A gentleman came into Promise Community Health Center in Sioux Center recently with a $20,000 hospital bill. The letter from the hospital stated that he might qualify for financial assistance and could set up a payment plan.
He asked Promise’s outreach coordinator Jessica Mora if she could help him with filling out the paperwork for the financial assistance and inquired if there were any other options available to help him with paying for his bill. While talking to him, she discovered he was eligible for the Iowa Health and Wellness Plan under the Medicaid expansion in Iowa. He met all the requirements, including income. Plus, Medicaid will cover bills that go back three months for new enrollees.
So she signed him up.
“He was not aware that he was eligible, so that really made his day,” Mora said.
Mora gets that situation from time to time. People have daunting medical bills, and they don’t know how they’re going to pay for them. They don’t realize that they are eligible for Medicaid assistance or don’t realize the program has expanded in Iowa.
But she and fellow community care coordinator Fatima Arteaga, both bilingual in English and Spanish, are there to help people determine their options. They will help anyone for free – whether or not they are patients of Promise.
Here are some common Medicaid questions that Mora hears from people:
What is Medicaid?
Medicaid is a health insurance program for people who are in certain eligibility groups and who are low income.
Do I qualify for Medicaid coverage?
Mora said people often think that only pregnant women, disabled people, or children can get Medicaid. And that’s the way it used to be.
However, due to the Medicaid expansion in Iowa in January 2014, adults between the ages of 19-64 with household incomes of up to 133 percent of the Federal Poverty Level now can qualify for coverage through the Iowa Health and Wellness Plan.
To be eligible, people also must live in Iowa and have U.S. citizenship or documented permanent legal status of more than five years.
What if I earn too much to qualify for Medicaid?
People with incomes that are too high for Medicaid have other options:
1.If they have medical costs that use up much of their income, they might qualify for payment help through the Medically Needy Plan under Medicaid.
2.Their children can be covered under the Healthy and Well Kids of Iowa (hawk-i) program. That has a higher income standard – with a family of four being able to earn as much as $94,000 per year to qualify. The same application to the Iowa Department of Human Services for Medicaid applies for hawk-i, too. Therefore, families that can’t get Medicaid are automatically enrolled in hawk-i if they qualify.
3.People also can apply for coverage through the federal Health Insurance Marketplace during the annual open enrollment period. Tax credits are available for people who fall under income guidelines to lower their monthly premium costs. Eight out of 10 people who apply have received tax credits.
Can I be dropped from Medicaid?
Unless their eligibility status changes, Mora said people will not lose their Medicaid coverage as long as they follow the requirements asked of them.
For example: If people don’t complete the annual renewal paperwork, they could be dropped. If they don’t provide requested information, such as proof of income or proof of citizenship or legal status, they could be dropped.
Mora said the annual renewal paperwork seems like a lot, but it really isn’t. It’s more to confirm the information on record for them. She would gladly help anyone with it.
What do I need to apply?
Mora said people should bring along two primary items for her to help them complete a Medicaid application:
1. Proof of income. They could bring along paystubs from the past 30 days, W2 forms, or a tax return from the past year.
2. A Social Security number if they have one.
How will the upcoming change to privatize Medicaid management affect me?
People on Medicaid should not see any changes in their benefits due to the change, Mora said. The transition, which is scheduled to take effect March 1, will impact health-care providers more than patients. As long as the provider is working with a managed care organization as required – as Promise and other healthcare systems are – the patients should not be affected much.
Finally, don’t hesitate to ask questions.
“Anybody is welcome to come in – not just Promise patients,” she said.
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