For parents of Florida children who have been struggling to provide their families with the medical care access they need to enjoy optimal health, recent news related to a decade-old class action lawsuit may offer new hope. A settlement reached last month between the plaintiffs, the state’s healthcare officials, and an independent medical and dental group obligates the state to work to improve those young Medicaid patients’ access to health services.
That lawsuit against the state of Florida has alleged that, during the period between 1999 and 2004, three-fourths of Florida’s children in the Medicaid program never received dental care. Worse, it claimed that a half a million of the state’s Medicaid-enrolled minors were provided with no preventive health services. Those access problems had been attributed to low Medicaid reimbursement rates in the state, as well as inefficient state monitoring systems and structural barriers within Florida’s system for administering the program.
As part of the settlement’s provisions, Florida’s Agency for Health Care Administration is required to further improve critical access to dental and health services for the affected children. It must also pay $12 million in legal fees to the plaintiffs. In addition, there will be opportunities for pediatricians to receive higher Medicaid reimbursement rates. The agency must mandate that all managed care plans offer those opportunities to child healthcare providers who meet certain treatment and patient access goals.
There are other key benefits that are detailed in the agreement, or that can be deduced from its provisions. For example, the new emphasis on increased access should enable parents to get their newborn children enrolled in the program much faster. The approval of a parent or guardian will also be required before a child’s doctor can be arbitrarily replaced. Most importantly, the AHCA is required to make every effort to ensure that the Florida Medicaid program is improved to the point where it is able to meet the national standards for care.
Obviously, this is just a settlement agreement, and agreements do not just automatically produce the results they intend. There is still much work to be done to ensure that the state’s 2 million Medicaid-enrolled children receive the health care to which they are entitled by law. At the same time, however, this agreement does present a positive roadmap that can guide all of the involved parties toward a better health care future for the state’s children.
Medicaid Tips for Better Healthcare Access
With many parents and seniors no longer having access to the types of comprehensive healthcare benefits that employers once provided as a matter of course, the need for programs like Medicaid is greater than ever. To get the most out of this assistance, it is important to understand some key tips for securing the best access to needed healthcare.
- States have specific rules governing access to the program, and access to healthcare. Both children and seniors alike have access to Medicaid services, but strict eligibility provisions do apply. In addition, states can have different enrollment processes and dramatically different cost-sharing requirements. As a result, you should consult the specific standards and requirements in place within your jurisdiction.
- In Florida, child eligibility for Title 19 (Medicaid) benefits is based on a combination of age and family income:
- Children one-year-old or younger are eligible if the family income is no more than 206% of the federal poverty level.
- Children between the ages of one and five are eligible as long as that income is no more than 140% of the poverty level.
- Children between the ages of six and eighteen can qualify with family incomes up to 133% of the poverty level.
- Young adults aged nineteen and twenty qualify with incomes up to 30% of the poverty level, as do adults with dependents.
- Pregnant women qualify if their family income is a much as 191% of the poverty level.
- Anyone who qualifies for SSI (Supplemental Security Income) is also eligible for Medicaid benefits.
- Families with children can apply online, or fill out a paper application and return it to a local service center.
- Medicaid currently provides coverage for more than four and a half million senior Americans, as well as 3.7 million disabled persons. Some seniors may be unaware that Medicare eligibility does not prevent them from also qualifying for Medicaid assistance. For millions of seniors, Medicaid provides critical gap coverage for services that Medicare often fails to provide. That can include everything from extended nursing facility care to eyeglasses and some prescription drugs. In instances where both programs provide coverage, Medicare pays first, and Medicaid then pays at least part of the remainder of the bill.
- To determine Medicaid eligibility for seniors, various monthly income and overall asset standards are used. Seniors interested in applying for Medicaid should familiarize themselves with those eligibility requirements.
Navigating the Medicaid Maze
As helpful as settlements like this might be for families with Medicaid-eligible children, that doesn’t change the complex nature of the program, or its eligibility requirements and application process. As difficult as those things can be for parents with children, they are often just as complex for the state’s seniors. It generally takes years of pre-planning for seniors to ensure that they have access to the program’s help when they will need it most. Without that planning, many of our most vulnerable elders can find themselves in need of long-term care or expensive medical treatment, but unable to meet the eligibility standards that would qualify them for assistance.
If you want to ensure that programs like Medicaid can help you with those needs later in life, sound estate planning is the answer. A competent and experienced legal team can help ensure that your estate plan properly positions your assets so that your application for Medicaid is not delayed or denied when you need assistance the most. Contact Robert Kulas Attorneys at Law now to learn how we can provide you the guidance and assistance you need to navigate the Medicaid maze.
