OVERVIEW OF PROGRAMS

The Nebraska Medical Assistance Program (NMAP) and S-CHIP are administered by the Nebraska Department of Health and Human Services (HHS), Division of Finance and Support. 

Eligibility for both programs is determined by local offices of the Division of Economic Assistance and Family Support, within HHS.  A list of local offices is available at www.hhs.state.ne.us/map/mapindex.htm.  The Medicaid application can be downloaded from www.hhs.state.ne.us/med/medprog.htm.

Kids Connection is the state’s S-CHIP program.  It is a Medicaid expansion program, rather than a separate program.  See eligibility matrix for income and resource requirements.  There are separate application forms for Medicaid and S-CHIP but children may use the Kids Connection form to apply for both programs.  Medicaid and TANF applications are processed simultaneously (for individuals/families that apply for both). 

General resource exclusions: home, up to $1,500 face value in life insurance policies, one car regardless of value, up to $3,000 in an irrevocable burial trust or irrevocable burial insurance plan.

For children and families, the following income disregards apply:  $100 of gross earned income, the amount paid for childcare, and the cost of health insurance. 

For elderly and disabled, the following income disregards apply:  the first $20 of income (earned and unearned), the first $65 of earned income plus one half of the remaining income, and the cost of health insurance.

MEDICAID

Categories for Adults

Special Enhanced (SE) Medical Assistance for Pregnant Women

Family income cannot exceed 185% of FPL.

No resource test.

Qualified providers may make presumptive eligibility determinations for pregnant women.  This eligibility continues until the local HHS office determines continuing eligibility for Medicaid.

During the presumptive eligibility period, pregnant women are eligible for the full range of ambulatory outpatient Medicaid services (except inpatient hospital).

Breast and Cervical Cancer Clients

Income cannot exceed 225% of FPL.

Women must be screened for breast or cervical cancer through the National Breast and Cervical Cancer Detection Program.  In Nebraska, this program is called “Every Woman Matters”.

Qualified and Unqualified Aliens

Must meet eligibility requirements of any category.

Unqualified aliens are entitled to emergency services only.

Categories for Families/Children

Special Enhanced (SE) Medical Assistance for Newborn Babies (born to Medicaid eligible mothers)

Family income cannot exceed 185% of FPL.

No resource test.

Under Federal law, a child born to a Medicaid-eligible woman is eligible for Medicaid for 12 months as long as the child lives with the mother.

Enhanced Medical Assistance for Children (infants up to age 1)

Family income must be less than 150% of FPL.

No resource test.

Only the children in the family are eligible.  No adults can be Medicaid eligible under this category.  Children age 18 and younger who are found Medicaid eligible for one month are initially eligible for six months with no income or resource test after month one.

Medical Assistance for Children ages 1 through 5 (through the month of their 6^th birthday)

Family income cannot exceed 133% of FPL.

No resource test.

Only the children in the family are eligible.  No adults can be Medicaid eligible under this category.

Children age 18 and younger who are found Medicaid eligible for one month are initially eligible for six months with no income or resource test after month one.

School Age Medical Assistance for Children ages 6 through 18 (through the month of their 19^th birthday)

Family income cannot exceed 100% of FPL

No resource test.

Only the children in the family are eligible.  No adults can be Medicaid eligible under this category.

Children age 18 and younger who are found Medicaid eligible for one month are initially eligible for six months with no income or resource test after month one.

“Ribicoff” Program for Children age 20 and younger

Do not meet the requirements of Aid to Dependent Children (ADC), e.g., physical absence of one parent or financial deprivation.

Income Limits:

One or two people: $392/month

Three people: $492/month

Resource limits:

1 person: $4,000

2 people: $6,000

Income limits are the same as Medically Needy Income Limits (MNIL).

Adult parents cannot qualify under this category.  Eligible children can “spenddown” or share the cost to establish eligibility.

TANF

Aid to Dependent Children (ADC) (family unit must contain at least one child under the age of 18 or under age 19 if the child is a student)

Aid to Dependent Children (ADC)/Medical Assistance (Section 1931 of the Social Security Act)

Continuing Medicaid

Transitional Medical Assistance (TMA)

These families receive an ADC cash assistance grant and are Medicaid eligible as a result.

Income limits (approximately 40% of FPL):

1 person: $222/month

2 people: $293/month

3 people: $364/month

Resource limits:

1 person: $4,000

2 or more people: $6,000

These families do not receive an ADC cash grant.

Income limits (below 50% of FPL):

1 person: $374/month

2 people: $505/month

3 people: $636/month

Resource limits:

1 person $4,000

2 or more people:  $6,000

These are cases closed due to collection of child support and are automatically eligible for Medicaid (both children and adults) with no income or resource test for four months.

Cases that are ineligible for ADC payments due to earnings and a member of the unit was eligible for a cash grant in 3 of the preceding 6 months.

Parents and other caretaker relatives qualify for Medicaid until June 2003.

These families do not receive an ADC cash grant for one of the following reasons:

·         Grants of less than $9.99 are prohibited;

·         Parents choose not to cooperate with Child Support or Employment First, and therefore, reject a grant.

The TMA period is 12 months.  The first six months of TMA are granted without regard to income.  In the next 6 months, earned income must be below 185% of FPL.   There is no resource test.

TANF welfare-to-work program is called “Employment First” in Nebraska.

At the federal level, the passage of TANF in 1996 broke the historic link between ADC and Medicaid.  In Nebraska, however, families continue to automatically qualify for Medicaid if they are receiving ADC.

In the second six months of TMA,

all members of the family are eligible if their earned income is below 100% of FPL.  If above 100% of FPL, the family can pay a premium and be Medicaid eligible.

Only earned income is used to establish eligibility.

Medically Needy

Ribicoff Children

Aid to the Aged, Blind and Disabled (AABD) – Medically Needy

Medically Needy Caretaker Relatives

These individuals meet the programmatic requirements of their respective categories but exceed the income  requirements.  They may use medical expenses to “spend down” their income or “obligate excess income” to qualify for Medicaid. 

Elderly/Disabled

Aid to the Aged, Blind and Disabled (AABD)

Individuals receiving Supplemental Security Income (SSI) payments or a State Supplemental Program (SSP) payment.

Income Limits:

Individual: $563/month

Couple: $835/month

Resource Limits:

Single person: $2,000

Couple: $3,000

Aged are 65 or older.

Blind and disabled are determined as such utilizing the Social Security Administration’s (SSA) definitions. 

Recipients of SSI are not automatically enrolled in Medicaid – the state makes its own eligibility determination using the SSI eligibility criteria.

Spousal impoverishment rules apply for long term care/nursing home residents or those on waiver.

Aid to the Aged, Blind and Disabled (Medically Needy)

AABD clients who have income over cash assistance standards but have a medical need and are not eligible under the 100% of FPL standard (Qualified Medicare Beneficiary).

Income Limit:

1 or 2 people: $392/month

Resource Limit:

1 person: $4,000

2 people: $6,000

Aid to the Aged, Blind and Disabled 100% FPL

Income cannot exceed 100% of FPL.

Resource Limits:

1 person: $4,000

2 people: $6,000

Qualified individuals in this category are entitled to full Medicaid benefits as well as payment of Medicare premiums, deductibles and coinsurance.

Under Federal definition, this category would be called QMBs, and Medicaid is required under Federal law to pay Medicare premiums, deductibles and coinsurance for this group.  However, Nebraska does not refer to this group as QMBs and provides full Medicaid coverage in addition to payment of Medicare premiums, etc.

Aid to the Aged, Blind and Disabled – Qualified Medicare Beneficiaries (QMBs) and Qualified Individuals (QI-1s)

For QMBs, income must be over 100% but cannot exceed 120% of FPL.

For QI-1s, income must be over 120% but cannot exceed 135% of FPL.

Resource Limits:

1 person: $4,000

2 people: $6,000

For QMBs and QI-1s, Medicaid pays Medicare Part B premiums.  These individuals are not eligible for any other Medicaid benefits.

Under Federal definition, Nebraska’s QMBs are actually Specified Low-income Medicare Beneficiaries (SLMBs), but Nebraska covers Federallly-defined QMBs under the category above (AABD 100% FPL).  Therefore, the state refers to the Federally-defined SLMBs as QMBs.

Qualified Disabled Working individuals (QDWIs)

Income cannot exceed 250% of FPL.

Resource Limits:

Individual: $4,000

Couple: $6,000

AABD clients who were eligible for Medicare as a disabled individual and who return to work are required to pay their Medicare Part A (hospital) premiums to maintain coverage.  Medicaid pays this premium on their behalf.

Medicaid Insurance for Workers with Disabilities

Income cannot exceed 250% of FPL.

Resource Limits:

Individual: $4,000

Couple: $6,000

Clients with disabilities who are eligible for Medicaid except that their income is too high.  Medicaid coverage enables them to work.  They are eligible without paying a premium to 200% of FPL.  Between 200% and 250% of FPL, they must pay a premium.

S-CHIP

Kids Connection

For children through age 18 (through the month of the child’s 19^th birthday).

Income Requirements:

For infants under age 1: Income must be over 150% of FPL but cannot exceed 185% of FPL.

For children ages 1 through 5:  Income must be over 133% of FPL but cannot exceed 185% of FPL.

For children ages 6 through 18:  Income must be over 100% of FPL but cannot exceed 185% of FPL.

No resource test.

Only the children in a family may be eligible, not adults.

There is no cost-sharing for the program.

The Kids Connection program is a Medicaid expansion, not a separate, stand-alone program.  Benefits and delivery systems are the same as Medicaid.

Children cannot have creditable health insurance coverage and may not be eligible for Medicaid.  However, there is no minimum amount of time that a child must be uninsured in order to qualify.

Children age 18 and younger who are found S-CHIP eligible for one month are initially eligible for six months with no income or resource test after month one.