Medical Social Services in Minnesota

Financial Resources

Many financial resources are available and should be discussed with the social worker.

Medicare

Medicare is a federal health insurance program for people 65 or older, certain younger people with disabilities, and people with permanent kidney failure treated with dialysis or a transplant. The Medicare information contained on this page was obtained from the Medicare Web site and from the "Medicare and You 2001" booklet.

Skilled Nursing Facility Care Under Medicare
Medicare pays for care in a skilled nursing facility when these five conditions are met:

1. Daily skilled nursing or rehabilitation services are required that can only be provided in a skilled nursing facility.
2. The patient is in the hospital three nights in a row before entering the skilled nursing facility.
3. The patient is admitted to the facility within a short time (generally 30 days) after leaving the hospital.
4. The condition for which the skilled nursing care is required was treated in the hospital or arose while the patient was receiving care for a condition treated in the hospital.
5. A medical professional certifies that skilled nursing care is necessary.

Medicare only pays for skilled care in a nursing home. Medicare does not pay for custodial care when that is the only kind of care needed. Care is considered custodial when it is primarily for the purpose of helping with daily living or meeting personal needs and could be provided safely and reasonably by people without professional skills. Examples of custodial care are using eyedrops, bathing, dressing and bladder catheters. Care is considered skilled when it must be performed by a nurse or a physical therapist. Examples of skilled care are wound care, physical therapy and IVs.

Home Health Care Under Medicare
Medicare pays for home health care when these four conditions are met:

1. The patient requires intermittent skilled nursing care, physical therapy, or speech/language therapy.
2. The patient is confined to the home.
3. The doctor determines that the patient needs home health care.
4. The home health agency providing the care participates in Medicare.

Hospice Care Under Medicare
Hospice benefits are available under Medicare. Hospice is care provided for people who are terminally ill and their families. Emphasis is on providing comfort and relief from pain. It includes both home care and inpatient care, when needed, and a variety of services not otherwise covered under Medicare. The three following conditions must be met:

1. The doctor certifies that the patient is terminally ill.
2. The patient chooses to receive hospice care instead of the standard Medicare benefits for illness.
3. The care is provided by a Medicare-participating hospice program.

If the patient or family chooses hospice care and later requires treatment for a condition other than the terminal illness, Medicare's standard benefits may be used. When standard benefits are used, deductibles and coinsurance payment may be required.

For additional information or current updates on Medicare, contact 1-800-633-4227 (toll free) or go to the Medicare Web site .

More Financial Resources

Medical Assistance (MA)/Medicaid
Medical Assistance provides insurance coverage for low-income persons who meet financial guidelines. Federal, state and county governments fund Medical Assistance. Medicare is a federal health insurance program for all people 65 or older and for certain people with disabilities.

Medical Assistance pays for most medical care including home health care and nursing home care. In Minnesota, persons eligible for Medical Assistance may also apply for other programs such as the Alternative Care Grant (ACG) or Community Alternatives for Disabled Individual Program (CADI) which may pay for additional services to help a patient stay at home. For information on coverage in each state, please contact the county or social services department.

To apply for Medical Assistance, call, write, or visit the patient's local county Department of Social Services. In Olmsted County, call 507-285-8382. The patient will need to complete an application and provide the agency with information and certain documents to help verify eligibility for the program.

Personal Health Insurance
Some insurance policies provide nursing home, home care and/or hospice benefits. Insurance coverage varies greatly depending on the individual insurance policy.

Social Security Disability Income (SSDI)
Social Security Disability Income provides monthly income to individuals who have worked long enough and recently enough under Social Security to be insured and have a severe physical or mental impairment or combination of impairments that prevents them from working for a year or more or that is expected to result in death. Applications are made through the local Social Security office. For information, call or visit the local Social Security office or call the Social Security Administration toll free at 1-800-772-1213.

Supplemental Security Income Program (SSI)
Supplemental Security Income provides monthly income to people who are 65 or older, blind or disabled. Eligibility is based on financial need. Some people are eligible for both SSDI and SSI. Many people who receive SSI are eligible for Medical Assistance and food stamps. For information, call the local Social Security office.

State Welfare Programs
The patient's local county Department of Social Services is a resource for several programs such as Medical Assistance, food stamps, fuel assistance, General Assistance and also programs such as the Alternative Care Grant (ACG) or Community Alternatives for Disabled Individuals (CADI). Contact each local social service office for information.

Comprehensive Health Insurance Plans
Several states offer comprehensive health insurance plans for people with pre-existing conditions who are experiencing difficulty obtaining insurance. Often, there is a six-month waiting period and the patient must offer proof that health insurance cannot be obtained. For information about each state's plan, contact the state insurance commissioner's office. In Minnesota, call toll free at
1-800-531-6674 or 952-593-9609.

Veterans Administration and Veterans Services
Veterans may be eligible for benefits including nursing home coverage, hospital stays, medical treatment and medications. Call the local Veterans Service representative for information and help with applying.

Workers' Compensation
Workers' compensation is a state-regulated program that pays medical costs and other benefits to workers who have been injured on the job. For information, check with the employer's personnel office.

COBRA (Consolidated Omnibus Budget Reconciliation Act)
This law mandates that some workers can continue to keep their health insurance coverage for a limited time after they leave their jobs. For information, call toll free at
1-800-998-7542.

Rehabilitation Services
This agency helps people with disabilities return to suitable employment by providing rehabilitation, evaluation and retraining. It is a federal- and state-funded program. Ask the social worker for information and help in locating the office closest to home. In Rochester, call 507-285-7293.

MinnesotaCare
MinnesotaCare is a health insurance program for Minnesota residents who are not eligible for Medical Assistance and are not covered by any other health insurance for the previous four months. The monthly premium is based on income and family size. For information, write MinnesotaCare, 444 Lafayette Rd. N, St. Paul, MN 55155-3829 or call toll free at
1-800-657-3672. In Rochester, call 507-285-8382.

Medigap Insurance
Medigap is a Medicare supplemental insurance policy sold by private insurance companies to fill "gaps" in original Medicare Plan coverage. The best time to buy a Medigap policy is during Medigap open enrollment. During this time, an insurance company cannot deny insurance coverage or charge larger premiums because of past or present health problems. For more information, call the State Health Insurance Assistance Program or call Medicare toll free at
1-800-633-4227. In Minnesota, call the Senior Linkage line toll free at 1-800-333-2433.

Long-Term Care
This is a private policy. The benefits and costs of these plans vary widely. For more information on these plans, contact the National Association of Insurance Commissioners (NAIC). The association represents state health insurance regulators and has a free publication called "A Shopper's Guide to Long-Term Care Insurance." A copy of the "Guide to Health Insurance for People with Medicare" can be obtained by calling Medicare toll free at 1-800-633-4227.

Prescription Drug Assistance
Many financial resources are available to assist with purchasing prescription drugs. Because it is impossible to include every resource on this Web site, please contact the Senior Linkage Line toll free at 1-800-333-2433. A representative can provide further resources. In addition, patients may wish to contact their local social service agency for information on programs available in their county of residence.