Medicaid Doesn’t Have to be Overcomplicated!

Written by: Connor Kavanaugh, Special Needs Planner

September 22nd, 2020

Many people have the false assumption that Medicaid is not worth learning about, because they are under the impression that they won’t qualify due to income or asset limits. This is simply untrue! With effective planning, most special needs individuals can qualify for Medicaid benefits.

Another often confused topic is the key differences between Medicare and Medicaid. (That’s right, you aren’t the only one that gets confused!) Medicare and Medicaid are both medical programs provided by government entities to pay benefits to individuals who experience disability. That is where the similarity ends. They’re completely different, and each has its own rules and regulations! The two can be easily confused, and this is the point where many people give up. They are already overwhelmed with the never-ending world that is special needs planning and deciphering between two similar-sounding government programs just isn’t high on their to-do list. Especially if an individual does not believe they will qualify regardless.

Medicare is medical insurance for the elderly and individuals that experience disability. It’s just like any other medical insurance policy, except that the federal government provides it. It pays expenses related to short-term illness or injury, acute care and rehabilitation. If an individual is under the age of 65 and experiences disability, they will automatically get Part A and Part B after if they have been receiving disability benefits from Social Security for 24 months. (Learn more about Medicare here!)

Medicaid, however, is a federal, state and locally funded program! ln addition to covering medical services, it provides benefits for those needing long-term, custodial care, disabled, and financially eligible. Certain Medicaid services for people that qualify will assist people who have difficulties with the “activities of daily living,” such as bathing, dressing, eating, and going to the toilet, as well as those who need skilled nursing care. Medicaid also covers most medical expenses that are not covered by Medicare or other insurance.

One benefit of gaining Medicaid approval is that Medicaid will pay for long term care expenses that Medicare does not cover. You may also gain access to additional services, such as adult day care, medical transportation, physical, occupational and speech therapy, and K-Plan!

The K-Plan, in our opinion, is one of the most important benefits that a family has available to them. The K Plan is an Oregon-specific Medicaid state plan option authorized under the Affordable Care Act.

It allows states like Oregon to provide home and community-based services and supports while receiving a six percent increase in federal medical assistance funds from the federal government for those services.

These services massively benefit Oregonians who want to stay in their home and remain independent, healthy and safe. At the same time, it saves both the state and federal government money because we are providing more extensive home and community-based, long-term services and supports in lieu of more expensive institutional care! A great win-win program.

To be eligible for the K Plan, you must be an Oregon resident who is eligible for medical coverage and long-term care services via Oregon’s state Medicaid plan, and must have received a developmental disability diagnosis. To be eligible for this Medicaid program, there is an income limit of 300% of the Federal Benefit Rate (FBR). As of 2020, this means a single individual cannot have income more than $2,349 per month, or more than $28,188 per year. Liquid assets, such as checking accounts, savings accounts, stocks, and bonds, are limited to $2,000 for a single individual, and $3,000 for a married couple (when both spouses are applicants).

To apply, you can click here to access the state of Oregon’s page on the application process! All CDDPs use the same application for Developmental Disability services. Your local CDDP office can give you the form and help you complete it.

Medicaid can seem daunting but don’t let the confusing definitions and legal jargon intimidate you and scare you out of getting the benefits that you and your family deserve. If you’d like to learn more about Oregon K Plan, Medicaid, or how to apply, you can click here. Please contact your county case worker or if you’re not receiving county DD services, call your local county DD services office! You can view and find the one closest to you by clicking here!