Legal Services for Cape Cod and Islands, Inc.
LSCCI LOGO A
CAPE COD
CONSUMER'S
RESOURCE GUIDE
TO
PUBLIC HEALTH CARE
PROGRAMS
Prepared by Legal Services for Cape Cod and Islands, Inc.

Legal Services for Cape Cod and Islands, Inc. provides advice and representation to
low-income people on these programs and other matters. Contact us at:

Legal Services for Cape Cod and Islands, Inc.
460 West Main Street
Hyannis, MA 02601
508-775-7020 , 428-8161 , 1-800-742-4107

Plymouth Office
18 Main Street Extension
Plymouth, MA 02360
508-746-2777 , 1-800-585-4933



MassHealth -- MassHealth is really three different programs. Usually, they only cover services from a health care provider who is enrolled in MassHealth. For most services, they will only pay the provider directly and will not reimburse you. Each has its own eligibility criteria. Applications are given out at local Welfare offices or available directly from the Division of Medical Assistance at 1-800-242-1340. Do not let anyone tell you that you cannot apply. Everyone has the right to apply and you cannot receive a formal eligibility determination unless you do apply. The three programs which make up MassHealth are:

(1) Medicaid -- (Also called Medical Assistance. Do not confuse with Medicare. See below.) Everyone who receives TAFDC or SSI (cash assistance from Social Security for low-income elderly and disabled people) also gets Medicaid coverage. But if you are low-income and pregnant or disabled or over 65 or under 18 or, in some cases the parent of a child under 18, you may qualify separately for Medicaid. Whether your income is low enough to qualify depends on a number of things, including your age. Some people may be eligible with a deductible or "spend down," which means that once you incur a certain amount of medical expenses (determined by your income) you can become eligible to have Medicaid pay any other expenses. (See income eligibility chart.)

Usually, if you live with someone who is legally liable for your support, that person's income and assets count in determining your eligibility for Medicaid. But under two special programs, known as the Kaileigh Mulligan program and the "community waiver" program, children and people who are over 60 can receive services under Medicaid, without regard to the income and assets of the parents or spouses with whom they live if those services are necessary to keep them from being institutionalized.

(2) Recipients of Emergency Aid to the Elderly, Disabled and Children (EAEDC).
EAEDC is a cash assistance program for certain low-income families and children who are not eligible for AFDC and low-income elderly and disabled people who are either ineligible for SSI or are waiting for their eligibility to be determined. Recipients of EDC are covered by a limited form of MassHealth.

(3) CommonHealth - This is a program for disabled children and working disabled adults. You do not have to be low-income to be eligible, but, if you are not, you may be charged a premium on a sliding scale based on your income and family size.


Hospital Free Care -- Acute care hospitals in Massachusetts are required to provide their services for free or at a reduced charge to certain patients. Apply through the hospital billing office. You will be eligible if you receive EAEDC or are enrolled in CenterCare or Healthy Start or have income below 200 % of the Federal Poverty Limit. If it is between 200 % and 400 % of the Federal Poverty Limit, the charges may be reduced. Even if your income is higher, you may be eligible for free care if the hospital determines the bill would result in a financial hardship. This program covers the hospital's charges only, not doctor's fees.

Medicare (Do not confuse with Medicaid) -- This is the health insurance program run by Social Security for people over 65 and the disabled. You do not have to be low-income to be eligible. Medicare has two parts. Part A covers hospital services and related health care. Part B covers a variety of services, including doctors' bills. People who are receiving Social Security disability or are over 65 and receiving Social Security retirement will receive Part A coverage for free. Others who are eligible will have to pay a premium. Everyone is charged a premium for Part B coverage. Apply for Medicare at Social Security. Low-income Medicare beneficiaries may also be eligible for Medicaid coverage. If so, Medicaid will pay the Medicare premiums, co-payments and deductibles.

Health Security Plan -- Most people who are receiving Unemployment Compensation and have income less than 400 % of the Federal Poverty limit qualify for this program which either provides direct health insurance coverage or pays to maintain the insurance coverage you had when you were working. Apply at the Department of Employment and Training.

Healthy Start -- All pregnant women may use the Healthy Start information and referral services. You may also be eligible for coverage of prenatal care and delivery if your income is below 200 % of the Federal Poverty Limit and you are not eligible for Medicaid and have no other insurance which would cover that care. Apply by calling 1-800-642-4250.

CenterCare Program - Health centers which participate in CenterCare provide primary care services on a sliding fee scale to patients who have no other insurance and whose income is below 200% of the Federal Poverty Level. The only participating health center on Cape Cod is Outer Cape Health Services, Inc. (both Wellfleet and Provincetown) which also uses the same sliding fee scale for low-income patients who are not enrolled in CenterCare.

Veterans' Services -- Low-income veterans and their low-income spouses, children and, sometimes, parents may be eligible for a state-run medical program similar to Medicaid. This is in addition to any services available through the federal Veterans' Administration. Apply with your town's veterans' agent.

Mental Health Services -- Each area of the state has its own assortment of mental health services. You do not have to be low-income, but some services are available only to certain populations (such as children or outpatient clients) and you may be required to pay a fee determined by your income. Apply through the Department of Mental Health regional office: 508-775-1199.

Children's Medical Security Plan -- John Hancock Insurance runs this state-sponsored program which provides limited coverage for check-ups, doctor's visits and prescription drugs for children age 18 and under. It is free for families whose income is under about 200% of the Federal Poverty Level, with a sliding scale for others. For more information, call 1-800-9092677.


STATE AND PRIVATE AGENCIES PROVIDING
HEALTH CARE, INFORMATION AND REFERRAL


AIDS
AIDS Actioin Committee 1-617-437-6200
AIDS Hotline 1-800-235-3776
Latino AIDS Hotline 1-800-637-3776


CANCER
American Cancer Society 1-800-952-7664


CHILDREN
New England SERVE 1-617-574-9493
Office for Children 1-617-727-8912


DISABLED
Information Center for Individuals with Disabilities 1-617-727-5540
Commission for the Blind 1-617-727-5550
Commission for the Deaf and Hard of Hearing 1-617-727-5106
1-617-727-5106 TTY
Office of Handicapped Affairs 1-617-727-7440
1-800-322-2020 TTY


ELDERLY
Alzheimer's Information 1-800-351-2299
Executive Office of Elder Affairs 1-800-882-2003
MA Association for Adult Day Health Services, Inc. 1-508-798-8653 X2151
MA Councils on Aging and Senior Centers 1-617-661-1115
MA Home Care Corporation 1-617-272-7177


IMMIGRATION
General Information and Referral 1-800-521-9400
MA Immigrant and Refugee Advocacy Coalition 1-617-357-6000 X229


MENTAL HEALTH
Department of Mental Health 1-617-727-5600
1-617-727-9842 TTY


MENTAL RETARDATION
Department of Mental Retardation 1-617-727-5608
1-800-227-7548


PUBLIC HEALTH
Department of Public Health 1-617-727-2700
1-617-727-9842 TTY


SEXUALLY TRANSMITTED DISEASES
Department of Public Health 1-617-522-3700 X408


SOCIAL SERVICES
Department of Social Services 1-617-727-0900


SUBSTANCE ABUSE
Department of Public Health 1-800-327-5050


VETERANS' SERVICES
Department of Veteran's Services 1-617-727-3578


WELFARE
Department of Public Welfare, Client Services 1-800-842-2900


VERY IMPORTANT NOTE -- This pamphlet attempts to explain the basics of some very complicated programs in a few pages. It had to be written in generalities and leaves out a lot of detail. It might not apply exactly to every case. Also, the information is accurate as of April, 1997, but the program descriptions and other information could change at any time. Do not use this information as the basis for important decisions. Use it to identify programs and agencies which may be of help to you and your family and then apply for the program or get more information about the agency.


INCOME ELIGIBILITY FOR PUBLIC HEALTH CARE PROGRAMS
(Monthly Amounts)
Family
Size
Oridinary
Medicaid
Standard
(1)
Federal
Poverty
Level
(2)
133% of
Federal
Poverty
Level
(3)
185% if
Federal
Poverty
Level
(4)
200% of
Federal
Poverty
Level
(5)
400% of
Federal
Poverty
Level
(6)
1 $522 $657 $874 $1216 $1315 $2630
2 $650 $884 $1635 $1175 $1768 $3536
3 $775 $1110 $1477 $2055 $2221 $4443
4 $891 $1337 $1778 $2474 $2675 $5350
5 $1,016 $1564 $2080 $2893 $3128 $6256
6 $1,141 $1790 $2381 $3313 $3581 $7163
7 $1,266 $2017 $2683 $3732 $4035 $8070
8 $1,383 $2244 $2984 $4151 $4489 $8978
9 $1,508 - - - - -
10 $1,633 - - - - -
each add'l
person
+$133 +$226 +$301 +$419 +$453 +$906

(1)

Use for Medicaid eligibility if neither (2), nor (3), nor (4) apply. Also, always use in computing Medicaid " spend-downs. "

(2)

Use for Medicaid eligibility of people who are 65 or older or disabled and for children who are under 19, over 5 and born after 9/30/83.

(3)

Use for Medicaid eligibility of children who are at least one year old but under six.

(4)

Use for Medicaid eligibility of pregnant women and children who are less than one year old.

(5)

Use for CenterCare, Free Care Pool and Healthy Start eligibility

(6)

Use for Free Care Pool and Health Security eligibility.
IMPORTANT NOTE:
The amounts in columns (2) - (6) are as of April 1997, but the Federal Poverty Level is updated for inflation each year and Medicaid usually adopts the new amounts for columns (2) - (4) as of April 1.

ALSO NOTE:
The amounts in Columns (1) - (4) are net amounts after certain deductions determined by the person's circumstances. The amounts in Columns (5) and (6) are gross amounts.
Disclaimer: LSCCI makes no warranties or representations as to the legality or applicability of these materials to your situation; at all times, you are strongly encouraged to seek the advice of a competent attorney. If you have a legal problem, please call LSCCI to determine if you are income eligible for our services or for a referral to a private attorney. If you are an elder living on Cape Cod, Nantucket, or Martha's Vineyard, we may also be able to help you.

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