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Video: A Look at Medicaid and Medicare

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This video, broken down into chapters, features two benefits planners who discuss Medicaid and Medicare rules and share their insights.

Buck (animated character) (00:01):
Hi, I’m Buck. Just a quick note that most of the figures used in this training update each year. I’ll be popping in to give you the latest figures as needed. Thanks for your attention. Let’s get to it!

Susan Harrell (00:21):
Hi there, I’m Susan Harrell and I work for the Washington Initiative for Supported Employment or Wise. I’ve been here for about 20 years and I’ve worked about 35 years in the field of supporting people with significant disabilities to go to work and to maintain employment. And along the way, I’ve learned a lot about Social Security benefits as well as medical benefits and have really tried to use that information to help people to get better and better employment outcomes across time. I also have a personal connection with these services, I have a brother who experiences disabilities. He has a traumatic brain injury, and he also is somebody that has needed quite a bit of support across time and has accessed public benefits. So personally I know how important it is to individuals and families. And as a professional, I also know that it helps to support the work we’re doing. to try to assure that people really do experience the kinds of employment outcomes that all of us want to experience. I’ll pass it over to you, Scott.

Scott Leonard (01:28):
Yea, hi everyone. My name is Scott Leonard and I’ve worked in the field of supporting people with disabilities for about 20 years now. And of those 20 years, I’ve spent 15 helping people navigate through different government benefit systems. And I find that people, first of all, don’t always understand that there’s a connection between their cash benefits that they get from the government and then their medical benefits. What we also find out is that people are more concerned about losing their medical benefits many times than their actual cash benefits. So this will be a good opportunity to help explain Medicaid and Medicare in more detail.

Susan Harrell (02:04):
And I think we’ll also get an opportunity to really explore why is it that people be more afraid to lose their medical benefits than their cash benefits, right? On the surface of it, if you’re relatively healthy and you don’t have a lot of needs for your own medical insurance, it might not be readily apparent how crucial these medical benefits can really be to somebody’s ability to live and workin the community.

Susan Harrell (02:29):
For our agenda for today, we’re going to be talking about cash benefits and immediately giving you an overview of cash benefits and the connection of that to the medical benefits, right? So, we’re hoping that you took the other two parts of the series. The one on SSI, as well as the one on SSDI, because there is a connection between those cash benefits and medical benefits, and we’re going to provide you with a brief overview of those today, but it would be, I think really useful for folks if they haven’t looked at the other trainings that we’ve done to be able to access that information and take a look at it. And then we’re going to drill down into two different kinds of medical benefits because not all medical benefits are created equal. We’re going to start with Medicare and dig into so basic information about what Medicare can provide, and provide you with some information about how to access and look at those benefits, right? And then the next part is going to be Medicaid. Now this, I have to say Scott, is a bit of a challenge because there’s so many flavors of Medicaid, but we’re going to attempt to give you the very least a good framework for what Medicaid is, how it comes into play in people’s lives, and how many different options, just with a sampling, there are for Medicaid coverage for people. Because I think that is one of those areas where there’s a lot of fear associated with loss of that benefit. And then we’re going to give you some resources for help because we all need those, I think at times, to be able to figure things out. And these ones will be specific to the Medicare and Medicaid benefits that we’re discussing today, as well as with one of the resources, to all of your benefit picture.

Scott Leonard (04:25):
Sure. And something about this presentation is this is, this is pretty high level on some of these topics, right? When we’re talking about Medicare, for example, there are general rules and then there’s exceptions to those rules. And we’ll be talking about the general rules with Medicare. And then as you said, Medicaid is actually, there’s a lot of complications with Medicaid, but we’ll be giving you the essential information that you need today.

Scott Leonard (00:00):
So let’s talk about cash benefits from Social Security and their connection to medical benefits. Okay. So as Susan said, we’ve done a training on SSDI Childhood Disability Benefits and Disabled Widows/Widowers Benefits. Those are the disability benefits from Social Security, and those are called Title II benefits. When people are eligible for SSDI Childhood Disability Benefits or DW benefits, they’re on a pathway to becoming eligible for Medicare. So Medicare is associated with those benefits. Now we also threw onto this slide, Social Security, Retirement Insurance Benefits. We haven’t yet done a training on retirement insurance benefits, but we included it here for a number of reasons. One is that it is a cash benefit, right? And two, I think a lot of people think about, “Oh, when you retire, you get Medicare”, right. People tend to think about retirement and Medicare being together. They may not always realize that when you’re eligible for disability related benefit, you also can qualify for Medicare.

Susan Harrell (01:07):

Scott Leonard (01:07):
So for those Title II benefits, they qualify for Medicare eventually.

Susan Harrell (01:11):
And I think in general, that that Americans are more familiar with Medicare than they are with Medicaid in many cases because of that attachment of Medicare to retirement benefits. So when we’ve had these discussions in recent years about healthcare coverage for Americans, they talk a lot about Medicare as the coverage that people would get. And, and really it’s because it’s so common it’s so it’s something that we all touch if we get to that full retirement, Social Security.

Scott Leonard (01:46):
Sure. And then the other cash benefit is Title XVI or SSI, that’s Supplemental Security Income. And when people qualify for SSI, they qualify for Medicaid in Washington State. So what we find is that it’s really helpful to go through the trainings on the Title II benefits and on the Title XVI benefits, because it does create a framework for understanding both Medicare and Medicaid, particularly around SSI and Medicaid, because Washington State is a state where if you have SSI, you qualify for Medicaid.

Scott Leonard (02:23):
Well, there’s lots of other ways to qualify for Medicaid, as you explained, but they tend to use the SSI rules as sort of a starting point. It creates a framework for the rules that are going to be around those other types of eligibility pathways to Medicaid.

Susan Harrell (02:35):
Yeah, and really, I think when we talk about framework, what that means is that for some Medicaid programs, they are following what we laid out in our SSI training, right? They are following the calculations around SSI, eligibility, and other things. And for those Medicaid programs, there’s going to be a resource limit of $2,000. They’re going to follow. It looks a lot like SSI. When you think about eligibility for Medicaid and then the other programs, it’s almost, as if they’re saying we’re going to pay attention or not pay attention to income and or resources, but it’s in light of the SSI rules, right? So even if a program has differences in the way that they look at income or resources, it’s, as if they’re saying this, one’s going to be different than… the way that we look at SSI in this way, we’re not going to have a resource limit for instance. Right? And so they, they are framed really around SSI rules and that’s what makes it so critical for people who are helping individuals to understand their eligibility for Medicaid, to have a good general understanding of SSI. But there is one other factor that comes up as well in some of the programs, and this goes back to eligibility for benefits, and the way in which people have to meet the definition of disability with Social Security in order to be eligible for benefits. Do you want to kind of discuss that a little bit?

Scott Leonard (04:10):
Right. And we do talk about this in some of the other trainings in detail, but sort of a high level view of how Social Security defines disability. So first of all, the disability needs to be considered either terminal, or it’s going to be considered long-term meaning it’s going to last for 12 months or longer. But it’s also defined as being substantial, meaning that it impacts a person’s ability to perform Substantial Gainful Activity through work, right? Substantial Gainful Activity is one of those terms you hear a lot when we’re talking about Social Security. We may use the term SGA when referring to Substantial Gainful Activity.

That’s the same thing. Typically with SGA, there’s a dollar amount that is assigned to it. And those amounts are listed below. Now, you’ll see two different amounts. One is for people who do not experience blindness and another, which applies for people who meet the Social Security definition of blindness. But the idea on SGA remains the same that if a person is working and earning money and their monthly caliber earnings are at, or above that SGA amount, they would be considered as performing SGA.

Scott Leonard (05:25):
So for these two benefits, Title II and Title XVI, Social Security does look at SGA at the time of application. Now, once someone gets on Title XVI, which is SSI, SGA doesn’t matter quite so much anymore. Right. But with the Title II benefits, it does. And what we see is that at different stages, Social Security does look at SGA. And if someone were to perform SGA, meaning that they’re at a job and they’re making a certain amount of money over those limits that we discussed, they may eventually lose their cash benefits, their SSD Childhood Disability Benefits, or the Disabled Widows benefits, right? But what will happen is they typically keep the Medicare for a much longer period of time, often years. So it’s important to understand that even if the cash benefit stops with title to Medicare typically continues.

Susan Harrell (06:18):
Yes. And I think the other thing is, is that even with the Medicaid programs, eligibility, for some of those programs still revolves around. Even if they’re not somebody not on SSI and they’re looking for Medicaid, if it’s a disability based Medicaid program, they’re going to be looking to Social Security’s definition of disability in whole, or in part to try to determine if the person is eligible for that Medicaid program. So it’s, to me so interesting how much you see cash benefits interwoven into the framework for medical benefits, regardless of whether somebody is actually receiving cash benefits. So that framework is really important and it’s part of why it’s complex to explain. And, and the thing we want to encourage you to consider is that the information we’re providing you today is really to give you some basic knowledge about what’s out there and to help you to understand if you want to dig in deeper, what kinds of different considerations go into programs without going too deep. And then we want to give you the resources to be able to dig deeper if you wish to.

Susan Harrell
07:36):And, and I think ultimately that that’s one of those balancing acts that we do when we come upon information. That’s so interconnected with other other things that we train on is trying to figure out exactly where to draw the line so that we make it understandable and palatable really, to pick up the information. And remember it is we consider this to be building the foundation of understanding across layers of other individuals that are out there supporting people with disabilities to go to work, or perhaps they are actually the individual or a family member that is supporting our work, right? Okay.


Scott Leonard (08:14):
One more thing about this slide Susan, is that it’s a shame that the names, Medicare and Medicaid, they just sound so similar. And I think that, that, that gets people confused. It’s easy to confuse those two. So just, just understand that they’re very, very different programs.

Susan Harrell (08:30):
It’d be really nice if we could give them nicknames, it’s like something we would entertain any kind of suggestions people might have or what we might do there.

Scott Leonard (08:40):
Well, Washington state does have a brand name for Medicaid and that’s that’s Apple Health. So if that helps folks, they can think about Medicare and Apple health, Apple health being Medicaid. But throughout this training, we talk about generally in terms of Medicaid, correct?

Susan Harrell (08:54):
Yes. Right.

Scott Leonard (08:55):

Scott Leonard (00:00):
So now let’s talk about the cash benefits and medical, and this basically it takes information from that last slide, but it adds a little bit more information. It talks about when the medical benefits begin. So if someone applies for SSDI and they become eligible for SSDI, they may eventually become eligible for Medicare, but it takes 24 months after the Disability Benefit Entitlement begins before they can actually get that Medicare. Right. Yeah. It’s the same with Childhood Disability Benefits and also for Deceased Widows and Widowers Benefits. Those also get Medicare, but it takes 24 months again, after the Disability Benefit Entitlement begins. And we, when we, I mentioned 24 months after Disability Benefit Entitlement begins with talking about when the cash benefits would begin. Right, right. Yeah. and, and the reason why I say that is people who are eligible for SSDI Disability Insurance, and also for the Deceased Widows Widowers benefits.

Scott Leonard (00:55):
Once they’re, once they’re found to have a disability and qualify for the benefits, they have a five month waiting period before they actually get the cash benefits. And it’s from that point that they would start the clock of 24 months. Right. So it could, it does take a while. And that’s a long time for people to wait, to be able to get Medicare insurance up to two years. So just as people should be aware that there are other ways that people may qualify. For example, Medicaid. When we talk more about Medicaid, there’s other avenues to receive medical coverage.

Susan Harrell (01:25):
I think this is a body of work that goes unattended sometimes. And when somebody becomes disabled, when they have something happen where it’s a disabling condition, they first apply for, for Social Security Benefits. If that’s, you know, what, where they’re angled towards that is a process. And it takes them some time often. And then they have to wait for cash benefits to actually start. Because even if they’re determined to have the onset of disability at a certain date, there’s still that wait for the cash benefit. Right. And then they have this wait for the Medicare. And often people don’t have a connection to systems that can help them to think about what do you do while all this stuff is happening while you’re waiting for these things, what are you going to be able to do? Both with cash assistance, as well as the medical today, we can talk about not only the, the Medicare that will come when you get Disability Insurance or Childhood Disability Benefits or whatever the case may be with the cash benefits. But we can also talk about Medicaid coming into play while someone’s waiting for Medicare eligibility to start right? For that to begin.

Scott Leonard (02:46):
Exactly. Yeah. So we included retirement benefits here because it was also in the other slide and people want to know, when will the Medicare start? In general, it starts at age 65 or older for, for, for many people. And I want books to understand that there’s exceptions to all of these rules, right? There’s always, it always tends to be some exceptions. So this is the general overview of the rules of when these, when these medical benefits become available. And then SSI. So SSI person can qualify for Medicaid. And those actually start once the person’s eligible for cash benefits, there’s not a 24 month period of time where they need to wait for that benefit to kick in.

Scott Leonard (00:00):
People want to know, can I have Medicare and Medicaid at the same time? And you can. In fact, people can have Medicare, Medicaid, and private insurance all at the same time. Typically what happens is they bill in a certain order. So let’s say a doctor takes all three of those. They will bill private insurance first.

Then they bill Medicare and then they bill Medicaid. Now, sometimes if someone works for a smaller employer, they might bill Medicare insurance first, and then bill that private insurance. So for example, if someone’s under the age of 65 and they have Disability Benefits and they work for an employer that has less than a hundred people, they may make the decision, the Dr. May make the decision to bill Medicare before the, the private insurance, but Medicaid is always a payer of last resort. And that’s what we see with other types of insurance is Medicare always pays last.

Susan Harrell (00:52):
I often hear people say that they think that they should drop their private insurance because they have Medicare and Medicaid, right. Or they have one or the other so that they should just drop their private insurance. Do you get people that talk to you about that as well?

Scott Leonard (01:11):
I have heard that sometimes because it costs money and we’ll talk about how there’s some ways that that cost may be covered by the state. Actually, you know, what I hear more is that people think I have private insurance, I don’t need Medicaid anymore.

Susan Harrell (01:25):
That’s true. It works both ways.

Scott Leonard (01:28):
And they don’t realize that Medicaid may be paying for more than just say doctor’s bills, right? It might be paying for a lot of other services in their life.

Susan Harrell (01:37):
Well, and really, I think about this as if we were talking about investments and we would talk about a varied portfolio in order to get the most out of dollars you would invest. I think about this as a varied portfolio in medical coverage as well. Like if you can have a variety of options, it expands the options for health care that you have available because some doctors will not take Medicaid for instance. So having private insurance there as well is very useful, it expands the potential of you being able to get the services you need when you need them. And I really think that, as you said, we’re going to be talking about getting some help to pay for private insurance. But just expanding the, the alternatives that you have for care is, is great for folks too. So yeah, it’s, I think it’s a, it’s a good thing to explore and to try to maintain if you have the option to do that.

Scott Leonard (02:38): That’s a really good point.

Scott Leonard (00:00):
So Medicare is actually considered our country’s health insurance, and it’s funded largely by FICA taxes and also premiums that people pay. And Medicare is actually initially managed by Social Security Administration. They determined the eligibility for Medicare, and they also enroll people into Medicare, but there is a Medicare website and people can go onto that Medicare website and get a lot of information about Medicare, not just from Social Security. There’s a lot of good information from the Medicare website, which is And in the corner there, you see a copy of what a a Medicare cards looks like. And each person gets a specific number. Now they used to do a Social Security number for their Medicare card. It’s only recently that they replaced that with a different type of identifying number. Which is a good idea, because generally you don’t want to be walking around with your Social Security number on a card that you’re giving to other people when you only need to pay for, for some medical bills.

Scott Leonard (01:00):
And then that card also shows part A and part B hospital coverage and medical coverage. That’s a very common thing that we see on Medicare cards. That’s a type of coverage that you would get through Medicare. So let’s just do a snapshot of these different parts of Medicare, what they cover and how much it costs. And we’ll spend a little time on this slide. So, first of all, I mentioned part A and that last, and that last slide. Part A is hospital insurance. And it also covers some skilled nursing facility coverage, there’s hospice, and some home health care that can all be covered under part A of Medicare. Now, for most people, when they get Medicare, they get part A, and it’s free. There are instances where people can buy into part A there’s a premium that they can pay. And we’ll talk about that a little bit later in the presentation. So that’s hospital insurance.

Scott Leonard (01:54):
Let’s move on to part B. Part B is medical insurance, not means it can pay for doctor’s bills, for example. And part B has a monthly cost. Buck, can you show here the latest figures for the part B premium? Now, that amount can vary. Some people pay less and some people pay more. And actually sometimes people qualify for what’s called a Medicare Savings Plan, and that will cover that cost. We’ll talk a little bit more about that later in the training. If you have saved Social Security Disability Insurance, the monthly premium amount for part B will typically be taken out of your monthly disability benefit check, but let’s say you do not have a Social Security disability check, and that does happen sometimes. Like maybe you are no longer receiving an SSDI, but you continue to qualify for Medicare. There’s really no need to worry because they will reach out to you and find you and request them part B premium amount.

Susan Harrell (02:54):
Yeah. They can get their money.

Scott Leonard (02:56):
Yeah, definitely. And they will let you know all the ways that you can submit payment, for example, by submitting a payment online, or by mailing in a check. Now I’m going to jump over part C and go into part D and part D covers prescription drug coverage, and an easy way to think of it as D for drugs, right? And the cost really depends on the plan. And what we mean by that is when a person has prescription drug coverage, they have to sign up for a prescription drug plan. And that the cost of that plan may vary. There’s lots of different plans. And we’ll talk a little bit more about that, but people have the availability to shop around and choose choose a drug plan that meets their needs,

Susan Harrell (03:39):
Right. And when you say, choose a drug plan that meets their needs, that means for many people that they take the list of the drugs that they’re currently taking, and they compare it to the plan to try to make sure that there’s good coverage, right? So they look through the form drug formularies to make sure that there’s a good match, pretty complex.

Scott Leonard (04:02):
Yeah. When you go onto the Medicare website, there’s a Medicare plan finder, and you can go in there and actually enter each type of medication. And it’ll talk about which plans covered those, those, that medication. And also the geographical area that they serve. And that’s the way that people will be able to shop around. And choose a plan.

Susan Harrell (04:20):
It’s a whole new world with the online resources we have, isn’t it? Yeah. This, this you know, shopping on online kind of a thing has really changed things for people. If they have access to the internet and can do that. But we also have other resources that they can connect with to get that kind of assistance as well, right?

Scott Leonard (04:42):
Yeah. Now parts A and part B are called… We sometimes call it classic Medicare and the prescription drug coverage part D was, came into the system less than 20 years ago. But now I want to talk about part C. And part C are Advantage Plans. There’s also Medigap plans. We’re going to be talking primarily about the Advantage Plans, and these are interesting. So an Advantage Plan is private insurance, and this is completely voluntary, but what happens is if a person chooses an Advantage Plan, in the sense it replaces their Medicare, right? So what happens is they sign up for a plan. Now that plan may cost money. Some plans are free. Other plans, cost money. They qualify now for this insurance and don’t get an insurance card. And now when they go to the doctor, they don’t bring their Medicare card. They bring this new insurance card.

Scott Leonard (05:35):
And what happens is the Medicare Advantage Plan will coordinate the billing with Medicare. So people don’t have to worry about that. So Medicare Advantage Plans will combine parts A and parts B of Medicare. And sometimes they also include parts D just like the prescription drug coverage. People can go onto the Medicare website and they can shop around at different plans and see if there’s one that meets their needs. Now, my experience is that people don’t typically know too much about Advantage Plans, and they may not know why they would want to necessarily do this, right? I want to give an example of how it was beneficial, personally. So my mother had Parkinson’s disease and she had Medicare. So at one point she needed to see some specialists in regards to her Parkinson’s. And we were having a really hard time finding a provider who would take Medicare, the specialist that we need. So, we asked about, well, what type of private insurance do you take? And we went back and we looked online and found out that there were Advantage Plans were the same as those particular insurance companies. So my mother purchased part C. So now she’s paying for some money for the Advantage Plan. She went back into the doctor’s office and she was able to see a specialist because that specialist took that particular type of insurance. And it really helped her out in that particular situation. So when people purchase Advantage Plans they may see a boost in their coverage and they’re may have more choice on who they can see. Yeah.

Susan Harrell (07:13):
It oftentimes costs a bit more, but obviously, if there’s a very specific need, it’s well worth it, to be able to pay that little bit more, to get what you need.

Scott Leonard (07:26):
That’s right. And it’s not for everyone, but I think it’s good for people just to be aware of. Yeah. And also just to be clear, usually people have to continue paying for their part B, this is an additional cost that people have to pay, but that boost might be exactly what they need, right? Something else I want to talk about is, you know, we’re up here calmly talking about benefits, Medicare and soon Medicaid. But you know, at the time I knew a lot about benefits, but then when I was helping my mother navigate the benefits, I started to feel less confident in my understanding about the rules. And that’s because there’s an emotional component to it, you know? So while we’re being calm, I think we recognize that when people are trying to navigate Medical Benefits for themselves or for a loved one it can be stressful and there’s an emotional component. And I think in those situations, it’s important to receive support. And that’s why we have a few slides on some ways that people can find support at the very bottom of this slide. You see, we have a website for what’s called SHIBA. We’ll be talking more about that. And that’s an example of an organization that can help people navigate through some of the complexities with Medicare and, and feel confident with the decisions that they’re making.

Susan Harrell (08:42):
Right. I mean, I think your mother was very fortunate that she had you right there at her corner. But trying to figure out how to have somebody like you in a person’s corner at those emotional times really essential. And I think we tend to forget how overwhelming things can be in those moments. And when somebody has a disability themselves that they’re, they’re trying to figure out there’s so many different complexities above and beyond what we’re talking about with these things that having someone that can be objective and assist, it’s sorting through everything and, and kind of pulled away from the emotional experience itself really can provide a lot of clarity.

Scott Leonard (00:00):
I want to also talk about late enrollment penalties. So part B actually part C, part D, excuse me, part ,B part C, and part D, they’re all voluntary. But if someone does not choose to have part B or does not choose to have part D and they don’t have creditable coverage, meaning that they do not have some other medical coverage, that on average is as good as those parts, they could be assessed a penalty. And that penalty can actually be pretty significant. So, for example, let’s say someone has part A and part B, and they decided to get rid of their part B, but they don’t have creditable coverage for each year that they don’t have part B. They could be charged 10% of that monthly fee, and that gets added each year. So the next year that they are not on Part D, that could be another 10%. And that could cause that cost to go up considerably.

Susan Harrell (00:57):
I actually knew someone who had this happen to them. And it was really because of the understanding about what is creditable coverage. So there was a, a young adult whose father passed away and he became, he was eligible for benefits on his father’s records. So Social Security Childhood Disability Benefits, and therefore became eligible for Medicare. His father originally, I think first father had retired any have been on, on the benefit. The medical benefit from a company that his father worked for that continued benefits through retirement for the parent, as well as for as dependence. So this individual was drawing insurance benefits from his father’s record and decided that he didn’t need part B or part D in the Medicare picture because he got that from private insurance. But the thing is, is that creditable coverage is about the working individuals insurance coverage.

Susan Harrell (02:08):
Creditable means that you have a working individual that’s covered by insurance, not a retired individual that is covered by insurance, right? So there’s, there’s this issue with being able to help people to understand when they say no, it just because they do have private insurance coverage for let’s say part B and part D doesn’t mean that they should be opting out of those two things, because if the private insurance coverage ends and it was not creditable coverage, it wasn’t coverage that was coming from a working person’s insurance. Then the penalties have continued to be assessed year by year by year, and trying to get out of that situation when you really need part B and part D there are some strategies and we might be able to talk a bit about those, but in general, it becomes overwhelmingly expensive for somebody to get that coverage. Why do you think they do this, Scott? Why do they, why do they require the penalty for those folks that opt out of part B and part D if they don’t have creditable coverage

Scott Leonard (03:18):
Well, I think they want as many people as possible to pay into the insurance program, right? Because it’s insurance, it’s a pool and that’s how they work. The more people that pay into it, the more affordable that it is for folks. That’s my understanding, do you agree?

Susan Harrell (03:31):
Yes. And I think the other, the other thing is, is that you want healthy individuals for the most part paying into part B and part D because that’s what lowers the overall cost of a program, right? So if you require it, what you’re really assuming is when somebody is healthy, they’re going to say no, typically to part B and part D they don’t need it. They’re healthy. Why would they pay for it? And then when they want it is when they’re not so healthy and they’re more expensive to cover. So I think the whole idea is let’s make it so that everybody is enticed to buy in to avoid these penalties. But the creditable coverage

thing is really the piece that I’ve seen get people over and over again, because it is assumed like if I were working, it had my own private insurance coverage, Hey, no problem, I’ll opt out of part B and part part

But if I lose my job and I buy private insurance through Cobra, for instance, where I get to continue my private insurance coverage after I’ve lost my job for a period of time, that isn’t creditable coverage anymore, because I’m no longer a working individual. So trying to help people to understand that if you walk away from that, you’re going to have to track it. You’re going to have to try to pay attention to when you might need to hop back on is an added layer of complexity for people.

Scott Leonard (04:54):
Yeah, that’s definitely true. And one more thing about this slide, we show the part B premium, that amount tends to change each year, and it tends to go up. People will typically receive information in the mail about what that amount is going to be, but they can also just do a web search toward the end of the year to get that information.

Susan Harrell (05:14):
Those booklets that people get from about Medicare are pretty bulky. They’re, they’re quite a lot of information aren’t they?

Scott Leonard (05:24):
It’s a lot to navigate, sure.

Susan Harrell (05:25):
But the good thing is, is that we know that people do get information. They may not really be able to go through it and sort it all out themselves. But those who are supporting them, we’ll be able to see an indicator if they are paying attention and asking the individual, have you gotten information about, you know, various things that may happen, that we’ll discuss when it comes to Medicaid or Medicare, because information does arrive. Sometimes we’re just not preparing the individuals for this is your moment when there’s a decision. So let us know when this right. So if nothing else, the people who are taking this session with us today could really help an individual by asking them to alert them when they receive information in the mail about their medical benefits. It’s a good indicator that it’s time to dig a little deeper and make sure that everything’s okay.

Scott Leonard (06:19):
That’s a really good point. And my experience is people receive a lot of information from Medicare, so they are getting it. They are getting that information. It’s a matter of understanding it.

Susan Harrell (06:29):
And really for Medicaid. And we know that sometimes they round file it. They just put it in the garbage because they don’t know that this isn’t a…It looks like something icky. I don’t really want to take a look too deep. Maybe it’s just junk mail. Can I put it in the garbage? That’s a terrible error. (laughs).

Scott Leonard (00:00):
So this slide is just focusing on initial enrollment into Medicare. And this is just for people with disabilities who are under the age of 65. So this is actually somewhat of a narrow focus. So part A, which is hospital insurance and part B, which is medical insurance people with disability. So if someone’s receiving say SSDI right, and those 24 months had passed. Around the 25th month, they will qualify for Medicare. Social Security will enroll them in part A and part B that happens automatically for folks. So they’re there… That is good to know that if someone’s receiving SSD benefits, they don’t necessarily need to be tracking when those 24 months are up and then they need to apply for part A and part B Social Security will automatically enroll them into one of the… into both of those parts. Now we said that part B is voluntary.

Scott Leonard (00:53):
So people do have the option. If they do get automatically enrolled, they do have the option to then become unenrolled. In part B. What we see is that when people who are receiving disability benefits and they’re under the age of 65, they tend to start getting notifications about three months before the time that they’re going to actually become eligible for the Medicare card. And then they continue to have a window of time when they can make some decisions. So if you look at part C for example, now that is option, but they would probably start finding out about part C plans about three months before there…that 24 month period ended. And then that particular month would be the fourth month. And then the next three months, they would also have some time there to make a decision about whether they wanted to use one of those optional advantage plans.

Scott Leonard (01:46):
So we say that there’s like a seven month window to apply for part C. And this is just the initial enrollment, by the way. And then part D similar is prescription drug coverage, as we said, and there’s also that seven month window. So Social Security doesn’t necessarily automatically enroll someone into a prescription drug plan. They have to choose one, but they start getting notification three months before they’re going to qualify for that card. And then they have that month to make, would have those three months to make a decision to have the month when they received the car to make a decision. And then the next three months to make that decision now, depending on when they make a decision will of course influence when that prescription drug plan is going to kick in. But I want people to know that there is a period of time when people can make a decision on Advantage Plans and prescription drug coverage, and that they’re probably not going to be automatically enrolled.

Scott Leonard (02:39):
They will have to choose one of these plans, but they do get a lot of notifications from Medicare about all these plans. And so there, and there is enough time to make that decision. Now, there is an exception. So if someone is Medicaid eligible and they do not choose a prescription drug plan, the state will actually choose one for that person. They will go on to a prescription drug plan. And the reason is because Medicaid is a payer of last resort. If part D is available for someone and they have Medicaid, they’re supposed to apply for part D. And if someone doesn’t do it, they say, okay, fine. We’ll just enroll you in a prescription drug plan. And that sounds fine, except we don’t really know if that drug plan that they selected is really the drug plan that the person wants or the best plan for that individual.

Scott Leonard (03:26):
So there is a safety net for people to make sure they have prescription drug coverage, if they have Medicaid and Medicare, but I still encourage people to go and shop around and find the drug plan that works best for them. Makes sense. Yeah. this is just about initial enrollment, you know, there’s periods of initial enrollment, there’s general enrollment and there’s special enrollment periods, and it actually gets to be a lot to try to manage. Yeah. So this is just, again, focusing on the initial enrollment. People do have different times in the year to say, to sign up for part B or to sign up for part C. And so if you want more information about that, I recommend people go to the website and they can get that information or a contact sheet, which we’ll be talking about a little bit.

Susan Harrell (04:12):
Yeah. You’re going to hear a lot about SHIBA as a piece of this. And actually we had them on the previous slide listed there too very useful resource. And then I really do think provides a lot of general information as well.

Scott Leonard (04:26):
I think that website’s actually pretty user-friendly and I’m able to find my situ… I could find my situation if I’m the rules of my situation. And when might be say the general enrollment period or a special enrollment period, I’ve found it to be pretty helpful.

Susan Harrell (04:38):
So it gets the Scott stamp, the endorsement for easy access. We need to start rating these sites for that. I think (laughs).

Scott Leonard (00:00):
Continuation of Medicare coverage. So earlier on, we were talking about how we’re talking about substantial gainful activity. And we were talking about title two benefits, SSDI Childhood Disability Benefits, for example. And if a person is on those benefits and they’re working and they start making SGA that dollar amount that we talked about at some point, their cash benefits could stop. But what we see is that even though their cash benefits have stopped, their Medicare continues for years and it can continue for a long time. It, it, it may continue for up to, you know, at, at a minimum of 93 months after their Trial Work Period ends. But we often just see is that when they first perform SGA and their and their benefits may stop…it may be six and a half years after that point that they actually keep their Medicare. So people don’t have to be too concerned about that if their cash benefits go away because they’re successfully working, which is great, they will keep Medicare. They tend to keep Medicare for a long time.

Susan Harrell (01:09):
Yeah. Which is really important. It’s essential to people to know that they have that kind of coverage.

Scott Leonard (01:15):
Yeah, absolutely. And then let’s say though, we called it the continuation Medicare continuation of Medicare coverage. So that period of say six and a half years, that they keep their, their Medicare, if that stops, they go beyond that time period, people can actually choose to buy into Medicare, they’d be buying into part A but they could also then buy into part B once they have part A. And so that is an option for people. So just so just as a heads up for folks, even if, when people get to the place where the Medicare goes away, there’s an option to potentially buy into it.

Susan Harrell (01:48):
And I think that it gives people that opportunity to ramp up their employment efforts and hopefully to get to a place where they have a little bit more money to be able to buy in to the Medicare that they would eventually be looking at losing otherwise. And I do think that one of the other things is that this is relatively cheap compared to private insurance purchase. When we’re talking about buying into part A, part B, and even part D when you look at employer plans how much your employer might be paying to cover you with private insurance, this is not super expensive coverage. And so kind of putting that framework into place and helping people if they are getting to a point where they might have to buy in for them to understand that that’s coming, if they want to continue their coverage, having that conversation and preparing people, I think is the most critical factor.

Susan Harrell (02:48):
So you don’t really want to bill that you didn’t expect. And especially if you find out that there are people that could have told you that it was coming down the pike and help you to figure out how to make that work within your budget. So all of these things, I think, as we’re sharing them are about really helping to support people, to know what their responsibilities are, to make decisions, and to really feel more solid and secure about what’s going on in their lives and these areas where we can help them to predict what may be happening.

Scott Leonard (00:00):

So you were talking about how some of these costs there, they’re not very expensive relative to say private insurance, right. But still for people who are low income, some of these costs can be really expensive and especially like Medicare part B, that’s a…that can cost $135 and 50 cents. So for someone who’s low income, that can be, that can be a lot of money to, to to pay. So there are Medicare Savings Plans and we’ll have, we have another slide where we’re going to talk about this and this reduce the cost associated with Medicare part B. So if people have low income and resources, they may qualify for a Medicare Savings Plan and there’s no cost for that plan. Also, people can qualify for extra help, which is also called a low income subsidy. And that’s basically help with the cost of part D, which is for the drug coverage. So again, if people had low income and resources below certain limits, they may qualify for extra help. They may qualify for support for helping keep the cost of the prescriptions at a minimum.

Now, if people have Medicaid and Medicare, they automatically enroll in a Medicare Savings Plan and they automatically qualify for extra help.

Susan Harrell (01:19):
So that really is a big deal for people to be able to access these various ways to cover those premiums. And again, this is something that a lot of people aren’t aware of. So for instance, somebody who is receiving Medicare and maybe they need some Medicaid based services, a piece of information they rarely receive is how that may impact the premiums they’re paying in Medicare, because they will automatically qualify for coverage of some of those premiums. So it’s, it’s another nice little nuance that can enhance what somebody brings home and keeps in their household. When they’re looking at dual coverage between Medicaid and Medicare.

Scott Leonard (02:08):
That’s right. That’s right. And we’re going to be talking a little bit more about different pathways that people can become eligible for Medicaid. Sometimes those cost money, but the cost of say buying Medicaid may be less than the cost of part B. It may be advantageous for them to go that direction. So that’s a really good point.

Susan Harrell (02:24):
And I kind of see us as we may be considered nerds. I mean that there is a possibility that people fake for dirt, but it’s so much fun when you’re able to figure out strategies that land money in people’s laps that help them have bigger, better lives, you know, even $135 a month extra woo-hoo, you know? I mean, that’s super exciting. And I think it feeds my desire to learn more because as nerdy, as it sounds, knowing that I can go through and research these things and introduce people to new ways to have is really powerful.

Scott Leonard (03:02):
I completely agree. If people have a question about Medicare Savings Plans, they can go to the website, Washington Connection, we have that link later on to get more information about those plans and apply, and then extra help people tend to apply actually through Social Security and Social Security will send lots of information now about this low income subsidy, the extra help. But if people have Medicaid they tend to just sort of automatically enroll in that tends to happen behind the scenes is my experience. Yeah. So this slide, there’s a lot of information on here. These are on the Medicare Savings Plans. We’re not going to actually go into a lot of information here because I think it could be overwhelming, but these are terms that people hear about. So we wanted to have it here. These are

Medicare Savings Plans. So you see QMB you hear people saying, “Oh, I’m eligible for QMB”. And like, well, what is, what is QMB? That’s a Medicare Savings Plan. There’s a few here. There’s QMB, which is Qualified Medicare Beneficiary program. SLMB, which is Specified Low Income Medicare Beneficiary program. The QI program, which is Qualified Individual program, and the Qualified Disabled Working Individual or QDWI. That, a lot of that ends up happening behind the scenes where the decision is made for which Medicare Savings Plan the person is eligible for. So for example, if a person’s income and resources are below those limits listed here for QMB, they would qualify for the QMB Medicare Savings Plan. Now you can see on this slide, all the things paid for through that plan, Medicare part A premiums, Medicare part B premiums, coinsurance deductibles, co-Payments… That’s a huge cost savings for people who have low income. Now I’d like to point out something at the bottom of this chart, the buy- in. This is what we call the state buy-in and it refers to an individual qualifying for Medicaid and Medicare.

Scott Leonard (05:06):
If a person receives Medicaid, then you automatically qualify for a Medicare Savings Plan. And at a minimum will have their part B premiums, coinsurance, and deductibles covered. You’ll notice on this chart, we don’t have income limits or resource limits listed here for the state buy-In because those income and resource limits are dependent on the person’s eligibility pathway for Medicaid and the rules of that pathway.

Susan Harrell (05:32):
It is all very confusing. Yeah. You know, like so many things, it really is like, you have to lay out this table. I take a look at it and try to figure out, you know, why does somebody fall in a certain place and what limits are there? But I think in general, the message that I get is that there is some assistance as people graduate in their income levels to try and help them out with the premiums on various parts of Medicare, and that’s the most essential message.

Scott Leonard (06:00):
Exactly. That’s exactly it. And we include this information only because people do hear these terms, but they don’t know what they mean. And this is, this essentially lays out what these terms are and sort of the boundaries of, of eligibility.

Susan Harrell (00:00):
Let’s talk about the framework for Medicaid a little bit more. Medicaid is a federally and state funded program. It’s a partnership between the federal government and state governments, and is about a needs-based health coverage, health insurance program. And States providing Medicaid services are required to cover certain mandatory services and they have to cover certain mandatory eligibility groups. And that’s their agreement with federal government is like, “yeah, we’re gonna, you’re gonna be partnering with us to pay for these services, but we have to cover certain mandatory things”. And they provided these in a state plan that is identified by the federal government. So you have this state plan services and it is really the core group of services that a state is mandated to provide. Now that’s like medical appointments. There’s, there’s a whole list of things that are not the ad-ons that we typically see for individuals, for instance, with significant disabilities that need services and supports in their home or their community.

Susan Harrell (01:13):
And those come into play and they vary from state to state by states proposing optional services and optional eligibility groups. So that’s something where you’re going to get a different as you go state to state around the nation. It’s not consistent and predictable from state to state. And in fact, even Washington State the groups or the services that are covered may change from time to time because the state is proposing to the federal government, “Hey, we’d like to, we’d like to provide this program. Will you give us your stamp of approval to provide it?” And so they can provide some additional services and additional groups that would be Medicaid covered well beyond the required or mandatory services that they have in their state plan. And Medicaid programs are means tested. Now, it shouldn’t be a big surprise since framework for them is, is largely in the SSI program, right?

Susan Harrell (02:21):
So in the SSI program, those benefits are means-tested. You have to have a need for those benefits. And income and resources may be considered for Medicaid as well. And that’s because they are intended…the services under Medicaid, are intended for folks considered to meet a low-income standard. And when I use the word may income and resources may be considered in certain Medicaid programs, they may not be considered, or they may be considered at a different amount than the SSI program considers income and resources. So, again, this is another place where it’s like going into an ice cream shop and you’ve got many different flavors to choose from. And they all have different things about them, right? It’s sort of the same thing, or like your analogy of the house in our earlier training, where there are different rooms in the house trying to help people see that if you lose Medicaid in one way, doesn’t mean that you don’t have other paths where you can access Medicaid that have different definitions of what’s provided what the income standards are and whether or not there are resource limits.

Susan Harrell (03:42):
So like I said, the “House of Medicaid” has many doors and each with a set of keys or rules. The program that is associated with SSI, and so Medicaid, if I’m on SSI cash benefits, I’m going to have Medicaid automatically. If I stop receiving cash benefits and would otherwise be eligible for SSI. And I stop receiving cash benefits because of my working efforts, I would go into, what’s known as 1619B Medicaid. It’s a way to assure that people aren’t afraid to lose their Medicaid as they go to work. Right? So that’s one of those examples of a Medicaid option for someone. We also have this New Adult Medicaid that came with the affordable care act and has expanded the coverage groups for Medicaid so that whether or not somebody has a disability, they may be able to access Medicaid anyway, and this has been a real gift to a lot of people who are, for instance, maybe they’ve become injured or, or have a disability that, that has progressed to a point where they’re not able to work.

Susan Harrell (04:53):
And they’re waiting for a decision about cash benefits or they’re waiting for their Medicare to kick in across that 24 month waiting period. They would be able to perhaps access Medicaid this way. But there’s also this thing called Apple Health for Workers with Disabilities, which is Washington State’s Medicaid buy-in program. People pay a premium for this Medicaid coverage. We’re going to be discussing that. That is something that came through the Ticket to Work legislation that was passed in 1999. So another, in my lifetime, recent addition to the Medicaid flavors for people that was introduced federally and States could make some decisions about what they wanted to do in introducing a buy-in program that promoted or gave a work incentive to individuals that were actively working. And then we have home and Community-Based Waivers. Now this is another one of those optional programs that was introduced.

Susan Harrell (06:01):
And it really is about supporting people so that they are able to live and work in their communities. And it provides a host of services that may be much bigger, much broader than we typically see covered with Medicaid. And the thing about all of these is that they are different in the way they look at income, the way they look at resources, the services that are provided. And these are just four examples in our number of different rooms or number of different flavors of Medicaid. So determining where someone should fit is going to be dependent on their income and resources, but it’s also going to be dependent on what they need for cirrhosis out of the Medicaid program. And so we wanted to make sure that you understood, it’s not your role to understand all of these, this exercise of going through some examples is to help you to be able to convey to people. There are a number of different ways to become eligible for Medicaid. And if you are not able to be eligible in one Medicaid pathway or one Medicaid room, you may be able to be eligible otherwise. So it’s, you need benefits, planning to sort out these options.

Ultimately, we’re just going to give you an overview of what some of those are so that you can help to dispel myths and fears around it. I think that’s really our largest intent today with this information.

Scott Leonard (07:33):
Yes, absolutely. I think people don’t understand this, that there’s lots of different ways to qualify for Medicaid. And it’s hard to, you don’t want to get lost in the details necessarily of all the different ways that they may qualify for Medicaid. So I liked that sort of high level approach. I’m talking about it as being different flavors or as different doors, for example, to Medicaid. So sometimes when I’m meeting with people, I talk about the, “The house of Medicaid” and there’s several doorways to get into the house and you have a set of keys. And if you go in that’s one set of rules, maybe this one has a certain income limit and a certain resource restriction, and that gets you into the door, but things might change in your life. And maybe now you can no longer go through that doorway. So then you walk around to another door and you have a different set of keys, which is another set of rules. And that allows you to kind of click in and get into Medicaid. And now there’s different rules perhaps around income and perhaps different rules around resources. And so that helps people understand that there are all these different ways that people can qualify for Medicaid. It’s important for people to realize in the past, it’s not always been easy to qualify for Medicaid. And now there’s so many different pathways to Medicaid eligibility that I think that people don’t have to be quite as concerned about that as they have been in the past.

Susan Harrell (08:50):
It’s changed a lot in the last 20 years. And then even over this past year, there’s some really promising news that we can talk a little bit about, but it’s not the same as it used to be when we’d be really concerned that somebody wasn’t going to have access to, to what they needed.

Susan Harrell (00:00):
So if eligibility is lost under one Medicaid pathway, the state is required to consider eligibility under other pathways before terminating Medicaid coverage. And the eligibility for this is redetermined every 12 months. So they’re going to go through a process of looking at, did you, do you meet the income standards? Do you meet the resource standards and any of the other standards associated with the Medicaid program that you’re involved in are going to be things that are reviewed? I wanted to go back to number one though, because I think sometimes individuals get information that they are losing Medicaid under one pathway. For instance, Social Security sends the individual a letter and they say you were over the resource limit and where you were no longer eligible for Medicaid. Like just for instance. So the individual receives that letter from Social Security and then a bit later, they receive information from the state of Washington saying, Hey, fill out this information to help us determine your Medicaid eligibility. And the individual is thinking well, the state of Washington is confused. I’ve already heard from Social Security that I’m not eligible for Medicaid. So this must just be a mistake. They get rid of the, the information. So the, the state has opened the door to consider eligibility. They’re asking you for information and you as an individual, aren’t providing the information cause you don’t understand that that’s what’s happening. And you feel like they already told me I don’t get Medicaid, why would I go through filling out this paperwork? Do you have that happen as well?

Scott Leonard (01:41):
Absolutely, and when people don’t fill out that paperwork and they may send it out a couple of times, but then they stop and the person can actually lose their Medicaid when really, if they had just filled out that information and given it to the state so they can make the decision about which other way that the person could qualify for Medicaid, they would’ve stayed eligible for that benefit. Yeah.

Susan Harrell (02:00):
Yeah. It’s a, there’s a lot of things to be sharing with individuals about cash and medical benefits as time goes on. And a lot of that framework, if you can get it to them early on, will completely help to avoid these crisises that tend to come our way as a result of an individual, just not getting the information they need to be prepared for what’s happening.

Scott Leonard (02:24):
Yeah. I think people really need to pay attention to that, the letters that they get in the mail, because that might be about Medicaid, the loss of Medicaid. So let’s find another Avenue for you to qualify for Medicaid, or it could be from Social Security about Medicare. And this is a time period when you may want to change your prescription drug plan. But people need to read that mail to understand what’s going on and the timeframe that’s available to make those decisions. And I understand it’s, it’s hard though, for people to always respond to that paperwork because there’s a lot of paperwork that comes in when you receive government benefits. It’s a lot to manage.

Susan Harrell (02:59):
It is. It’s not entertaining reading. It’s not, you know?

Scott Leonard (03:03):
And it’s not always clear.

Susan Harrell (03:05):
No, it can be really confusing. So I wanted to give you this sort of a graphic with three examples of Medicaid pathways. Now these are just three examples, but I thought we could lay it out and kind of compare just so that in general, we could display some differences in resource and income thresholds and things like that. So on the far left is the Social Security 1619B program. This again, it’s the program where somebody is working and is no longer eligible to receive a cash SSI benefit. They may well continue their Medicaid eligibility through 1619B. And this really keeps them attached to the SSI program, well past when they get a cash benefit.

Susan Harrell (03:51):
The annual income threshold for 1619B is listed below. When we say income, we are referring to earnings and wages. There is also a $2,000 resource limit per month for the 1619B work incentive, which makes sense because it is associated with the SSI benefit program.

Susan Harrell (04:17):
Now, some of the additional information is that home and Community-Based Waiver Services, the services that somebody may receive in their home or in a community setting to support them well above typical Medicaid programs would be an eligibility group that’s covered if I was on 1619B Medicaid, the other things are that there are no premiums for the program, so you don’t have to pay a premium for it. And an individual threshold could be set if I’m a higher user of Medicaid. If my expenses are a lot more. And the reason for that is that 1619B was really constructed to make sure that people could rise to an income level where they could afford to cover their medical expenses prior to loss of Medicaid. So that the threshold that is set is really based on a number of factors, which in part are an indication of the average cost of the Medicaid within a state.

Susan Harrell (05:21):
But if somebody is above average in their use, they certainly can have an individual thresholds set. And that would be something. If I knew that somebody needed a lot of personal care, a lot of support in their home, a lot of support in their job definitely would be suggesting to them that they talk with a benefit planner to help them to sort out, can they get an individualized threshold.

Scott Leonard (05:43):
That’s right. And they can gather all that information and give it to Social Security for them to make that decision. But I’ve seen people with thresholds that are significantly higher than that amount. I’ve also noticed that there’s different thresholds with different States.

Susan Harrell (05:53):
There definitely are. And that’s something where many of the things we’re talking about, if that if we’re looking at a variation from state to state plugging in the current year and whatever the administration or government entity is, that’s overseeing it. So in this case, it’d be SSA 1619B. If I put that into my search engine, then I would be able to pull the numbers for other States and to see how that plays out. The next Medicaid pathway that I want to talk about is under that umbrella of Washington, Apple health that you referred to earlier which is the moniker, the title, the branding for the Medicaid programs in our state. We have the adult Medicaid that really came about as a, as a part of, or a product of the Affordable Care Act.

Susan Harrell (06:43):
You can see here, the annual income threshold for this program.

Susan Harrell (06:48):
There is no resource limit for this program. You do not have to have a disability for this program, even though we’re really presenting to folks that hopefully are interested in employment and for people with disabilities still this there’s not a disability standard for this program. It will cover personal care and other Medicaid services, but it does not cover the home and community-based services typically that we talk about with waivers. Although it may allow you to be enrolled in another program that we’re going to be talking about shortly, and there are no premiums for the, this new adult Medicaid program. So it’s a really great option for people that are waiting for Medicare coverage. For instance this provides an easy Avenue to get some kind of medical coverage when people really need it. They’re maybe not able to work. They don’t have the coverage otherwise or they need it because they’re really trying to figure out how to sort through what they need to do next.

Susan Harrell (07:50):
And it’s very clear that Medicaid coverage would enhance their lives and help them along because you don’t really have to prove to, you don’t have to prove disability with this one. Sure. and then there’s our Medicaid buy-in, which is now called Apple health for workers with disabilities. But many of us that have been around awhile still call it Healthcare for Workers with Disabilities or HWD. And this program was the one that was set up through the Ticket to Work Act in 1999 that the framework was set up or passed federally. And then in Washington State, this program started up in the early two thousands,

Susan Harrell (08:30):
And it allows people to buy into Medicaid. Now you have to be working at the time you were applying in order to be eligible for this program. So it is designed for people who are working. There are some provisions for job loss that people would want to be aware of as they explore this program, because yes, you have to be working at the point that you are applying and become eligible, but there is a recognition that things may happen that cause a person to become unemployed during the space and time of their eligibility for the program and their annual review, that’s set to that same month each year that they became eligible. So you just have to be aware of having a backup plan. But what is amazing about this program is that there are no income limits and no resource limits in order to be eligible for the program. And this means that a person can have as much income as they wanted as much savings as they want, and still be eligible for Medicaid through Apple Health for Workers with Disabilities. It’s really incredible. And in addition, HWD is reasonably priced. The premium can’t be any more than 7.5% of a person’s total monthly income. So what does that mean? It means that if I had total monthly income of a thousand dollars a month, the premium would only be $75 per month maximum. And it may be far less.

Scott Leonard (10:13):
One of the things that I’ve noticed Susan, is that a person may be eligible for say Adult Medicaid, but then they get a job and go over the income threshold for that program. And if the person has a disability, they can then move over to HWD, which has no income limit, and they can remain eligible for Medicaid. So there are ways that people can move around and land on these different eligibility pathways.

Susan Harrell (10:40):
Most definitely, and it’s, it’s really, it provides more access for folks, which is such a relief when we’re trying to encourage people to be able to live larger lives.

Scott Leonard (10:53):
You know, another thing I want to say about this HWD program is that, you mentioned Susan, that, you know, you have to be working at the time of when you apply for HWD program to become eligible. And, you know, sometimes people lose their jobs. And then at the next annual review date, they may not be working. They may not be eligible for HWD at that time. So what do you do about the money that you may have saved up? Because you’re on HWD you can save up money and that money does not count towards your resource restrictions. Well, with HWD what they say is that if you save your earnings in a separate account, those earnings, if you come off of HWD, even if they’re over $2,000 will not count as a resource for Medicaid purposes. So when people are signing up for HWD or if you’re already on HWD, you should be aware that it is advantageous to set your earnings a dedicated account. So if you come off of that program, those funds will not count as a resource.

Susan Harrell (12:00):
Yes. And dedicated is really, the word. It’s super important to be separated out. So it takes a little bit of work at the front end, but it provides you with that protection for those dollars, you have saved if you need to bounce into another Medicaid program.

Susan Harrell (12:18):
Yeah. And, you know, I think one of the reasons that we really listed these three programs is because these three programs I lean on pretty heavily, when I’m thinking about strategies for Medicaid coverage for folks, it’s not that there aren’t other avenues and other options for people, but these are really flexible and fairly simple to try to figure out exactly where something may come into play. We have other options on, sometimes you have to pull those out. But I certainly think that if I were thinking about the, the most commonly used for typical circumstances, these three would be the three that I would come upon. How about you?

Scott Leonard (13:00):
Yeah, I would say the same. Yeah.

Susan Harrell (00:00):
So I want to talk a little bit about Waivers because we alluded to them in the last slide, Waivers are directly tied to Medicaid. This is where people may be getting services, and they’re just told they’re on a Waiver and nobody utters the word Medicaid. So when they’re asked questions about whether they need Medicaid coverage, they say no, because they don’t realize that their Waiver is a Medicaid covered service. So I want to talk a little bit about what a Waiver is just really briefly. A Waiver is something that allows someone to be supported in their community instead of in an institution. And so it, it allows States to propose to the federal government that they will provide a variety of services that will support that individual in successfully navigating in the community either by supporting them in their home, supporting them in the community or combined effort on both parts.

Susan Harrell (00:55):
Even with Employment Services, with some of the Waivers… And the federal government takes a look at it because they’re partnering with States to pay for it. And basically what they say is they will waive the requirements of somebody needing to be in an institution to get those various pieces of care because a state can provide those services. They’re proposing to provide those services at a cost that actually represents a savings over the institution. And so they say, “okay, you don’t have to have an obligation.

The individual can waive the right to be in an institution to get those services and instead get them in their community”. That’s really what they’re about. And there are some examples in Washington state, what you get are very different depending on what, what Waiver you’re on. But here are some examples. There’s the Basic Plus,

Susan Harrell (01:48):
There’s the Core Waivers, and there’s Community Protection Waivers. Now those are Waivers that are over in the Developmental Disabilities arena administered by the Developmental Disabilities Administration. And then we have COPES and that is a home and community services, kind of a program. There’s New Freedom. There’s others that are out there. And really, again, we’re not going to try to give you an all-inclusive example. We kind of are looking at what are the things that have come up where people have had questions. The benefits planners are going to be essential when somebody is on our Waiver and concerned with maintaining their eligibility as they go to work. And ultimately that’s the key.

Scott Leonard (02:28):
That’s right. Yeah. Like the rules, for example, around these, those DDA Waivers, that Basic Plus community protection the Core Waivers have a different set of rules and say the COPES Waiver or new freedom. And that’s, that’s a lot for people to sort of manage. And so it’s really helpful for a benefits planner to define sort of what those parameters are around, around income and resources.

Susan Harrell (02:50):
You know, when I, when I’m working with an individual, I’m trying to figure out what it is that we need to do. Strategically, as they tell me about their employment goals, I asked them about their priorities. Cause I want, I want to have an idea of what are the most important things to them. It helps me to narrow the information, but I also ask some questions about their income now. And, and I, I shore up that information by seeking information from Social Security and taking a look at pay stubs and things like that. But I’m looking at income. I’m looking at resources because a $2,000 resource limit could be really, it could impinge on somebody in a big way, even if they currently have Medicaid coverage, their goal may be to be able to save a lot more money to not live this way, to not have it have to go into certain places to protect it. So that could be a part of their priority. And then I try to figure out their goals for employment, ultimately, to get to the Medicaid services they need. Then I produce strategies that will help them given everything else that I’m hearing. And that’s really the process that we look at to sort out the complexities and get down to the individual level, to help somebody maximize their work efforts and still know that they’re going to get the Medicaid that they need

Scott Leonard (04:12):
And, and, and also to present options and they can make the choice, right? Sometimes don’t realize that they have choices about which pathway they want to go on for a variety of benefits.

Susan Harrell (04:21):
I’ve heard so many times, if you make too much money, you’re gonna lose Medicaid, just flat out and that kind of information, without taking into account the individual circumstances and what they need it again, condemns people to a life of poverty. As we’ve talked about in our other sessions, I’ve had parents cry when they realize that they’ve been guiding their sons and daughters in a way that’s really limited without full knowledge of what kind of Medicaid coverage the person could get the Buy-in. And it’s happened for years because they’ve been informed by professionals, “This is it. If you want them to be able to get the services he needs, he can’t make more than this”. Right. And I, there are limits. There are limits for, for people in some, some of the things that they are looking at as their priorities. But in many cases there are options and strategies and, and ways to go well beyond what they’ve been told are the limits.

Susan Harrell (00:00):
Here is there’s two pages here that we’ve provided to not because we’re going to go through all of these words. But because we wanted to show you all of the many different flavors of Medicaid that are just examples of some of the ways that people can get to the services that they need. Now in the upper right-hand corner, it really defines what the income thresholds or the resource thresholds are for these different programs. And then the table itself provides you with a variety of Medicaid pathways. And you can see on this page that we have financial eligibility for the DDA Home and Community-Based Services Waivers, right? And that green bar only goes over certain pathways for Medicaid, and so that indicates that if somebody needed that kind of a waiver, these are the programs, these are the pathways that would provide them with eligibility.

Susan Harrell (00:58):
And then if you go dig into each of those pathways, you can read about what the income standard is. Now that’s the income threshold. It typically refers to a number that’s going to be up in that chart on the right hand side. And then it also gives you some other information about who fits into those groups.

Now, this information is something that provides a lot of detail and is not necessarily something that each and every one of the people that are participating in this webinar are going to have an interest in digging into nor do they need to dig into it. But for those of you that really wanted more detail, we wanted to provide you with the options for that. And for those of you that really just want to skim the surface, just look at all of the different ways that people can access Medicaid just on this first page, which included some ways to access.

Susan Harrell (01:51):
If you don’t need the DDA Waivers, right? As well as ways to access if you do. And then if we go to the next Medicaid page, this is for financial eligibility, for the Home and Community-Based Services Waivers serving largely other populations beyond the DD waivers, the Developmental Disabilities Administration waivers, as well as some people that are served there in that arena and the waiver there is known as COPES their Home and Community-Based Services Waiver. So this defines well, three different main groups for financial eligibility for the COPES Waivers. It also provides you with the Apple Health for Workers with Disabilities, which is a waiver eligibility with the Developmental Disabilities Administration on the prior page, as well as with this COPES Waiver. And also ultimately the message that I really hope that you can absorb is that when somebody is told that they can’t work, or if they work, they’ll lose Medicaid, it’s really important to be sure that someone’s taken a good, hard look. These are just a few of the examples. And I, I think this is the greatest fear. People are willing to work their way off of cash benefits if they make enough money from employment. But loss of medical benefits is really scary to individuals and for good reason. So it’s really, really important to try to share the message that they have options. However you choose to do that.

Scott Leonard (03:32):
You know, Susan, I actually love these charts around doing benefits, planning with people. I still refer to them because I need that level of detail to give people the information that they need to make choices. Right. But I think, yeah, as you said for this presentation, that’s a lot of information for folks, but they do. I think it is clear that there are all these different avenues and these are just a couple of slides. We can have many more slides and many more avenues for Medicaid eligibility, right?

Susan Harrell (03:59):
Yeah. And again, it’s like, we’re trying to figure out what are the things that are the examples that really can fit into the framework of options. So yeah, like I said, for those of you that are interested in digging in a little deeper, you’re able to take a look at that. And for those of you that really just need to get the overall message that there are options, hopefully that this gives you that as well.

Susan Harrell (00:00):
You notice that when we’re talking, sometimes Medicaid programs have resource limits and as a person’s income increases, the more likely it is that they’re also going to increase their resources. So, you know, somebody that’s on 1619B and making 33,000 a year, for instance, is going to have an issue with the $2,000 resource limit most likely. And so for those folks, there are ways for them to be able to save and still remain eligible even within the Medicaid arena that they’re already in. And so we’re going to be talking about that and looking at that strategy as well.

Scott Leonard (00:45):
This slide is about ABLE, which stands for Achieving a Better Life Experience. ABLE is a mechanism where people can save money and maintain their benefits. The money that is saved in an ABLE account up to some established maximum limits will not count as a resource for SSI and Medicaid purposes. So who is eligible? ABLE is available to people who meet the federal criteria for having a significant disability. And the disability began prior to a certain age, that age limit is listed on this slide. This requirement is often satisfied by being eligible for Social Security Disability Benefit prior to that age. But if a person did not begin receiving disability benefits until after that age limit, they can still qualify for ABLE if they can show that their disability began earlier, prior to that age and that they met the federal criteria for having significant disability with an ABLE account, people can save money up to a certain limit each year. And if a person is working, they can actually save even more annually. Those limits, which I actually think are really high are shown here. Now I mentioned maximum limits earlier. There is a maximum limit to how much money can be sheltered in ABLE for SSI purposes. And if a person saves beyond that, their SSI will be suspended, but not terminated, and they can still maintain their Medicaid eligibility up to a threshold that is even higher.

Susan Harrell (02:16):
It’s pretty powerful. And this is one of those things where there may be people that aren’t aware of it because it is so recent. And it’s transformative. It changes people’s options. When they are able to save like this. It gives them, I think, more security in thinking about their future, which has been pretty limited for lots of people with disabilities over the years, unless they could afford to set up a Special Needs Trust, or they were eligible for a Special Needs Trust that provided them the same sort of protection, but that was hard for people. And this really is such a great option for lots of people. But it is so new that it’s likely that the word hasn’t gotten out to all of the nooks and crannies in, in not just services that are being provided professionally, but also directly to individuals and families.

Scott Leonard (03:13):
Yeah. ABLE is a great program. Now, there is an annual fee and some other additional fees, but overall it’s not very expensive. And what’s really cool here is that people have the option to invest these savings. There is a range of investment risk options that a person can choose from. And if the money that is invested grows, the person does not have to pay taxes on those funds. It’s really very empowering for the individual.

Susan Harrell (03:42):
It’s remarkable to think about it being again, like anyone else’s portfolio, when you’re making decisions about the kinds of investments you want to make sure

Scott Leonard (03:51):
If people want more information, they can go to the website listed below.

Susan Harrell (03:56):
Great, good information. And we did talk about this in a previous presentation as well, but it not only relates to those cash benefits, but of course the Medicaid, as you mentioned earlier. So it’s a really good tool.

Scott Leonard (00:00):
So Foundational Community Supports Program: This program is actually not a program that gives people Medicaid, but if people qualify for Medicaid, they may qualify for the Foundational Community Supports Program, or FCS as a lot of people refer to it. And basically it helps the most vulnerable individuals either get supports with housing or employment. And or I should say housing and employment, and there’s a variety of providers who can provide assistance with housing and employment. And so we provided here a link to a map you can actually go on there and look at the various FCS providers that are available in their area. And they can also look at a list. So we have a link there of the list of different types of providers that are across Washington State. And what’s, what’s great about this program is that people can also, they can self-refer. I’ve worked with agencies who provide FCS services, where someone’s actually just walked into the organization and say, I want employment supports. They have Medicaid, and they may qualify for this program. And when they do, they receive some supports with helping to pursue successful employment.

Susan Harrell (01:09):
Right, and so that chart where we showed those three Medicaid options, for instance, very simple, typical way somebody might have Medicaid either through SSI or 1619B, or through that new Adult Medicaid option where they don’t consider resources only consider income. Or through Healthcare for Workers with Disabilities. If they are already working a little bit right, where maybe they’re working an hour or two or something like that, and they really want access to some supports to grow their employment or supports in their housing. They have Medicaid coverage. They could go right into an organization and say, I want services and get the assistance they need to get on.

Scott Leonard (01:53):
Right, there’s people who have, because there’s so many ways to qualify for Medicaid, as long as they have one of those Medicaid and they have some, some support needs, they can qualify for these programs though this program. And it’s really great to help them out with their employment and housing needs.

Susan Harrell (02:07):
Yeah. And again, you know, as complex as all of these things are, I get hopeful as I begin Scott and I didn’t construct all of these different complicated programs. I want to make sure you all know that, but I start to have hope when they’re introducing easier avenues for people to readily get what they need, that we’re finally getting to a place where the level of complexity is going to drop down enough, that it makes it a fairly easy access option for individuals. Whether it’s the Medicaid things or the services themselves that are attached to Medicaid. Trying to eliminate as much complexity as possible is so important. And it seems like there are a number of things, a number of changes that have happened from the introduction of the Affordable Care Act and the new Adult Medicaid to the work that’s been done on Apple Health for Workers with Disabilities, the Medicaid buy-in to eliminate income limits for instance, and allow an individual really to know they’ll… They can look to that as a way to always have Medicaid if they have a disability and they work and earn a lot of money, to this Foundational Community Supports where the access to services is simplified. It’s really exciting.

Scott Leonard (03:26):
Yeah, it is. And you know, one thing that’s interesting about this program is that people who, for example, want to look for work and they’re receiving services through FCS, they can receive benefits planning as part of that service, you know. So they’re valuing the importance of understanding benefits while a person’s making decisions around work. And I think that’s really that’s really great about this program.

Susan Harrell (00:00):
Many of you may have heard about Estate Recovery. It is the way in which there could be recovery of the cost of care that somebody receives from a recipients estate, under certain circumstances. And it’s, it’s really recovery of the cost paid for long-term care in other medical or Medicaid services that somebody receives. It does not usually allow for Estate Recovery to happen when a person is still living. And also during the lifetime of a surviving spouse or a registered domestic partner, so someone that is a partner to that individual, and while there is a surviving child of that recipient of those medical services, who is under the age of 21, or who is blind or somebody with a disability of any age, that’s a dependent or in the care of that parent. There are some other factors around Estate Recovery too. The age of the person who receives the services is certainly one of those parameters, as well as the dates when services were received and the type of services. So we already identified that long-term care is one of those services where there could be Estate Recovery where the cost of that care could be recovered.

And there are some other identified services, but there are also different dates of implementation for when Estate Recovery occurs. Like for instance, this is a person over the age of 65 by a certain date? Are they over the age of 60 by a different date that was later implemented? Are they over the age of 55?

Some of the more recent dates and times and ages that were implemented. And so what I say to people when they’re wondering about this, is that getting the details through benefits planning, even for Estate Recovery, is something that you can certainly do and probably should do. If you have concerns about this and in light of the Estate that you have. The typical rule of thumb for lots of the individuals that I’ve dealt with in long-term care services like through Waivers, is that it comes into play when somebody is over the age of 55. And for many of those services is certainly would come into play. Now, there were lots of people that I work with that don’t have much of an Estate, but the fact that we’re talking about ways in which people can save money, means that we would be putting them into a position where there would be money that could be recovered through Estate Recovery.

Scott Leonard (02:45):
That’s correct. Yeah. I tend to tell that information to folks, as they’re talking about savings strategies.

Susan Harrell (02:52):
Yeah, it’s important to prepare people again for whatever is going to happen.

Scott Leonard (00:00):
Medicaid and the Premium Payment Program: We talked about this briefly, and I’m going to go through this slide just just to make sure we have enough time to finish this presentation, but… So, people who pay for private health insurance coverage, so that would be through an employer or a private policy or even COBRA, and they have Medicaid. They may actually be able to get reimbursed for summer. All of that cost. A lot of people don’t know about this. This is pretty amazing. So basically when people fill up this application and a W-9, they would send it to that address, the Premium Payment Program, Health Care Authority, or they can fax it in and then they’ll make a decision. And I’ve seen people who have Medicaid…they, maybe they were paying for private insurance and then they apply for this. And now they no longer have to pay for that private insurance. It’s pretty, that’s pretty powerful.

Susan Harrell (00:50):
And I do come upon people that are covered by parents. Maybe they’ve been, they’ve had a disability for a long time and their parents insurance plan through their work is able to cover them. And it comes at a cost to the parent, let’s say $300 a month. Well, if somebody’s on Apple Health for Workers with Disabilities and it costs them $150 a month in their premium, they certainly recoup that, plus a lot more in getting the Premium Payment Program rolling to cover that health insurance premium that is paid for by their parents.

Scott Leonard (01:25):
It’s such an interesting idea that you pay $150 for Medicaid, and now you no longer have to pay the $300 for your private health insurance or your parent’s private health insurance, really powerful. And people tend not to know that.

Susan Harrell (01:38):
Right? I come upon it all the time when I’m out presenting. I would say that if I’m presenting to a group of 30 people that the odds are that there’s somebody in that group that could benefit from this Premium Payment Program.

Scott Leonard (01:51):
Yeah. So there are some limits, I mean, plans that are purchased through the Health Benefit Exchange or through the Washington Health Plan Finder and they’re getting tax credits, they won’t be eligible for reimbursement. But if people have any concern about it, they can just fill out the application and include a W-9, submit it off to that Health Care Authority and let them make that decision.

Susan Harrell (02:11):
And I’m glad that we left it toward till towards the end, because in the middle of all of these other things that we’re talking about to understand that you can immediately land money in somebody’s lap, just by knowing this little secret is pretty cool.

Scott Leonard (02:26):
It shouldn’t be a secret, but it certainly feels that way doesn’t it?

Susan Harrell (02:29):
It does. There’s, there’s a lot of people that just really don’t know about it.

Scott Leonard (00:02):
So questions about medical coverage. So we’ve been talking about SHIBA at the first half of this presentation. If people have questions about Medicare or they need help navigating Medicare, I highly recommend that people get in contact with SHIBA. The phone number is there, or you can click on that that website. My experience, and, and when I talk to other individuals and families, I’ve only had really positive experiences with SHIBA. They go through a lot of training and they can provide a lot of detailed information and assistance to help people navigate some of the complexities with Medicare. And, you know, we were doing this presentation on Medicare. It was a high level, high level discussion, but there are some intricacies and subtleties that we didn’t get into, but a SHIBA representative may be able to help someone navigate through some of those.

Susan Harrell (00:51):
And they really are well-Trained. I took a training a five day training with the SHIBA volunteers at the centers for Medicare and Medicaid, the regional office in Seattle at the time. And the level of information they receive, how much detail they get, the big hefty notebooks of, you know, resources that they are able to utilize and how frequently they get those kinds of trainings is really impressive. So they are really skilled whether somebody is in somebody with a disability, or they’re thinking about retirement and thinking about Medicare, they are a great, great resource for all of those situations and answering questions and supporting people to make decisions.

Scott Leonard (01:33):
Absolutely. And it was, we were talking about earlier, when you’re making decisions about your own medical care or about the medical care of a loved one, there’s an emotional component there, and it can be stressful and they’re just such a good resource to help people navigate in those situations.

Susan Harrell (01:49):
They are, they’re great.

Scott Leonard (01:49):
If people want more information about Medicaid or they want to apply for Medicaid or Medicare Savings Plan, they can go to Washington Connection because at least that’s a good starting place, right, to sort of look at the different options for Medicaid and Medicare savings plans.

Susan Harrell (02:03):
Yes. And then they’re also working set of coordinators, as we had talked about in some of our earlier presentations and I have them listed here on this slide. The first two, Plan for Work and Plan to Work are funded by Social Security, the Social Security Administration. And so they are available to help people who are interested in going to work or who are working as their priority population, and they’re also on cash benefits to navigate a number of different issues. And that may well include the medical benefits component that we’ve talked about today. And then there’s a division of vocational rehabilitation for people who are enrolled with DVR. They can also access benefits planning services. So those are two different avenues that can bring you to free benefits planning services that really covers statewide need. There may be other resources as well. We didn’t really get into talking about where people might get benefits planning in other lesser known ways, but these benefit planning resources are also connected to other benefits planners and may be able to provide additional guidance.

Buck (animated character) (03:16):
If you want more information about the topics in this training, we welcome you to explore the Benefit U website. There, you will find handouts tools, calculation sheets, web links, and other resources to help you navigate your benefits and to make informed decisions as you move toward your life goals. After exploring the Benefit U website, if you still have questions, or if you need assistance with a particular matter related to your benefits, you can request benefits planning. When you request benefits planning, you may be connected to a certified benefits planner who can help you with your benefits situation.

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