What happens after I apply?

DHS will tell you if you are eligible for Medicaid within 45 days of the date you apply. If you are applying because you have a disability, you will be told within 60 days.

If DHS does not decide if you are eligible for the program within your time limit, Medicaid may have to repay you for medical bills you paid after the time limit. Save copies of any medical bills you paid after your time limit. You will be sent a letter if you are eligible for being repaid.

What if I am homeless?

You can receive Medicaid benefits even if you do not have an address. If you are eligible, DHS will make sure you get your Medicaid benefits.

What if I am turned down?

If your application for Medicaid is turned down, you can fill out an appeal form. You can ask for a special meeting called a hearing. At the hearing, you can explain why you think your application should be approved.

For more information about your right to appeal and receive a fair hearing, ask your caseworker.

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If I am eligible when do my benefits begin?

If your application is approved, your eligibility for Medicaid usually begins with the month you apply, as long as you meet all the eligibility requirements. You will receive a medical card that you can use for your medical expenses. However, you may be eligible for Medicaid for UP TO THREE MONTHS before the month you apply. If you have medical expenses during any of the three months before the month you apply, be sure to tell your caseworker about them so Medicaid can decide whether it will pay for those bills. If possible, you should not pay your medical bills until you learn whether you are eligible for Medicaid. Inform providers that you have applied for Medicaid.

What medical services does Medicaid pay for?

Who provides these medical services?

When you take part in the Medicaid program, the doctors, hospitals, clinics, Health Maintenance Organizations (HMOs) and others who give you care need to be enrolled with Medicaid.

What other services can I get through this program?

If you receive Medicaid, DHS may be able to help your family pay for your funeral and burial expenses if you should die.

How do I stay eligible for Medicaid?

Help Medicaid get payments for your health care

You must give DHS any information you have about medical benefits, such as health insurance you receive from another source. If you do not provide this information, you will not get Medicaid. If you have a good reason for not providing this information, tell your caseworker. Your children who are eligible for Medicaid will continue to receive it whether or not you cooperate.

If you receive Medicaid and get money from another source, such as a health insurance company, for services Medicaid paid, you must repay Medicaid.

Sometimes Medicaid pays a medical bill that another one of your health care resources should have paid. When this happens, Medicaid has the right, by law, to collect money from this resource to cover the bill it paid.

Tell your caseworker when you move

You must let your caseworker know when you move so your medical card and other important information can be sent to your new address. If you are homeless, tell your caseworker how you can be reached. If your caseworker cannot find you, your Medicaid will stop.

Keep your appointments

You must try to keep all your appointments with your caseworker. If you cannot keep an appointment, be sure to tell your caseworker right away.

Report changes in your family situation, income and assets

You must tell your caseworker within five days if there are any changes in your family situation, to include; income (the money you receive), as well as if you are age 65 or older, or disabled as definded under Aid to the Aged, Blind and Disabled (AABD) or in your assets (the things you own). If you are unable to reach your caseworker, you can report changes by calling the toll-free Change Report Line 24 hours a day, 7 days a week at 1-800-720-4166 (voice). Persons using a teletypewriter (TTY) can call toll -free at 1-800-447-6404.

Any change may affect your eligibility for Medicaid. For example, if you get a health insurance payment for a bill Medicaid has paid, you must report it to your caseworker. You will be asked to turn the payment over, or if the payment is more than Medicaid paid, you will be asked to repay the amount Medicaid paid.

If you withhold information or do not tell DHS the truth about your family situation, income or assets (if you are AABD), you may be guilty of fraud. If you help others withhold information or make untrue statements about their family situation, income or assets, you also may be guilty of fraud. Fraud is a serious crime. If you are found guilty of this crime, you may have to pay a fine, go to prison or both.

Liens and Claims

Medicaid has the legal right to recover the amount of assistance persons receive through the Aid to the Aged, Blind and Disabled (AABD) program. Medicaid uses liens on real property and claims against estates in certain situations to do this. For more information on liens and claims, get the brochure called Property Liens and Estate Claims from your local DHS office.

Also, call this telephone number if you know someone who is withholding information or not telling DHS the truth about the medical services they need or if you know someone who is charging Medicaid for medical care that he or she did not give.

What do I do if I am contacted by a collection agency or threatened with a lawsuit about paying a medical bill which I think Medicaid should pay?

Medicaid pays for most medical care you get during the time you are eligible for assistance. Medical providers who accept you as a Medicaid patient for a medical service covered by Medicaid should not ask you to pay for that service if you were eligible for Medicaid at the time of the service.

If you are contacted by a collection agency or are sued or threatened with a lawsuit about payment for medical expenses you think Medicaid should pay, you can ask to have the bill reviewed by calling or writing DHS.