Joel 

All right, everybody. Welcome to the Senior Reset podcast and events.

Here is where we are trying to bring resources, education solutions, entertainment, and training to the senior community and their families. There’s a lot that needs to be learned as we get older and not a lot of places where you can find that information in an easy-to-get format and we’re going to remedy that.

To that end, we are going to have some great guests today. We have Crystal Lane from integrative healthcare systems, and she has got a great career behind her 33 years as a nurse. She’s passionate about reaching the seemingly unreached in today’s society by providing them with medical education and awareness, communication with professionals, quality care coordination under the provider title, integrated healthcare coordination, and the Medicaid waiver. Crystal and her company are currently serving the entire state of Indiana and they are expanding to 41 different States and two Virgin Island territories. So almost anywhere in the United States where you are, if you are dealing with Medicaid issues, Crystal may be able to help.

But today we are going to dig into Medicare and Medicaid. What are they? Who qualifies for these? And how can these systems help you, our title for today’s podcast is Demystifying Medicaid, and we are going to attempt to do just that and not in a manner that is horribly boring and make you want to rip your ears out. So, all right, so without further ado, Crystal welcome. 

Crystal 

Thank you, Joel. 

Joel 

Can you tell us a little bit about just give us a little bit of your background, I just gave like a little two-second summary but tell us how you got to where you are today and how you know the need that you’re trying to fill with integrative healthcare solutions. Or system, sorry. 

Crystal 

So the FSSA contacted me in order to kind of head up. 

Joel 

And what’s FSSA? Because a lot of people listening aren’t even. 

Crystal 

So they are sorry, I just assume everyone knows I guess. They oversee Medicaid rules and Reg. So, they contacted me wanting me to head up a pilot program. So that’s kind of how I got started in this. But as a home health and Hospice nurse, it’s really that nurse’s responsibility to ensure that the gap has been closed in healthcare, and honestly it wasn’t. So, this was a very interesting venture that had expanded exponentially through the time that the pilot was going on, so it was. 

Joel 

Do you mind explaining a little bit about what that gap is that you’re referring to? 

Crystal 

The gap in services is when a patient is discharged from the hospital, the home, with absolutely no help whatsoever. So, there may not be attendant care in the home. Nursing may not be in place. They’re a fall risk. They shouldn’t be alone. There isn’t a call button for them, just to be able to summon a nurse essentially.

Their meds may not be accurate when they get home, so all of those factors are involved in that patient’s healthcare, and they were being sent home with nothing. And so, it was up to the patient to navigate their own health care. And most of those patients don’t have the ability to do that.

Unfortunately, there are families that just don’t want to be involved and so the patient is left with nothing and they’re not getting their medications or the right medications, because once they’re discharged to home, they may have all the new medication. And so that’s not being fulfilled appropriately. There aren’t any services in place. That patient may not be able to cook their own meal after a stint, a good stint in the hospital.

And so, it was just really disheartening to see. The need there. That no one is doing anything about it, and this actually does in the healthcare coordination, it is our responsibility to assist with closing that gap. So, our coordinators assist those patients with everything that I just said. We set up all the services, we follow those services we do face-to-face visits with those patients or clients on this side of the fence.

And it’s just really important that we’re there during those follow-ups in any subsequent physician visit that that patient or client has, and we do all of that to ensure that they’re getting continuity of care. And that all of those physicians or anyone in the care team is knowledgeable as to what is happening with that patient or client. That’s kind of where we closed the gap within that system that, that break that shouldn’t be there. 

Joel 

Wow. All right. Well. So, what makes a position like that necessary? I mean, I imagine that people are getting referrals out to Medicaid or Medicare when they leave the hospital. But if that coordination just isn’t happening, what are some of the factors that cause that in the system? 

Crystal 

Honestly, you know in the hospital setting, the nurses are very overwhelmed sometimes and you know they may have a nurse-to-patient ratio, you have one nurse and who knows how many patients you have? It doesn’t really matter, I guess so much as how many patients, but the complexity of the case makes it more difficult.

But at the same time, that nurse is still coat-tailing the physician and if the physician doesn’t want to write in order for something, they’re not going to a lot of that stuff really gets overlooked, but also the patient themselves may not be communicating what’s really going on at home. And those underlying factors can also cause a break in their care or that gap. 

Joel 

Yeah, or well, is there like it gets sent to like, a case manager, right, with Medicaid or Medicare and there’s somebody that’s supposed to be on the ball with that stuff? I mean, government healthcare doesn’t always have somebody on the ball that’s. 

Crystal 

Right. I know that’s a big shock. 

Joel 

The problem is just the sheer number of people, though, right? It’s a, you know, case manager could have who knows how many people. 

Crystal 

Well, that’s true. And you know the case managers I know with the divisions of aging; they are very overwhelmed and they’re. That’s why we’re here on the integrated healthcare coordination side; because those care managers are very overwhelmed. They may have 100 to 150 clients on their caseload. How effective can it be, even if that care manager is reaching out to every client once every three months? It’s not effective. They can’t manage the entire aspect of their life as they should, with a lot of these clients because they may not have the ability to do so.

So, that’s where we come in to really grab a hold of the healthcare coordination side. And our coordinators just kind of run with anything and everything that they need in order to make sure that we are closing that gap. 

Joel 

Well, I guess with that, I want to introduce someone else we have here with us. Austin works with Crystal at Integrative Healthcare Systems, and he used to be one of these case managers that was just completely overloaded. 

Austin 

So, if you think about care managers, for example, a lot of care managers on average have 100 to 150. To 200. I mean, quite frankly, care managers are just as busy, if not busier than a one-legged man and a butt-kicking contest. That’s how it all goes, ultimately. You have things that are falling through the cracks and you’re trying to keep up with everything. But on top of it, if you, as a care manager, burn out, then how are you going to help your clients? I mean, ultimately, if we think about it. You have a waiver. The waiver requires care management. Shouldn’t those care managers have some sort of support when you think about integrated health healthcare services? That ultimately bridges the gap could be just as simple as making those weekly contacts when the care managers can only. Do maybe about 70 a month. And you think about 7 versus 150, that’s a little bit of a lopsided number right there. 

Joel 

Well, you know, let’s take that.

You mentioned the waiver program, and this brings up the main topic of today’s program is demystifying Medicaid and Medicare. And under Medicaid, you actually have this other, you know, and maybe you can even correct my knowledge on this, but it almost seems like you’ve got Medicaid and then you have like this other little rogue, you know, child of Medicaid called the Medicaid way. Over and they go through and it’s almost a whole different thing with different people that qualify, and different services are available.

So, if you don’t mind, just can you give an overview of just a brief high-level overview of what Medicare is, who qualifies for it, what Medicaid is, who qualifies for that, and then what this Medicaid waiver is? And maybe how that came about? 

Austin 

And feel free to correct me if I’m wrong Crystal, but Medicare, for example, is insurance for people who are advanced in age and would typically cover their medications, and their hospital doctor visits basically it takes our average insurance and makes it easy for the elderly to use.

Medicaid on the other hand, is for a group of that’s called the Aged and Disabled. They are able to get these types of services and get them paid for, such as attendant care, the home delivered meals. The personal emergency response systems. It’s almost like Medicare. But with added services and benefits. 

Joel 

So, if someone’s over 65 retirings, those are the people who are probably going to be tapping into Medicare services, but Medicaid could be any age. It really depends on your physical condition. How does that? 

Nicole

So, income plays a factor 2 right in Medicaid. 

Crystal 

Yeah, it does. It does so with a Medicaid waiver. Those clients actually qualify for what we call extra services, and they qualify for those based on their comorbidities. So, if they have … they’re a fall risk, plus they’ve had a stroke. I’m just throwing those out at it as examples. So, they’ve had a stroke and as a result of the stroke, they’re now at fall risk. So that would qualify someone for Medicaid waiver as long as they were within the income guideline.

With that being said, there is a process to being qualified. Having their assessment completed by a division of aging. So anywhere in the state. There are 17 divisions of aging within Indiana.

So, depending on the location that they’re in, so they would be assigned, they would call that division of aging and essentially get set up with an appointment for an assessment. Their initial assessment and then they have a secondary assessment. On top of that once they’re approved for waiver then services. Can be put on that client’s Service plan, whether it is home delivered, meals, attendant care, healthcare coordination, HMM, DME, or incontinent supplies. I mean, there are so many things that really waiver can cover.

Medicare, on the other hand, is a very complex beast over there. There are actual Medicare reps that will assist people in order to navigate the Medicare system. Medicare isn’t just cut and dry. Medicaid is fairly cut and dry compared to Medicare. Medicare has so many different plans. There’s, you know, part A, Part B, Part C, D, etcetera, etcetera. And they don’t always cover everything 100%. Typically, Medicare is an 80/20 plan, which then the client or patient has to have a supplement in order to pick up that 20%. It’s that is a very complex fee.

They also are very limited in, believe it or not, services. They don’t offer home-delivered meals. They don’t offer healthcare coordination, or I have a case manager within depending on who their Medicare plan is with because it isn’t just Medicare. There are other alternative plans as well, like Anthem and United Healthcare so. It just depends on what plan they actually have, and what that plan will cover.

Medicare, Medicaid waiver, Medicaid and waiver, I should say combined they cover everything 100%. So that is the difference between Medicare and Medicaid with a waiver additionally.

Did I just confuse you?

Joel 

That the whole, the whole point of this is to demystify Medicare and Medicaid, and but you, you have to start flushing things out to really start to kind of unravel them. So, like even right now, as we’ve tried to spell these out, it’s like a big, big bowl of spaghetti. Like, everything is going everywhere.

So, Medicare and is my understanding of it is Medicare is a federal program, but Medicaid is a state program. And also, from my understanding from my own interactions Medicaid requires you to list any other insurance first.

So, if someone is over 65, perhaps they have Medicare and Medicaid. How do they approach this with a provider? Do they approach it to have it covered by Medicare? And does Medicaid supplement it? Should they go and just try to get it straight covered? How would someone approach a provider that would need a service? 

Nicole 

I believe Medicare Trump’s Medicaid in most cases. If it’s a covered item, right Crystal?

Crystal

Correct

Joel 

Do you know what I just realized? I have not introduced Nicole Farmer to this in our talk today. Nicole is my co-host. 

Nicole 

That’s OK, that’s OK. 

Joel 

She’s a registered nurse in Indiana. She’s part of Signal Health Group, which is making this event and podcast possible. So welcome to our event, Nicole. You’ll be seeing a whole lot more of her if you follow us on our weekly podcast and events.

Yes, a lot of knowledge in this room. Let’s see if together with our brains combined, we can solve what is Medicare and Medicaid.

Medicaid seems like if you can qualify for it is going to work much better for you than Medicare, and it’ll cover a lot of the same services. Is that correct? Or are there things that Medicare covers that Medicaid doesn’t touch? 

Crystal 

Well, I think honestly, it’s just the opposite. I think Medicaid covers more. Once you are approved for Medicaid, it’s very easy for you to, if you qualify for the waiver program for those extra services to be added to your case essentially. But Medicaid actually covers more than Medicare. Medicare is not limited to older folks, either. If someone has been on disability for two-plus years, then they automatically are, I think, placed on Medicare. So, is that right, Nicole, do you know? 

Nicole 

Yeah, and they can apply for it if they do qualify for Medicare after they’ve been on disability acts. 

Crystal 

Whereas Medicaid is more of that income based. So, if you are within that income limit. Then you qualify for Medicaid. Now to be qualified for the waiver program, which is those extra services. Those rely on your inability to perform daily tasks, essentially, so if you’re having problems with your activities of daily living, you’re having issues with bathing or doing your laundry, or needing transportation healthcare coordination. I always have to throw that in there, of course. If you need home-delivered meals because you really can’t cook for yourself, those are all covered 100% under Medicaid waiver. Medicaid itself is income-driven. If you’re already on Medicaid, Medicaid, which you have to be in order to be on a waiver. The waiver is actually not income-driven per se, because you’re already on Medicaid at that point. So that’s already something that the hurdles have already been jumped with, with the income waiver if you need those extra services. If you’re having issues performing certain tasks at home. Then that’s where waiver comes into play, and that is all covered 100% under Medicaid. 

Nicole 

And I come from a home Care World. So, like with Medicare, that’s a skilled thing where they will cover 100% now Crystals, right? 80/20 typically, as far as outpatient services go, hospital doctors, but they will cover skilled nursing therapy and that kind of things in the home under Medicare which is federal. It’s not just an age requirement. The income guidelines aren’t there.

And then we go down to Medicaid, which is income-driven. They have to qualify for it. Those rates vary from state to state. What you can make and what you can do, cover a little more of the personal care services. So Medicare is going to come in and be in and out a couple of times a week. Maybe for nursing or therapy. Then we get into Medicaid, they’re going to be in there a few times a week for bathing and for some hands-on care.

But for someone that still can’t clean their house, can’t. You know, prep their meals, forget to take their medication, and these reminders, that’s when we work with people like Crystal and Austin on the waiver program. So, these people are already Medicaid qualified and now we have to see if they’re limited ADLs. Their inability to do their things will help them qualify for the waiver services. If I’m just understanding all of it correctly on your end. 

Crystal 

And there are different types of waivers as well. So, we are under three separate waiver programs, so ours are aged and disabled. So that can be zero to 100 and whatever. The age, there is no limit on age at that point. Then there is the TBI waiver, which is a traumatic brain injury, and we do, and we do have clients under the TBI waiver.

And then we have an MFP waiver, which is money follows the person, and that waiver is specific to folks who are being discharged from a nursing facility to a home. That waiver follows that client for one year. So that’s kind of the difference. Those are the waivers, kind of broken a little bit. I’m not going to go into too much detail because it can be a tangled web so. 

Joel 

Going into clear mud territory. 

Nicole 

The money follows the person; is basically someone that’s not quite set up for a full waiver yet, but needs services when they go home, correct? Right. 

Crystal 

Well, no it is. It’s entire. It’s just a whole separate. A waiver on its own specifications for nursing facility discharges to home. OK, so they can after that MFP waiver can qualify if they are still in need of waiver services, then they can qualify for that A&D waiver. 

Austin 

If I can dovetail off of that, usually when the money follows a person, the individual is going from nursing facility to home, they possess something called community transition funds, which ultimately will assist them in transitioning back home. Usually, it’s around $1,500. That they make request forms for specific items that they need. Those items are then ordered and put into their home. 

Joel 

All right, I want to go back a little bit and we’ll backtrack a little. Probably backtracked a lot over the course of this to try to flush some things out.

So Medicare, it can apply if you are disabled for an X number of years. And I believe Medicaid also has some kind of special program for disabilities. How does this in, in practice work for somebody that has a disabled dependent?

So, this could be someone with a disabled dependent adult you know could be someone who’s older, younger, that that they’re dependent. Or it could even be a child. Does somebody that is disabled dependent either through injury or even by birth like my own son has Down syndrome, so he’s probably going to be with us forever, you know, no empty nest. So, like, how would that work as far as qualifying for things like Medicare or Medicaid? Does it follow them because of their disability, regardless of income? I know it’s getting really kind of in the weeds. I’m just wondering if there’s any insight on that. 

Crystal 

So, there is a waiver program-specific for exactly what you’re talking about, Joel, and you know, for example, your son has downs. He could possibly potentially qualify for this, CIH waiver. Really, that’s kind of something that we don’t handle within what we currently do. Just because they consider that to be double dipping in waiver funds, so they don’t allow healthcare coordination for the CIH waiver.

CIH waiver is more like a transitional housing situation where there are group homes. That the client lives in. And they receive their medications there. They do have on-site staff. That kind of overseas and typically there may be 8 to 10 folks in a home. So, it’s a very small community within one home.

There’s also that outside program where they will go from the home into a work environment and that’s all controlled. So, I’m not really going to speak too much about that because that’s not something that I deal with on a day-to-day basis. But I do know that piece of it. Other than that, I’m really kind of not at liberty to discuss it.

But the A&D waiver, if there are limitations. It doesn’t matter if it’s something that occurred at birth, if it’s genetic if it’s something, a tragic accident happened, whatever that may be. They could potentially qualify for a waiver as long as they fall within the income guidelines of Medicaid. 

Joel 

Yes, I think I want to try to do a little bit of a pivot here. You know we’ve talked a little bit about Medicaid and Medicare and the Medicaid waiver and it’s a lot of really kind of intense deep topics. I want to focus on Medicaid a little bit on Medicaid versus Medicaid waiver.

Can you just talk for a little bit and help delineate what those two things are like? Why are they different? Why does somebody not be approved for something through Medicaid, but then be approved through it through a waiver?

What are these two programs, they seem almost completely separate, but at the same time, they’re like in the same breath as far as them being related so. Maybe we can try to delve into that a little bit, because if someone’s like, oh, you might be able to get that through. You know, it’s like, what does that even mean?

So we have Medicaid, which I guess is like the daddy, or the parent program and then you’ve got the Medicaid waiver, which is kind of an off. Do you mind? Just going a little bit of detail on these and separating out to the Medicaid and Medicaid waiver? It seems that Medicaid is there to help people who are disabled, who are low-income. But then this whole Medicaid waiver thing kind of spun off of it and seems to. Different requirements to how it services different things. You just go into the differences between Medicaid and the Medicaid waiver. 

Crystal 

So, Medicaid itself is a health plan essentially. So, you know that covers anything from medication, doctor’s visits, you know, etc. It doesn’t cover everything that is covered under waivers, so that is where things differ. So, the waiver is strictly you can just kind of look at, I’m sorry, Medicaid itself, you can look at as just as a regular health plan, you go to your primary care, it pays for it, you go to the pharmacy get your medication Medicaid pays for that.

The waiver is something that yes, is a spin but. It’s not insurance per se. It is a kind of supplement to Medicaid itself. And it covers those extra special services that Medicaid itself doesn’t even offer. So, the waiver covers those HMEDME, which is the home medical Durable medical equipment, attendant care services, homemaker services, care management, IHCC services transportation. So, it covers all of these things. The reason why it does is that Medicaid saw that there was a tremendous need for extra services that were not being offered by Medicaid.

So, the waiver you have to qualify for just because you have Medicaid doesn’t mean that you’re going to qualify for a waiver. You need to be under that category of aged and disabled or aged and or disabled. I should say you don’t have to be both. Or traumatic brain injury or money follows the person. The aged and disabled waiver is the one that we see the most.

And again, we serve as clients from birth through life. Typically, when someone is on the waiver for those extra services they continue to be on the waiver for the duration and that is because Their need was there to qualify them for those extra services. So again, it isn’t just a money-driven waiver program, it is… You have to medically qualify.

Now we don’t have to see, or we do on our end need to see a diagnosis, but the care managers who actually initially qualify that client for a waiver don’t need to see documentation from the physician. They just need to know what is going on with you in the home. What kind of needs are not being met and see if we can assist them in making sure that their needs are met and so that is the biggest difference I guess between Medicaid and Waiver. 

Nicole 

So, if I can just add to that real quick because we do and a lot of people don’t know that this waiver exists and a lot of people, I contact daily that need help with just their homemaking or their errands, they don’t even know that waivers out there. So, they called me, they have traditional Medicaid, but Medicaid doesn’t cover those extra services as we talked about.

So, we make that referral over, and for anybody that doesn’t know how you get waiver services, you contact your local area on aging, and they start the process for you. So, what I tell everyone that I send over is. Don’t undersell yourself. You know, a lot of the people that we’re talking about have a very hard time accepting this help that they desperately need.

So, what I let them know because my understanding is it is based on your physical need. So, Joel, a little bit that from my understanding Medicaid is money driven you to know it’s eligible based on your income. So, you qualify for that. Now you’ve got to have physical disabilities like it has to be hard for you to dress yourself. You need to have help with the shower. There need to be some physical limitations, so I try to tell everyone I’ll refer them over, and then the area on aging does their intake. Don’t be shy about it. It’s OK to need this help. Like you need to be as explicit as possible with the assistance you need to show them that you need that assistance. That you’ll qualify. 

Joel 

I got it so that that actually brought up another thing I wanted to bring up, so when we’re talking about Medicaid, there are probably a lot of people out there that are disabled or aged or just low income that need medical assistance. They kind of know that they should be looking into Medicaid. And since we’re focused a lot on seniors here, what we’ll focus there so that these local, local facilities on aging. What do you call them, local… 

Nicole 

The area on aging, they’re all called something different, but in each state, it’s the area on aging. So we’re here in. 

Joel 

So how would someone find those cause Medicaid is a different program in every state, but it seems like in every state there is this common local area on aging, but it’s they all have different names. How would someone find one of those in their area?

Crystal 

Medicaid actually has a listing of those, so if there’s one… 

Nicole 

So there’s the actual Medicaid office, Joel. Like, if you’re doing the traditional Medicaid. And then I didn’t realize Medicaid had a list of all those agencies. 

Joel 

Medicaid has a list on its website that… 

Crystal 

If you have a client who has Medicaid, on the back of their card is the customer service number, right? So, they can call that customer service line and ask for a division of aging. If they do have access to the Internet, they can Google Division of Aging. And that should populate some divisions of aging, and if they don’t have the right one, they can direct them to whom they need to speak. 

Joel 

Well, if somebody’s out there and they are struggling, it’s a hard time. It’s like it’s hard or maybe even dangerous for them to get dressed to use the shower, to clean, to cook. We call them activities of daily living, I believe.

So, if somebody’s having issues with those because of aging or disability, they need to call Medicaid or look up their local area on aging and see about waiver programs in their areas that’s kind of the course of action. 

Nicole 

If there are any Medicaid, if they’re already Medicaid qualified, they already have Medicaid, yeah. 

Crystal 

In order to present day in order for them to be qualified for a waiver, they have to have traditional Medicaid. So there again there are so many different plans out there. Even for Medicaid, in order to actually be qualified for a waiver, they have to have traditional Medicaid. Now next year in July, that’s all going to change. But as of right now, it’s tradition. 

Nicole 

So Crystal, if anybody in our area is listening because I know you guys don’t make the actual determination, I know those go through the state and the case managers with the Department of Aging. But if there was someone out there who just didn’t know since you are in multiple states, would you be a resource if your information was out there and they could contact you to kind of direct them because there are different states? Have different information phone numbers. Ours is *211, but if they wanted a person to speak with if they got Someone Like You then you would steer them in the right direction and then you would also probably end up helping out on the back end with your bridging the gap with the case. 

Crystal 

They can contact me. I answer a ton of those calls every day, so no problem. 

Nicole 

It’s just nice sometimes when we’re Googling and I do a lot of Googling too to find some of these places, but it would be nice to have a person in a face to direct some of our listeners too if they wanted to talk to someone one-on-one. 

Crystal 

They can contact me. 

Joel 

And when we release this as a podcast, we’ll make sure your contact information is in our show notes so people can reach out to you. 

Crystal 

Awesome. Thank you. 

Joel 

On that note, you’re about to cover 41 different states, and so this puts us in an interesting position to be able to ask you. Because we had a heck of a time trying to find someone that may be able to answer this question. Medicaid is a state program, and every state runs it differently. You know, there might be some states that maybe don’t even. Have a waiver program or there might be others that. Might not send out physical cards, and they might cover different things. Can you just go over for a little bit the differences people might see between their states when it comes to Medicaid? Because it’s hard to talk in general about Medicaid because every state might do it just a little bit differently. 

Crystal 

So, within those states, every single state has a waiver program believe that. So, it may be called something different, but they do have a waiver program. For example, Tennessee is 10 care. You know, Kentucky is bluegrass, so they all have their variations on what they’re calling it, but it’s essentially the same and the meat and potatoes of what the waiver covers within those states is pretty much the same. They tend to mirror, there are slight variations. But honestly, the bulk of it, it’s essentially the same. So, it’s Medicaid itself is, what is more, I think challenging to navigate within those states, waiver not so much and waiver is a fairly streamlined process just like it is in Indiana.

Not really too many variations… really none that pops off the top of my head at this moment. Austin, do they for you? 

Austin 

The one thing especially is when we’re talking about different states having Medicaid, Arizona is one of the states in the United States that actually does not have Medicaid… 

Nicole 

No Medicaid at all? 

Austin 

Yeah, I was talking to my friend Shirley down there. So, do you guys have Medicaid? How can you afford assisted living? And she said to me, Austin, I hate to tell you down here. People just take care of themselves. And I paused for a moment. 

Crystal 

I’m not personally licensed in Arizona, so that’s not a state that I’m familiar with. Whether they do or don’t, I can’t confirm that. But if Austin knows Austin knows which is great, and that’s why he’s in the position he’s in. But all the other states that I am licensed to practice in are great. They pretty much mirror each other. 

Nicole 

So are there little variations in the qualifying income? Limits and those kinds of things in different states probably vary. 

Crystal 

Now that does vary the more. 

Nicole 

What does it take to qualify? 

Crystal 

In those more poverty-stricken states, the income limit is way lower than in Indiana. I believe that it was Mississippi, correct me if I’m wrong, Austin, but I believe Mississippi’s income guideline is way lower than Indiana’s. And I’m using Indiana just because we’re here and that’s home base, so. But that’s more… 

Nicole 

So typically, there’s so much money you can make per year for a family of X amount of people, and usually they have, like those grids at the Medicaid office or maybe even online, that will show you, you know, you can make this much money if you have a family of this many to qualify. 

Joel 

All right, so let’s see if I can unravel everything that’s been said and try to give like a recap. So, when we’re looking at Medicare, Medicare is a federal program. To qualify for it, you have to be basically of retirement age, or you have to have been on disability for two years or more. Usually cost sharing. There are some caveats to that, but it’s not usually fully covered and so a lot of seniors get a supplement plan to cover what Medicare doesn’t cover.

When we get into Medicaid, Medicaid is state-based insurance for people who are low-income or disabled. Medicaid usually covers 100% of what you need it for, and usually covers more things than Medicare. If you are having issues with daily life because issues with daily life aren’t like an acute injury right, you’re not going to the emergency room because you have a hard time getting dressed in the morning when you have issues with your daily life and your basic things that you need to do to live, if you’re not successful or if you’re not able to do that in all reality. Maybe you have friends or family or whoever is coming over and helping you all the time. You may qualify through the Medicaid waiver program to get additional help. Trying to get those activities done, whether it’s helping people, helping transport you or driving you places or helping you clean, or taking care of you like an in-home caregiver, that kind of thing, that is if you are on Medicaid already and you are just to the point where you really can’t take care of yourself very well.

Is that kind of a good wrap-up of the three that I hopefully demystify a little bit?

Crystal 

I would say so. 

Joel 

And then the other thing to add, when it comes to Medicaid is that it is your, your Medicaid might be called something different in every state. I think here in Connecticut we call it. The Medicaid waiver. The waiver program may be called something different in your state and you know, the revenue thresholds may be different in every state to qualify for it, but when in doubt, you can contact your local Medicaid office or you can look them up on the Internet and they can also direct you to a local area on aging. And then to take this one step further, because you can’t do a synopsis about this, your local area on aging is generally like a nonprofit that helps you submit claims to Medicaid. 

Nicole 

Right. 

Joel 

Because when you’ve got the local and aging help with Medicare as well or just Medicaid. 

Nicole 

They’re typically more Medicaid, yeah. 

Joel 

OK, so, so if you’re in Medicaid and you need to get involved in the Medicaid system to get extra support, especially regarding necessarily exclusively, but especially regarding the Waiver. You can look up your local area on aging or you can contact your Medicaid office to find out where they are, and they are basically nonprofits. They have different names all over the place. But they are nonprofits that help you fill out the paperwork and get what you need to get done to get the Waiver program put together and finished. Or get into it, apply for it so that when you look at how daunting it can be to fill out, you know, some of these forms and try to get them to the right people. There are nonprofits there to help, and that’s what the local area of aging is. How was that? Was that as concise as we could be? 

Nicole 

I think you got it. And I would like to just add just a little bit about Crystal and Austin and what they do because I work with case managers day. And they’re overwhelmed. They are overloaded. They have referrals sitting at their desk. And that’s just what I know from home health, what alone trying to get them signed up with medical equipment and those kinds of things.

So, I think what you guys do is amazing. These people are already qualifying for some of these extra services that we’ve talked about, but that case manager may not have time to get them everything that could completely do them justice. So that’s where Crystal and Austin come in. And I just think it’s great that you take some of that load off their back and are able to provide more individualized attention to these people that ultimately need it. So, I just wanted to kind of add a little bit of what you guys do there, you kind of pick up the slack and take a little load off of the regular everyday system. 

Austin 

It’s a little bit of a tidbit, especially in the FSA manual for care management in Indiana. Give this the 9:00 that majority of divisions of aging are actually out for clients because it is actually supposed to cap out at 65 clients per care manager. Where we have care managers are 125/150 and the numbers just keep going up. 

Nicole 

Yeah, and that’s great that you guys are able to step in because they are just completely overloaded and with all the changes that keep happening, it’s just going to be more work for the case managers too. 

Joel 

I appreciate you letting us pick your brain today. So, this is where we just kind of laid out. We have got Medicare, we got this Medicare supplement Medicaid, the local area on aging and then getting to the Medicaid waiver where in that process would somebody reach out to you for assistance?

Like in between Medicaid and reaching out to the local area and aging after reaching out to the local area and aging when they’re submitting for the Medicaid waiver to, you know, getting Medicaid waiver services. At what point do you guys step in and kind of assist and help share and take some of the load off of the team? 

Crystal 

So, all of our clients have been referred by the division of aging and we do service the entire state of Indiana, so. So, you know, all 17 of those divisions of aging, we actually have clients through. But if you know if there is someone out there who needs assistance in navigating that system, they most definitely can reach out to us, and we can assist them through the process. 

Nicole 

So, if they’re ready, if they’re at a starting point, they can start with you, and you’ll kind of help guide them to where to go. 

Crystal 

We don’t want anyone who is in need of services not having the ability to get those services just because they have a fear of the unknown and they don’t really know what to do and the process involved. So you know we can step in at that point in a system with navigation. 

Joel 

And so how would somebody reach out to you if they wanted some assistance? What’s a good e-mail for them? 

Crystal 

It’s

Joel 

Does anybody else have anything to add here? I think it’s been a pretty good talk. We did our best at demystifying Medicare and Medicaid, although we may have to tackle this a few more times in the future to really unwind it all, I think this was a great start. 

Nicole 

And next week we’ll get into Medicare versus Medicaid or versus Medicare replacement plans a little bit more that Crystal kind of touched on. 

Joel 

Yeah, next week we are going to dig more into Medicare and Medicare, Medicare replacement plans, and the pros and cons of them. What do they cover that kind of stuff so? Well, thank you for coming out, and thank everybody for listening. And I hope you have a great week. Catch you at the next one. 

Nicole 

Thank you, guys, so much. It was great having you on. 

Crystal 

Thanks for having us.