Medicaid Beneficiary Income Thresholds and Service Categories

Restructure Medicare & Medicaid: Examples of Medicaid’s Mandatory Beneficiaries & Services Examples of Mandatory Beneficiaries e Children under age 6 with family annual income below $20,841 Children age 6 or older with family annual income below $15,670 Pregnant women with annual income below $12,382 Elderly and disabled with annual income between below $6,768 (for an individual) (@)E) www.kpcb.com Examples of Mandatory Services Physician services Laboratory & x-ray services Inpatient hospital services Outpatient hospital services Rural health clinic services Certified pediatric and family nurse practitioner services Early & periodic screening, diagnostic, and treatment (EPSDT) services for individuals under 21 Note: Supplementary Security Income and Federal Poverty Levels are 2005 levels. Source: Kaiser Family Foundation, 2005. USA Inc. | What Might a Turnaround Expert Consider? 321 Restructure Medicare & Medicaid: Examples of Medicaid’s Optional Beneficiaries & Services Examples of Optional Beneficiaries e Disabled and elderly with annual income between $7,082 (Supplementary Security Income, or SSI) and $9,310 (Federal Poverty Level, or FPL) e Nursing home residents with annual income between $7,082 (SSI) and $21,000 (3x SSI) e Pregnant women with annual income above $12,382 (>133% of FPL) e Children under 6 with annual family income above $20,841 (@E) www.kpcb.com Examples of Optional Services Prescription drugs Dental services Rehabilitation and other therapies Prosthetic devices, eyeglasses, durable medical equipment Hospice services Inpatient psychiatric hospital services for individuals under age 21 e Other specialist medical or remedial care Note: Supplementary Security Income and Federal Poverty Levels are 2005 levels. Source: Kaiser Family Foundation, 2005. USA Inc. | What Might a Turnaround Expert Consider? 322 HOUSE_OVERSIGHT_021002