There’s a lot of confusion, we find, about government or public health care programs. Medicare, Medi-Cal, Medicaid, CMS … just what are the differences?
Well, some would argue that Medicare actually helps adult people, whereas Medi-Cal really is better for children and prenatal mothers than the general population it serves. My opinion? They could all be better. But I’ll stop with opinions now…..
Medicare – Federal Health Insurance plan for seniors and the disabled. Contrary to what some may believe, you can be a 20 year old with Medicare. Most people under 65 with Medicare receive federal disability, like SSI or SSDI. In that regard, even some people who receive disability don’t qualify for Medicare because of the work credit eligibility requirements. I think that’s the limit as to who qualifies, although if you are a dependent child with parents who have Medicare you are probably covered as well.
Medi-Cal – This is California’s version of Medicaid. Medicaid is the program name used by other states, like New York, but they don’t have to. Basically Medicaid comes out of a federal law that forces states to offer basic health coverage for specific populations. In California that is Medi-Cal.
The eligibility requirements are again fairly strict; I’m not so sure you can qualify for it unless you are either under 21 or over 65, have dependent children, or receive any public assistance through the state (SSI, IHSS, TANF, Food Stamps, etc.)
Many people who qualify for food stamps do not qualify for Medi-Cal. Also, there seems to be a loophole that also gives anyone with a “chronic disability” access to Medi-Cal. We are exploring this, because on the surface it looks like just a letter from a doctor suffices for this, rather than making it a requirement that one receives disability. But I haven’t been able to exploit the loophole and most people end up being forced to use CMS.
There is also a population of people, mostly seniors, who are what we call “Medi-Medi”. That means they are Medicare and Medi-Cal recipients; in social service agencies that charge a fee or at clinics or hospitals, these people actually have better coverage than most private health insurance because they can double dip.
All of these programs require you to be under a certain income though. In Medicare if you are over a certain income you have a share of cost, that sometimes can be extremely high. With Medi-Cal, you can qualify based on income but also be charged a ridiculous share of cost based on property ownership and assets – a fatal flaw in the system. It forces even low-income people to pay exorbitant sums out of pocket, like a deductible, that can literally be $1000 dollars plus.
CMS – County Medical Services – is the only other way adults can access health care, and you know all about the hoops one must jump through there. If you are 0-165% of the poverty level, you are eligible to receive as needed services at no cost. Otherwise there is a share of cost.
The worst thing about CMS: You have to sign a lien agreement if you don’t qualify for the low-income service! In essence, the county is asking people who fall through cracks to give up future assets just to have basic, minimal medical procedures or services – at full cost, not a negotiated rate. True bullshit. Opps – sorry, another opinion.
{ 4 comments… read them below or add one }
I have a PPO through my job. They call it a Prudent Buyer plan (meaning it’s the cheapest one they offer). I really couldn’t afford it but can I really afford NOT to have it? I have been off work for almost three months with a debilitating condition, receiving state disability (roughly 60% of my working income), still owing my insurance premiums and trying to get by. Co-pays, prescriptions, deductibles, maximum-out-of-pocket… Everything resets at the end of December and I’ll start over.
What’s the poverty level? What’s 0-165% of being in the red every month? I HAVE medical insurance, am hardly ever sick, and now it will take me years to pay off the bills from the last couple of months. The ironic thing is that my condition is probably worse now because I HAVE medical insurance and couldn’t afford to go to the doctor sooner. And if I lose my job and lose that insurance?
Where’s that little shit Lieberman….
patty i feel your pain. I also think you are in a predicament that is all too common in this country and needs to change.
as for this post – I think its fair to say that I am by no means an expert on this stuff. These are all assumptions I have made through my encounters with clients who utilize these services. Readers: if you have more solid, concrete information about this, have stories that solidify the information above, or just want to bitch out Lieberman as per Patty Jones, please leave a comment below. This is by no means the “bible” of public health care…..
Lane,
I enjoyed your factual article on the various public health programs. I believe that your information is right on….as are your comments.
Having traversed these mazes for the past eight years, I can fully attest to the fact that the hoops are many, the paperwork overwhelming at times, the resulting co-pays relentlessly arriving month after month; their loud and unsettling demands for attention costing one their inner tranquility. Staying the course, while navigating upstream at nearly every turn, is ultimately exhausting and many eligible consumers of potential services simply become too ill to fight the good fight any longer. They relinquish their pursuit of the very benefits that would significantly smooth and advance their progress toward wellness, recovery, and personal achievement of self-defined success. Ah, classic Catch 22 in the finest government style.
In my opinion, the mix of western medicine and politics has proven fatal. Based on one’s ability to go up against the political machine that is currently holding our nation’s various healthcare systems hostage with their open, well documented corporate greed, unfathomable lack of compassion for human suffering, and willful contempt of public scrutiny is as realistic as compelling a newborn to perform complex surgery. The procedure may begin yet there is no doubt in any observer’s mind that the patient will not live to tell the tale.
I have begun to embrace eastern philosophies for my renewal, restoration, and abundant wellness. I believe Quan Yin (the goddess of compassion and mercy) feels the despair of the people. May this needless suffering end now. Healing one’s body and soul should never come at the cost of one’s dignity and/or financial standing, or worse yet, at the dogmatic ignorance of class, race, or human physical or mental limitations.
What is so friggin hard to understand? People need and deserve care. It’s instinctual throughout human history. Why should ‘profit’ at the cost of human wellness take up one more moment in any political debate? The way I see it … the current needless suffering taking place every moment of every day ~ up to and including the end of human life ~ at the hands of our politicians is premeditated and criminal.
Love, light up Truth for all to see. Compromise, shine Your compassionate light on those involved in the final decision. Resolution, do not stay silent much longer. Status Quo, take a flying leap. Let ALL awaken now, from the delusion that this current public healthcare nightmare has become, and impliment a working solution before the sun sets again.
Okay, I’ll get down off my soap box now…..
Sunshine,
You are a perfect example of why hippies don’t belong on soapboxes. Although I cannot invalidate your experience, it’s that politics of experience that I’d like to weigh in on.
In your opinion you separate western medicine, politics and corporate greed. I’m sitting here at this moment of political economy which tells me that our social reality is something to the contrary. In my opinion corporate capitalism is an all encompassing system that not only includes politics and greed but medicine (both eastern and western), religion (both eastern and western), sport, the arts and so on and so forth, By submitting to the dictatorship of capital we supplant all human goodness to the bottom line. That’s just the way it is!
So by focusing your energy on the personalities (politicians) instead of on your higher principles you undercut our collective effort by one. The persons (for the most part) are only playing the game by the game’s own rules. Rather than premeditated and criminal (a capitalist legality) the system is unconscious and unconscionable for as long as it exists. Insofar as it’s the only game in town we only have the collective energy of the people as the only countervailing force.
So please save your prayers for the ones who still suffer or in the words of the great mother “mourn for the dead, fight like hell for the living!”
Regards,
Danny