Medical Care Under 1965 Social Security Amendments

NEBRASKA

1. Name of State agency responsible for administering title XIX: Department of public welfare.

2. Date program began operation: July 1, 1966.

3. What groups became eligible when the program began?

(a) All persons who receive all or part of their incomes from the federally aided public assistance programs: Old-age assistance, aid to the blind, aid to families with dependent children, and aid to the permanently and totally disabled.

(b) All individuals in the above groups who would be entitled to financial assistance except that they do not meet the durational residence requirement of any of the public assistance programs.

(c) All individuals in the above groups who would be entitled to financial assistance except for an eligibility condition or other requirement in the State program which is prohibited in the title XIX medical assistance program.

(d) Persons in a medical facility (nursing home, hospital, or 65 years of age or over and in an institution for mental diseases) who, if they left such facility, would be financially eligible for assistance under the State's approved public assistance plans. This includes persons in medical facilities who do not receive money payments because they have enough income to meet their personal needs while in the institution, but not enough to meet their maintenance needs outside the facility according to the appropriate approved public assistance plan.

4. What are the maintenance levels for persons eligible for coverage? The public assistance standards in the money-payment programs listed above will serve as the maintenance levels, as Nebraska is not going to cover nonassistance groups initially. However, the State agency has set a standard of $150 per month for measuring eligibility of individuals in group 3 (d) above. 5. What are some major features of the Nebraska medical assistance program? The Nebraska plan provides for the following items of medical care and services:

(1) Inpatient hospital services (except limited, in the case of patients in mental institutions, to those age 65 or over, and excluding patients in tuberculosis institutions or in medical institutions as a result of a diagnosis of tuberculosis or phychosis);

(2) Outpatient hospital services;

(3) Physicians' services;

(4) Skilled nursing home services;

(5) Laboratory and X-ray services;

(6) Home health care services;

(7) Dental services;

(8) Clinic services;

(9) Prescribed drugs and medicines;

(10) Appliances and prosthetic devices;

(11) Ambulance services;

(12) Services of practitioners licensed to practice chiropractice, podiatry, optometry, nursing, or physical therapy.

6. What are the terms of financing the new program?

Nebraska is entitled to receive from the Federal Government approximately 60 percent of the costs of operating its medical assistance program. It is estimated that the Federal share of the cost of operating the program in Nebraska during fiscal year 1967 (July 1966-June 1967) will be $10,499,000.

7. How many persons are served by the new program?

The State estimated that 45,000 persons, or 3 percent of the population, would be served by this program during the first year.

NEW MEXICO

1. Name of State agency responsible for administering title XIX: Department of public welfare.

2. Date program to begin operation: December 1, 1966.

3. What groups became eligible when the program began?

(a) All persons who receive all or part of their incomes from the federally aided public assistance programs serving the aged, blind, disabled, and families with dependent children.

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(b) All individuals in the above groups who would be entitled to financial assistance except for an eligibility condition or other requirement (including durational residence) in a State program which is prohibited in the title XIX medical assistance program.

(c) Categorically needy individuals under age 21 in foster homes or private institutions for whom public agencies are assuming responsibility. 4. What are the maintenance levels for persons eligible for coverage? Not applicable. Plan provides medical assistance for money payment recipients only, hence, does not have income levels for determining medical indigency. 5. What are some of the major features of the medical assistance program? In addition to the five basic services (inpatient and outpatient hospital care, physicians' services, skilled nursing home care, lab and X-ray services) the State may provide under certain conditions:

(1) In a hospital or nursing home: Radiation therapy, private duty nursing, consultation, prosthetic devices.

(2) Outside of hospital: Medication and supplies, prostheses, physiotherapy, maternity home care, home nursing services, obstetrical care, rehabilitation center services, sight-saving and restoring care, dental care by public health units, oral surgery, and transportation.

6. What are the terms of financing the new program?

New Mexico is entitled to receive from the Federal Government approximately 71 percent of the costs of operating its medical assistance program. It is estimated that the Federal share of the cost of operating the program in New Mexico during fiscal year 1967 (July 1966-June 1967) will be $4,060,000.

7. How many persons are served by the new program?

It is estimated that in the first year of operation some 47,250 persons, or about 4.5 percent of an estimated population of 1,044,000, would receive assistance under the title XIX plan.

NEW YORK

1. Name of State agency responsible for administering title XIX: Department of social welfare.

2. Date program began operation: May 1, 1966.

3. What groups become eligible when the program began?

(a) All persons who receive all or part of their incomes from the federally aided public assistance programs: Aid to families with dependent children and aid to the aged, blind, or disabled.

(b) All persons who reside in the State who, except for having enough income for their daily needs (under State assistance standards), could qualify for public assistance under the Federal eligibility requirements and are without sufficient income or resources to pay for needed medical care. (c) All persons under the age of 21 without sufficient income or resources to pay for needed medical care.

(d) Inpatients 65 and over in institutions for the treatment of tuberculosis and mental diseases.

(e) All adult general assistance money payment recipients (21 or over) and other medically needy persons whose income and resources are insufficient to meet all the costs of medical care. For this last group, no Federal financial participation in the cost of their medical care will be claimed. 4. What are the maintenance levels for persons eligible for coverage? The amount of income and liquid assets they have, as well as the cost of the care they need, will be taken into consideration in determining what people are eligible. In general, however, income at or below the following amounts is considered to be sufficient only for maintenance and not available for medical care:

(a) For a single person: Wage earner, $2,900; no wage earner, $2,300. (b) For a family of four: Wage earner, $6,000; no wage earner $5,150. 5. What are some of the major features of the (State) medical assistance program?

In addition to the five minimum medical services, i.e., physicians' services, inpatient hospital services, outpatient hospital services, skilled nursing home services, and other laboratory and X-ray services, a total of 15 other medical care services are provided. Many of these were already included in New York's existing medical care program, but the following represent new or broadened services: (a) Home care programs;

(b) Provision of medical care to medically indigent children;

(d) Hospital outpatient care, including clinic and emergency room care; and

(e) Provision for inclusion of the cost of deductibles-coinsurance, and premium costs required under title XVIII.

Full intake social services are available to all applicants for medical assistance; also the same broad coverage of social services available under the other titles is available to the medically needy on a selective basis. Social services are to be available in mental hospitals, including the family care program (provided by social service department staff) and for persons released from mental hospitals (provided by the public assistance agency staff—if persons are returning to live in the community).

Conditions of eligibility under title XIX have been generally simplified to include: (1) Elimination of certain legally responsible relatives (except those permitted under title XIX); (2) use of declaration statements by applicants; (3) issuance of identification cards; and (4) spot checking of points of eligibility. The State has developed a program of public information to alert the public to the ready availability of the service. There will also be greater emphasis placed on preventive health services.

6. What are the terms of financing the new program?

New York is entitled to receive from the Federal Government approximately 50 percent of the costs of operating its medical assistance program. It is estimated that the Federal share of the cost of operating the program in New York during fiscal year 1967 (July 1966-June 1967) will be $217,330,000. Actual cost to the Federal Government during fiscal year 1966, in which the program was in operation for 2 months (May 1966-June 1966), was $19,346,565.

7. How many persons are served by the new program?

The State of New York estimated that about 2 million persons would receive medical care services during the first full year of operation.

8. Financial eligibility to determine persons who are medically needy: Amount protected for maintenance needs:

(a) Income scale for family household: 2

(1) With no wage earner; beginning with annual net income up to $2,300 for one person, $3,250 for two, $4,350 for three, $5,150 for four, and $850 for each additional member.

(2) With one wage earner; beginning with annual net income of $2,900 for one person, $4,000 for two, $5,200 for three, $6,000 for four, and $850 for each additional member.

(3) With two wage earners; beginning with annual net income of $4,850 for two persons, $6,050 for three, $6,850 for four, and $850 for each additional member.

(4) Of person in chronic care in a medical institution: May have $15 per month for his personal expenses; in addition, for maintenance of dependent members of his former family household, may apply $2,300 of his income for one such dependent, $3,250 for two, $4,350 for three $5,150 for four, and $850 for each additional member. (b) Assets. Real property: May have homestead. Other property: May have essential personal property; for each member of household, either $1,000 face value of life insurance or $1,000 liquid resources as a burial reserve; annual contribution up to $1,080 from person not residing in the family household; and savings to the extent of one-half of the appropriate income exemption as described under (a) above.*

1 Special limitation on outpatient services for a nonrecipient of public assistance who is a member of a family household having a gross income of $4,500 or more in a calendar year: Ineligible for such service unless and until there has been paid by him or in his behalf, either toward the cost of such services or as health insurance premiums, the lesser of either (a) 1 percent of such household's gross income, or (b) 5 percent of uch household's net income which exceeds 80 percent of the appropriate minimum exemption of the household.

2 References to number in family household include only wage earners and family members for whom they are legally responsible or have assumed responsibility. Persons in chronic care in a medical institution are not deemed a member of any household, except as specifically noted.

3 Including dependent members of the household of a person in chronic care in a medical institution.

4 Person in chronic care in a medical institution considered a member of his former family household for purpose of determining the amount of the savings exemptions of such family household. Such person with no dependents may retain savings up to $1,150.

NORTH DAKOTA

1. Name of State agency responsible for administering title XIX: Public Welfare Board of North Dakota.

2. Date program began operation: January 1, 1966.

3. What groups became eligible when the program began?

(b) Children between 18 and 21 in whose behalf an aid to famiiles with dependent children payment would be made, except that these individuals are neither disabled nor attending high school or a course of vocational or technical training.

(c) All persons who, except for having enough income for their daily needs (under State assistance standards), could qualify for public assistance under the Federal eligibility requirements.

4. What are the maintenance levels for persons eligible for coverage?

The amount of income they have will be taken into consideration in determining what people are eligible. In general, however, income at or below the following amounts is considered to be sufficient only for maintenance, and not available for medical care:

(a) For a single person: $1,600.

(b) For a family of four: $3,000.

5. What are some of the major features of the (State) medical assistance program?

Plan to add additional qualified professional medical personnel. Services go beyond the basic five: Inpatient hospital care, outpatient hospital care, physicians' services, nursing home services for adults, and lab and X-ray services. For example, North Dakota provides drugs, eyeglasses, dentures, and prosthetic devices prescribed by a licensed practitioner.

6. What are the terms of financing the new program?

North Dakota is entitled to receive from the Federal Government approximately 67 percent of the costs of operating its medical assistance program. is estimated that the Federal share of the cost of operating the program in North Dakota during fiscal year 1967 (July 1966-June 1967) will be $6,400,000. Actual cost to the Federal Government during fiscal year 1966, in which the program was in operation for 6 months (January 1966-June 1966), was $2,744,126. 7. How many persons are served by the new program?

The State estimated that 16,640 persons would be served by this program during the first year.

OHIO

1. Name of State agency responsible for administering title XIX: Department of public welfare.

2. Date program began operation: July 1, 1966.

3. What groups became eligible when the program began?

(b) Children between 18 and 21 in whose behalf an aid to families with dependent children payment would be made, except that these individuals are neither attending school nor a course of vocational or technical training. (c) All individuals in the above groups who would be entitled to financial assistance except that they do not meet the durational residence requirement of any of the public assistance programs.

What additional groups will become eligible and when?

(a) All medically needy persons who, except for having enough income for their daily needs (under State assistance standards), could qualify for public assistance under the Federal eligibility requirements. Effective August 1967.

(b) With progressive extensions periodically the program will be expanded to provide all essential health services by July 1, 1975.

4. Financial eligibility requirements

Not applicable. Ohio provides medical assistance for money payment recipients only. Hence does not have income levels for determining medical indigency. 5. What are some major features of the (State) medical assistance program? In addition to the five basic services (inpatient and outpatient hospital care, nursing home care for persons over 21, physicians' services, and lab and X-ray services), Ohio provides home health services, medical supplies, equipment and appliances, and prosthetic devices when prescribed by a physician; drugs prescribed by a physician or dentist as essential medical needs for use at home, nursing home, or similar place of residence; ambulance service and other essential transportation. Additional medical and dental professional personnel will be added to the present medical staff-a consultant for medical care, a consultant on dental services and a consultant for medical social services. Five medical assistance consultants will be added to the five district offices. 6. What are the terms of financing the new program?

Ohio is entitled to receive from the Federal Government approximately 52 percent of the costs of operating its medical assistance program. It is estimated that the Federal share of the cost of operating the program in Ohio during fiscal year 1967 (July 1966-June 1967) will be $18,334,000.

7. How many persons are served by the new program?

The State estimated that 325,000 persons, or 3 percent of the population, would be served the first year this program is in operation.

OKLAHOMA

1. Name of State agency responsible for administering title XIX: Department of public welfare.

2. Date program began operation: January 1, 1966.

3. What groups became eligible when the program began?

(b) All persons who, except for having enough income for their daily needs (under State assistance standards), could qualify for public assistance under the Federal eligibility requirements.

(c) All children (under 21) who could not qualify for public assistance but whose families cannot afford to pay for all or part of the cost of the medical care they need. (This includes families in which the parents are working but do not earn enough to pay medical expenses.)

4. What are the maintenance levels for persons eligible for coverage?

The amount of income they have, as well as the cost of the care they need, will be taken into consideration in determining what people are eligible. In general, annual income at or below the following levels is considered sufficient only for maintenance, and not available for medical care:

(a) For a single person living in his own home: $1,728.

(b) For a family of four living in their own home: $2.448.

5. What are some of the major features of the (State) medical assistance program?

The program provides for all hospital services which the physician says are needed, and for the length of time the physician considers necessary.

The following services have been added: Bloodbank, obstetrical cases, anesthetist services, physicians' services as specified for children, prosthesis for adults. Effective July 1, 1967, limitations as to kind and amount of care will be removed; e.g., physicians' services will not be limited to specified situations. 6. What are the terms of financing the new program?

Oklahoma is entitled to receive from the Federal Government approximately 70 percent of the costs of operating its medical assistance program. It is estimated that the Federal share of the cost of operating the program in Oklahoma during fiscal year 1967 (July 1966-June 1967) will be $50,734,000. Actual cost to the Federal Government during fiscal year 1966, in which the program was in operation for 6 months (January 1966-June 1966), was $20,348,715.

7. How many persons are served by the new program?

The State estimated that 389,000 persons are potentially eligible for this program, about half of whom would be served during the first year.

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