lab and X-ray services
• pediatric and family nurse practitioners
• community health clinics
• nurse midwives
• Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for children under 21
• prescriptions
• hospice
• adult dental
• medical supplies
• rehabilitation services
• medical transportation

WHO IS ELIGIBLE?

• recipients of Temporary Family Assistance (TFA)
• recipients of State Supplement for the Aged, Blind or Disabled (State Supplement)
• parents or caretaker relatives with income at or below 185% FPL and whose child is covered under HUSKY A
• children under age 19 with income below 185% FPL (HUSKY A)
• children ages 19 and 20 (Ribicoff Children)
• pregnant women with income under 250% FPL
• 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 (MNIL)
• employed persons who are disabled and earning more than the traditional income limits - Medicaid for the Employed Disabled (MED)
• people who are eligible for Home and Community Based Waivers (waivers allow Medicaid coverage without regard to the usual income or asset limits), including
  • Conn. Home Care Program for Elders
  • Personal Care Assistance Waiver
  • Acquired Brain Injury Waiver
  • Katie Beckett Waiver
  • Dept of Developmental Services Waiver
  • WISE Program (Mental Health Waiver)
• refugees (receive benefits that are the same as Medicaid for 8 months)

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

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 visit the Connecticut Medical Assistance Program's website, https://www.ctdssmap.com/CTPortal/Provider/Provider%20Search/tabId/50/Default.aspx, to conduct a provider search.

APPEAL PROCESS

To request an appeal if coverage is denied, write to the DSS Office of Administrative Hearings and Appeals in Hartford 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: June2009