MEDICAID

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MEDICAID - GENERAL INFORMATION

PROGRAM DESCRIPTION

Medicaid in Connecticut is a state/federal health insurance program administered by the Connecticut Department of Social Services (DSS) http://www.ct.gov/dss/lib/dss/pdfs/medicaidservicesv3kk.pdf. The program helps pay for medical and long term care for low income elderly, blind or disabled individuals and families with dependent children. Medicaid was expanded retroactive to April 1, 2010 to cover Connecticut residents, ages 19 through 64, wo do not receive Supplemental Security Income or Medicare. Medicaid coverage for this group, formerly covered by SAGA Medical, is called Medicaid for Low Income Adults (Medicaid LIA). Payments for Medicaid services are made according to DSS's stated reimbursement schedules, and providers are required to accept this amount as payment in full.

SERVICES COVERED

Medicaid provides coverage for many health services and medical needs. Covered services include:

inpatient and outpatient hospital services
physician care
nursing facility care
home health care
family planning
lab and X-ray services
pediatric and family nurse practitioners
community health clinics
nurse midwives
screening, diagnosis and treatment of childhood diseases or impairments (EPSDT)
prescriptions
hospice care
adult dental services
medical supplies
rehabilitation services
medical transportation
behavioral health services
substance abuse treatment
vision care

WHO IS ELIGIBLE?

recipients of Temporary Family Assistance (TFA)
recipients of State Supplement for the Aged, Blind or Disabled (State Supplement)
parents or caretaker relatives with income at or below 185% FPL and whose child is covered under HUSKY A
children under age 19 with income below 185% FPL (HUSKY A)
children ages 19 and 20 ("Ribicoff Children") with very low income
pregnant women with income under 250% FPL
people with income over the limit who have exceptionally high medical bills can become eligible by spending down their income and assets to DSS's Medically Needy Income Limit (MNIL) (Medical Expense Spend Down Policy)
employed persons who are disabled and earning more than the traditional income limits - Medicaid for the Employed Disabled (MED)
severly disabled individuals who can be cared for at home and who would be eligible for Medicaid if the legally liable relative's income is not counted when determining eligibility (Katie Beckett Waiver)
refugees (receive benefits that are the same as Medicaid for 8 months)
single adults with income at or below $610.22/month living in southwestern Connecticut or $506.22/month living outside southwestern Connecticut (Medicaid LIA)

WHERE DO PEOPLE APPLY?

Call or visit the nearest regional DSS office to apply. Applications can be downloaded from the DSS website - http://www.ct.gov/dss/lib/dss/pdfs/w-1e.pdf. Applications are usually processed within 45 to 60 days.

HOW TO FIND HEALTH CARE PROVIDERS WHO ACCEPT MEDICAID

Managed care plan enrollees (HUSKY, TFA, Healthy Start recipients): Individuals covered by a managed care plan must use the providers who are enrolled in that particular plan. Call the plan for referrals.
Fee-for-service enrollees: Individuals covered by a fee-for-service plan can call the Provider Relations Unit at DSS (866-409-8430 or 860-269-2031) or visit the Connecticut Medical Assistance Program website, https://www.ctdssmap.com/CTPortal/Provider/Provider%20Search/tabId/50/Default.aspx, to conduct a provider search.

APPEAL PROCESS

To request an appeal if coverage is denied, write to the DSS Office of Administrative Hearings and Appeals in Hartford to request a Fair Hearing within 60 days of the notice of denial. For information or assistance in preparing for the Fair Hearing, contact a local Legal Services office through the Statewide Legal Services program.

TO FIND PROVIDERS IN CONNECTICUT'S COMMUNITY RESOURCES DATABASE
Search by service name: Medicaid

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SOURCES: Connecticut Department of Social Services
PREPARED BY: 211/rj
CONTENT LAST REVIEWED: July2010