Nebraska Medicaid Program and Preventive Care

NEBRASKA MEDICAID PROGRAM AND PREVENTIVE CARE

Medicaid has served 72,391,294 low-income individuals nationally as of January 2019. Medicaid was signed into law in 1965 and was established to provide health insurance to low-income people. This is a federal assistance program, but it is run by the state and looks different across the country, making it a federal and state partnership. In Nebraska, coverage has NOT been expanded to low-income adults. However, Nebraska has enrolled 242,385 individuals in Medicaid and CHIP since January of 2019.

WHO IS ELIGIBLE FOR THE NEBRASKA MEDICAID PROGRAM?

You may be eligible if you are:

• 65 years of age or older
• An individual under 65 years of age who has a disability, or is visually impaired according to Social Security guidelines
• An individual 18 years of age or younger
• A pregnant woman
• A parent or caretaker
• A former foster care youth

WHAT ARE THE OTHER PROGRAMS OFTEN ASSOCIATED WITH MEDICAID?

CHIP
The Children’s Health Insurance Program, or CHIP, is an expansion of Medicaid as healthcare coverage for qualified children who are without other health insurance and who do not qualify for Medicaid. It provides the same services covered under Medicaid in Nebraska.

THE AFFORDABLE CARE ACT
In 2014, the Affordable Care Act allowed for standardized rules regarding Medicaid, CHIP, and the health insurance Marketplace benefits and eligibility. It also expands eligibility to people under 65 in families below 133 percent of the federal poverty level.

BASIC HEALTH
Basic Health, enacted by the Affordable Care Act, gives states the option to provide health benefits to low-income people who are not able to purchase coverage through the Health Insurance Marketplace because their income fluctuates above and below CHIP and Medicaid levels. .

MEDICARE
Though Medicaid and Medicare were enacted in the same year, they were designed to target different groups of people. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

MAY I HAVE BOTH MEDICARE AND MEDICAID AT THE SAME TIME?

Individuals can be covered by Medicare and Medicaid at the same time, if they qualify for both. For these “dual eligibles,” one plan may pay for certain services not provided by the other, such as long term care.

WHAT SERVICES CAN I RECEIVE UNDER MEDICAID?

As a federally qualified health center, Bluestem Health participates in Nebraska’s Medicaid Program. There are a variety of health services we can provide for our patients, including but not limited to those listed below, which are covered by the Nebraska Medicaid program:

• Dental Services such as cleaning of teeth, fillings, and X-rays.
• Complete Health Checkup for individuals age 20 and younger, including complete physical examination; immunizations; necessary lab tests; health education; hearing checkups; well-baby, well-child, Head Start, school, and sports physicals.
• Laboratory and X-ray Tests
• Outpatient Mental Health and Substance Abuse Services for Child, Adolescent, and Adults
• Screening Mammogram

HOW DO I MAKE THE MOST OF MEDICAID?

Bluestem Health and Medicaid both promote preventive care. In the spirit of preventive care, the Healthcare Marketplace offers these helpful tips:

• Put your health first
  • Staying healthy is important for you and your family
  • Maintain a healthy lifestyle at home, at work, and in the community
  • Get your recommended health screenings and manage chronic conditions
  • Keep all of your health information in one place
• Understand your health coverage
  • Check with your insurance plan or state Medicaid or CHIP program to see what services are covered
  • Be familiar with your costs (premiums, copayments, deductibles, co-insurance)
  • Know the difference between in-network and out-of-network
• Know where to go for care
  • Use the emergency department for a life-threatening situation
  • Primary care is preferred when it’s not an emergency
  • Know the difference between primary care and emergency care
• Find a provider
  • Ask people you trust and/or do research on the internet
  • Check your plan’s list of providers
  • If you’re assigned a provider, contact your plan if you want to change
  • If you’re enrolled in Medicaid or CHIP, contact your state Medicaid or CHIP program for help

HOW CAN I FIND A PROVIDER THAT ACCEPTS MEDICAID?

Each state Medicaid and CHIP program has its own provider network. For a list of providers in Nebraska, contact the Department of Health and Human Services at: http://dhhs.ne.gov/Pages/Contact-DHHS.aspx.

CAN I OBTAIN MEDICAID COVERAGE IF I AM OUT OF STATE?

Medicaid programs are required to cover Medicaid services when Medicaid recipients are out-of-state, as if they were receiving those services in-state. However, only the following services are included:

• Services for a medical emergency
• Services that are needed because the individual’s health would be endangered if he/she were required to travel to his state of residence
• When necessary medical services are more readily available in other states
• When it is a general practice for Medicaid recipients to use medical resources in another state

WHAT CAN I DO IF I DISAGREE WITH A DECISION MADE BY MY MEDICAID PROGRAM?

Anyone may appeal a Medicaid decision, such as those related to eligibility. They must file an appeal with the printed decision notice sent in the mail.

WHY DO I NEED MEDICAID COVERAGE, IF I AM LOW-INCOME CAN’T I JUST GO TO THE ER?

Medical coverage through Medicaid and otherwise is meant to be preventive. One cannot seek low-cost preventive care without medical insurance. Only using emergency room services is like skipping all routine car maintenance and only receiving services when a car has had a major accident or breakdown. If you qualify for services, it is in your best interest to obtain Medicaid insurance so you can maintain good health and avoid major breakdowns in your health. For more information about Medicaid and preventive care, contact Bluestem Health at: (402) 476-1455 or visit our website: https://www.bluestemlincoln.com/medicaid-medicare.