Medicaid

Medicaid is a very important program for people with disabilities because it is through Medicaid long term services and supports (LTSS) are funded. Medicaid is also the only program which uses Medical Necessity as a guidepost rather than whether a service is or is not covered. While Medicaid covers almost everything for children (under EPSDT) and has better coverage for adults than most other forms of health coverage, it does not, unfortunately, cover everything. To learn more, visit: Early and Periodic Screening Diagnostic and Treatment

Medicaid is funded by the federal and state government but every state’s Medicaid program creates their own state plan. To learn more about this plan, visit: Colorado Medicaid State Plan

The federal government www.cms.gov oversees Medicaid and assures certain criteria are met or specifically waived. Some of these criteria and common terms used include:

STATEWIDE

Services must be available statewide to the same extent services for non-Medicaid clients are available. If services in a specific area are not available, the Medicaid agency would need to provide transportation.

COMPARABILITY

Medicaid must treat all groups of recipients fairly. For example, barring specific approval or law, Medicaid cannot give one group of clients a benefit and not provide it to everyone. Medicaid can and does apply other utilization management criteria such as medical necessity. Medicaid is also allowed to have specific waivers that allow them to provide specific groups of clients services that are not provided to all Medicaid clients under the state plan.

FREEDOM OF CHOICE

This allows Medicaid clients to choose any willing provider. This does not require providers to enroll with Medicaid and does not require a provider to accept any specific client.

Medicaid is a very complex program. In Colorado the agency that oversees the Medicaid program is the Department of Health Care Policy and Financing. To learn more, visit: Health Care Policy and Financing

Colorado has categorical eligibility, which requires recipients fit into a category of eligibility. The primary disability categories include:

MEDICAID BUY-IN FOR WORKING ADULTS WITH DISABILITIES

Open to anyone aged 16 – 64 with a paying job (even part time). To qualify, one must have a disability using the Social Security Disability definition. You can use buy-in for regular state plan Medicaid and for home and community based services for elderly, blind, and disabled and community mental health. Other waivers will have buy-in options soon. For financial criteria and to apply, visit: Medicaid Buy Program Working Adults Disabilities

SSI