MCD 301-Lesson 3: What programs serve the same members as Medicaid?

You must first complete MCD 301- Lesson 2: What are waiver programs? before viewing this Lesson

Lesson Goal

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For you to understand how Medicaid fits into the larger safety net in the US public assistance system.


Lesson Summary

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In addition to the investments made in healthcare services for poor Americans using Medicaid, there are several other key programs that provide healthcare services, money and other resources to Medicaid members. Medicare also provides services to millions of Medicaid members (who are dually eligible). The TANF and SSI programs provide cash assistance to low income members, many of whom are also eligible for Medicaid. Finally, the SNAP program (aka Food Stamps) provides food security for low income Americans.

As more researchers and program operators begin to understand the impact of non-healthcare needs on healthcare outcomes (food, clothing, shelter – the Social Determinants of Health), maximizing the impact of these other programs become more and more important.


The Big Topics in This Lesson

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1- Medicare

The information under this topic revisits some of our earlier lessons on Medicare to explore dual eligibles further, including the types of healthcare needs dual eligibles typically have.

2- TANF and SNAP

The information under this topic introduces two important public assistance programs that often also serve Medicaid members – TANF (cash assistance for low income families) and SNAP (food stamps for low income families).

3- Supplemental Security Income

The information under this topic explains the eligibility rules for SSI and the overlap with Medicaid eligibility.


Lesson Video

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Lesson Q & A

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Click on each question to learn more

Q1: What is a dual eligible?

Answer:

A dual-eligible is someone who is covered by both Medicare and Medicaid. CMS also uses the term “Medicare-Medicaid-Eligible” (MME). There are about 11M dual eligible members, and they get medical services from both programs. Dual eligibles account for about $330B in annual spending. They are the largest cost group in both programs.

Q2: What types of healthcare needs do dual eligible members typically have?

Answer:

Compared to non dual Medicare members, Duals are much more likely to have mental health conditions (4 to 1), depression (3 to 1) and heart disease (2 to 1). Duals also have higher rates of pulmonary disease, stroke, heart disease, and diabetes.60% of duals have 3 or more chronic conditions.

Q3: What have been the recent focus areas for meeting the needs of dual eligibles?

Answer:

The Medicare Medicaid Coordination Office (MMCO) of CMS is tasked with streamlining the delivery of care for duals. While the MMCO operates multiple initiatives, the most high-profile effort to address the needs of duals in recent years has been the financial alignment incentive (FAI) demonstration projects (often referred to as the “duals demos”).

 

These demos create 3 way contracts between CMS, the state and the managed care organization to deliver care for dual eligible members. There are also quality incentive measures included in these contracts.

Q4: What is TANF and how does it relate to Medicaid?

Answer:

The Temporary Assistance for Needy Families (TANF) is a welfare program that provides cash assistance to working families for up to 48 months. In order to be eligible, families must be U.S. citizens and have a very low income. For example, a family of three must have a gross income below $784 a month and assets of less than $1,000. All the adults in the assisted family must work (or participate in work training) for at least 30 hours a week.

TANF funds are provided by the federal government to states in the form of a block grant, which

gives states the flexibility to set TANF eligibility rules and payment amounts.

While most TANF families would also be eligible for Medicaid, a family can likely be denied TANF but still be eligible for Medicaid. Numerous advocacy groups have worked with states to ensure families denied TANF are still considered for Medicaid health benefits.

Q5: What is SNAP and how does it relate to Medicaid?

Answer:

The Supplemental Nutrition Assistance Program (SNAP) provides money for low income families to  buy food needed. This program used to be called Food Stamps (and often still is though not officially).SNAP applications are managed by states, and if a beneficiary is approved, benefits are provided using a cash card (EBT) that is accepted at most grocery stores. Although benefits distribution is managed at the state level, SNAP is a federal aid program administered by the U.S. Department of Agriculture (USDA).

 

SNAP relates to Medicaid in  that there is significant overlap of the 2 recipient populations. Some estimates are as high as 75% of the people receiving food stamps also have at least one household member on Medicaid. Some states even use the same applications for SNAP and Medicaid eligibility.

Q6: What is LIHEAP?

Answer:

The Low Income Home Energy Assistance Program helps low income recipents pay for utilites. It is a cash grants sent directly to the utility company, or it can also be a crisis grant sent to households facing immediate danger of losing heat. About half of LIHEAP funds go for heating, 3% for cooling. 20% for crisis assistance and the rest goes to weatherization and counseling on how to reduce energy costs.

Q7: What is Supplemental SSI and how does it relate to Medicaid?

Answer:

Supplemental Social Security Income is a program that provides money to people who are older, blind or disabled. The Social Security Administration manages the program, but it is not funded from the Social Security trust fund (the one that funds payments to retirees who pay into the program). Most states use Supplemental SSI eligibility as a proxy for Medicaid eligibility, meaning if you qualify for Supplemental SSI you are automatically considered Medicaid eligible.In general Medicaid covers healthcare services while SSI income can be used for anything.

Q8: Who is eligible for SSI?

Answer:

To be eligible for supplemental SSI, you need to prove you are disabled and poor (low or no income and less than $2,000 in assets).

Q9: What can be paid for under SSI benefits?

Answer:

There are no restrictions on what an supplemental SSI beneficiary can spend their monthly cash payments on, but they are encouraged to be responsible and make sure that living expenses are paid for before spending Social Security Disability benefits on entertainment or luxury purchases.

Medicaid Dictionary

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 New Terms from this lesson:

TANF Temporary Assistance for Needy Families. A cash assistance welfare program to provide working families with up to 48 months supplemental income.

SNAP Supplemental Nutrition Assistance Program. Assists low income families with the ability to purchase food.

SSI Supplemental Social Security Income. Funding for all ages who are poor and disabled with limited assets.

Dual eligible Individuals eligible for both Medicare and Medicaid.

MME Medicare-Medicaid-Eligible. Individuals eligible for both Medicare and Medicaid.

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