Medicaid
What is Medicaid?
Applying for Medicaid without SSI
Appealing a Medicaid decision
What is Medicaid Spend Down?
Medicaid provides medical benefits to people who are financially needy. Medicaid is primarily a program for people who are poor. Medicaid also pays for support services provided to people with disabilities through the Family Independence Agency, FIA (formerly the Department of Social Services), and services from Community Mental Health.
The Federal Department of Health and Human Services, the Michigan Department of Community Health, and the Family Independence Agency administer Medicaid. The program receives both federal and state funds.
Some people mistakenly believe that any indigent person may qualify for Medicaid. The fact is that to qualify for the Medicaid program, you must pass four eligibility tests:
- Categorical eligibility, that is, persons who are blind, disabled, age 65 or older, Supplemental Security Income recipients, or a former Supplemental Security Income recipient.
- Non-financial eligibility, that is, people who are a Michigan resident, United States Citizen or have Alien status, and have a social security number.
- Financial eligibility, that is, people who are asset poor and income poor.
Procedural Requirements include completing and signing an application form, providing timely proof of eligibility, and reporting any changes in circumstances.
To apply for Medicaid, contact your local Family Independence Agency office. Your Support Coordinator can also help you complete the forms.
Applying for Medicaid Without SSI
To apply for Medicaid separately from Supplemental Security Income (SSI), you will need to contact your local Family Independence Agency office (FIA), formerly known as the Michigan Department of Social Services.
The application from may be confusing. You may request to have it mailed to your home or you may pick it up at your local FIA office. You will be asked about the following:
Your income and assets
Your age
Your medical expenses, including personal supports or direct care
Your marital status
Your medical insurance
Your ability to work in you are under 65 years old
Your citizenship
You will also be asked the same questions about your spouse's assets and income, and about the income of any legal dependents living with you. It is important for you to provide proof of your assets, income, and medical expenses. If you are under 65 years old, you will need to give the FIA worker permission to review your doctor's reports.
You must bring a copy of your social security card, or other proof that you have a social security number.
If you are asked to come into your local FIA office, you are entitled to bring a representative to assist you. This could be your parent, advocate, guardian, or a person you would like to act as your representative payee.
The local FIA office determines your eligibility for Medicaid. You will be notified within 60 days if you are disabled and within 45 days in other cases.
If you are denied eligibility for Medicaid, the FIA must give notice of why you are ineligible, and must explain your right to request a hearing. To appeal the decision, you must file a "Request for Hearing" within 90 days of the date you received notice of ineligibility form the FIA. If a hearing is requested before the date of the FIA's intended action, the FIA may not terminate or reduce services until a decision is rendered unless:
- It is determined at the hearing that the sole issue is one of federal or state law or policy; and
- The FIA promptly informs the individual appealing in writing that services are to be terminated or reduced pending the hearing decision.
The hearing before an administrative law judge must be conducted at a reasonable time, date and place, only after adequate written notice of the hearing. Prompt, definitive and final administrative action must be taken within 90 days after the date of the "Request for Hearing". Within 30 days, you may appeal the administrative law judge's ruling to the circuit court for the county in which you live. Within 30 days of receipt of the decision, any party or the FIA department of administrative hearings may request a rehearing.
Spend down means that you meet all eligibility requirements for Medicaid except for income. To become eligible for Medicaid your allowable medical expenses must be more that your spend down amount. Your spend down amount is the amount by which your monthly income exceeds that Medicaid allowance for living expenses.
Your FIA caseworker will send you a letter called the Spend Down Notice. This will give your spend down amount and tell how you may become eligible for Medicaid when your medical expenses are more than your spend down amount. You will also be given a form on which to list your medical expenses. It is called a Spend Down Report. Expenses for medical care include care from hospitals, doctors, clinics, dentists, drugs, medical supplies and equipment, health insurance premiums, transportation to get medical care, personal assistance services, adult home help services, and services from Community Mental Health.
Your spend down amount can change if your circumstances change. Some examples of these changes are income, persons living with you, employment or hospitalization. You must report any changes to your caseworker within 10 days.
Please note that you may need to do a spend down if you switch form Supplemental Security Income to Social Security Disability Income due to the retirement, death, or disability of a parent. This change in cash benefit may mean that you need to apply for Medicaid separately from your cash benefit from the Social Security Administration.