Do you qualify for Medicaid? For the answer or for more information, call Local 802’s Musicians’ Assistance Program at (212) 397-4802 and ask to speak to Cindy Green, the union’s social worker.

Times are tough. We are in an economic downturn. You or someone close to you may qualify for Medicaid, the health insurance of last resort. Created by Congress in 1965 as part of Title XIX of the Social Security Act, Medicaid is co-funded by the federal government and each state. States administer the program and set guidelines for eligibility and services. You usually qualify for Medicaid by being very low-income, very ill or both. The federal government requires coverage for certain people, such as children under 6 whose family income is 133 percent of federal poverty level or less, pregnant women at the same income level and families who meet the criteria of the old welfare program, Aid To Families With Dependent Children which was replaced in 1996 by the Welfare Reform Act.

States may cover other needy people such as infants up to age 1, pregnant women whose income is higher than 133 percent of the federal poverty level limits but no more than 185 percent, institutionalized people whose income may be higher than federal poverty level limits, TB infected people, uninsured low-income women receiving breast or cervical cancer preventive care and people whose income may be higher than federal poverty level limits but who have extremely high medical expenses. People who are not U.S. citizens are barred by the Welfare Reform Act from receiving Medicaid for five years except for emergency services.

Federally mandated Medicaid services include: hospitalization, prenatal care, childhood vaccines, nursing facilities for people 21 and older, family planning, x-rays and screenings, and home health care for people eligible for nursing services. 

States may opt to include other services. New York, New Jersey and Connecticut all cover optometrists, dentists, prescription drugs for non-Medicare eligibles, prosthetic devices, preventive services and nursing facilities for people under 21. New Jersey and New York both cover psychologists and physical, speech and occupational therapies. New Jersey also covers chiropractic, podiatry and hospice care.

New York covers drugs excluded from the Medicare Part D program (see my previous article, which you can read at www.Local802afm.org). Its Preferred Drug Program promotes the least expensive, equally effective prescription. (Antidepressants, anti-psychotics, anti-rejection drugs for transplant patients and antiretrovirals for AIDS are exempt.)

In New York, if you receive services on or after your 55th birthday or when permanently institutionalized, Medicaid may try to recover its costs from your estate after you die. A Local 802 member told me that his parents transferred the deed to their house to him 15 years before either of them needed services. This protected the property from being claimed by Medicaid after this member’s mother passed away.

In New Jersey, eligibility for Medicaid is determined at the county level. Participation in Work First New Jersey is not necessarily required. Any child born to a woman on Medicaid is eligible for a full year as long as the child lives with the mother, regardless of changes in the mother’s status.

If a person qualifies for Medicaid and Medicare, the costs of Part D and Part B can be covered by Medicaid but Medicaid will not cover prescriptions for Medicare eligibles except in states like New York, which covers some drugs excluded from Medicare. Usually Medicaid patients are automatically enrolled in a Part D program when they turn 65.

Medicaid is confusing. Rules and requirements vary state to state and you can be given misleading information. If you think you or a loved one may be eligible, start by calling the Musicians’ Assistance Program at (212) 397-4802. 

Martha Hyde is a multi-woodwind player who performs on Broadway. A member of Local 802, she is also a trustee on the Local 802 Health Benefits Fund. To view past articles in this series, search for the topic “To Your Health.”