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Is Diabetes A Disability For Medicaid

What Happens If You Indicate Youre Disabled

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If you indicate you have a disability on your Marketplace application, well send it to your state Medical Assistance office to see if you qualify for Medicaid based on your disability. If we send your application to your state Medicaid office, they may contact you for more information on your disability. If you dont qualify for Medicaid based on your disability, you may still be eligible based on your income or you may qualify for a tax credit.

You should still indicate that youre disabled even if youre not sure if your state will consider you eligible for Medicaid based on your disability. This will help make sure you get the most help available. Your state will determine if you qualify for Medicaid.

If you say youre disabled, but your state determines you either dont qualify for Medicaid based on your income or determines that you dont have a qualifying disability, you can still buy health coverage through the Marketplace. Plans cant deny you coverage or charge you more because of your disability.

If you dont indicate youre disabled, we wont send your application to your state Medicaid office because of a disability, but we may send it later in the process if we think youll qualify based on your income.

Symptoms And Complications Of Adult Diabetes

Symptoms of both diabetes type 1 and diabetes type 2 include frequent urination, unusual thirst and hunger, and extreme fatigue. People with type 2 diabetes also can suffer from tingling or numbness in the hands and feet, frequent infections, and cuts that are slow to heal.

Complications from diabetes include:

Does My States Medicaid Program Cover Cgm

It depends. Even if CGM is covered under your states policy, each state has its own criteria for which individuals qualify to receive it. For example, some states only cover CGM for type 1 diabetes, and other states have differing policies for short-term and long-term CGM use. To find out more about your specific states policy, check out our map below:

This map is the general landscape of Medicaid coverage for CGM. The fifteen states shown in red offer no coverage of CGM for Medicaid recipients, while the rest of the states offer some degree of coverage, as shown in the legend.

Fourteen states Medicaid programs provide CGM for people with both type 1 and type 2 diabetes: Alaska, Connecticut, Idaho, Illinois, Iowa, Indiana, Maine, Massachusetts, Minnesota, New Mexico, Ohio, Virginia, Washington, and West Virginia.

Seventeen states Medicaid programs provide CGM for people with type 1 diabetes only: Kentucky, Louisiana, Maryland, Michigan, Mississippi, New Hampshire, New York, North Carolina, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Wisconsin, and Wyoming.

Four states Medicaid programs provide CGM for children only: Alabama, California, Florida, and Georgia.

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Coordination Of Coverage With Esrd

If you have employer-sponsored or union-sponsored insurance and you become eligible for Medicare due to ESRD, Medicare will coordinate with your existing coverage for 30 months.

During that time, your private insurance will be your primary coverage, and Medicare will pick up a portion of the remaining costs. After those 30 months, if you still have coverage under your group health plan, it will become secondary coverage and Medicare will become primary.

Unitedhealthcare Connected For Mycare Ohio

Is Diabetes A Disability For Medicaid

UnitedHealthcare Connected for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare® Connected de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

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How Type 2 Diabetes Qualifies For Disability Benefits

Social Security Disability Income is a federal disability insurance benefit for those who have worked and paid into Social Security.

Keep in mind that SSDI is different from Supplemental Security Income . That program is for people with low incomes who didnt pay enough into Social Security during their working years to qualify for SSDI.

If that describes you, consider looking into SSI as a starting point.

In either case, benefits are limited to those who are unable to perform substantial gainful activity, according to Liz Supinski, director of data science at the Society for Human Resource Management.

There are limits on how much a person can earn and still collect, she says, and its about $1,200 per month for most people, or around $2,000 per month for those who are also blind.

The SSA no longer includes type 2 diabetes as a separate disability listing, so simply having that diagnosis wont qualify you for benefits.

However, if you have complications that meet the criteria under other disability listings, then you may be eligible.

The most common are:

If you have symptoms like these due to your diabetes, even though youre following your doctors prescribed treatment, you could be eligible for disability benefits.

However, keep in mind that if your condition isnt well managed because youre not following a doctors prescribed treatment, youre likely to be turned down for disability assistance.

Unitedhealthcare Senior Care Options Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

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Social Security Disability Insurance

This is for people who have worked for five of the last 10 years and meet the Social Security Administrations definition of disability .

SSDI offers assistance to help you return to work and provides ongoing income if you do not get better. When you receive SSDI you can also qualify for Medicare and prescription drug assistance, explains the ADA.

The Basics Of The Medicare Benefit

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Medicare consists of four basic parts, including:

  • Part A, which covers primarily inpatient hospital and skilled nursing facility services.
  • Part B, which covers primarily physician and outpatient hospital services, as well as durable medical equipment such as insulin pumps, test strips and some CGMs.
  • Part C, also known as Medicare Advantage plans, are offered by private insurance companies and cover the same benefits as Medicare Part A and B, plus many offer drug coverage, similar to Part D
  • Part D, which covers prescription drugs that you typically obtain at a pharmacy, and may also cover disposable insulin patch pumps.

As a person with T1D, Parts B and D will be the most relevant to your day-to-day diabetes management. Well discuss why below.

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Are Adults With Type 1 Diabetes Eligible For Ssi

According to the American Diabetes Association , there must be serious complications from type 1 diabetes to get Supplemental Security Income or Social Security Disability Insurance as an adult.

The ADA further states that Social Security Disability Insurance , is for people who have worked for five of the last 10 years and meet the SSA definition of disability. SSDI offers assistance to help you return to work and provides ongoing income if you do not get better. When you receive SSDI you can also qualify for Medicare and prescription drug assistance.

Supplemental Security Income program , is available to individuals who have limitedincome and resources, and are considered disabled by the Social Security Administration. SSIprovides a monthly assistance check. Medicaid is a health care program for people with lowincomes.

Definition Of A Disability

The Social Security Administration has a very strict definition of disability. To be considered disabled:

  • You must be unable to do any substantial work because of your medical condition
  • AND your medical condition must have lasted or be expected to last at least one year, or be expected to result in your death

According to the law, your SSDI payments cannot start until you have been disabled for at least five full months, although a recent law change expedited this process for people with ALS. Your payment will usually start with your sixth month of disability.

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Finding The Best Plan Step

You can sign up for Medicare online, via phone at 1-800-MEDICARE , or by visiting your local Social Security office. Medicare Advantage plans are sold through private insurers.

1) To review Medicare plans, use the Plan Finder. For the purposes of this walk-through, we are going to go through the process of finding an ideal Medicare Advantage plan .

2) From there, you will enter your home zip code, then press continue. Confirm your county, and answer the next question on whether or not you receive help with your costs from any of the listed programs, then press next.

3) In the next question , be sure to select that you do want to see your drug costs when you compare plans. In the question directly afterward, youll select how you normally receive your prescriptions .

4) Next, when adding your prescription drugs, be sure to add each drug you take to get the most accurate summary of what you can expect your costs to be. When you enter your insulin type, be sure to select add brand instead when a pop-up window prompts you on whether you would like the generic version of your medication. This will ensure you can get the exact medication your doctor has prescribed. For each medication, you will enter details around how much of the medication you take. Once youre done adding medications, click the green button that says Done Adding Drugs. You will then enter your pharmacy information .

What Is A Dual Special Needs Plan


Dual Special Needs Plans are for people who could use some extra help. That may be because of income, disabilities, age and/or health conditions. Dual Special Needs Plans are a special type of Medicare Advantage plan. They include everything you get with Original Medicare, plus prescription drug coverage and many other extra benefits on top. And you could get it all with as low as a $0 plan premium.

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Research Design And Methods

The data reported in this study were developed through a large-scale survey of HMO enrollees with diabetes that was part of the Pathways study . This project was carried out by a multidisciplinary team from the Center for Health Studies of Group Health Cooperative and the Department of Psychiatry at the University of Washington. The study protocol was reviewed and approved by institutional review boards at GHC and the University of Washington.

For this study, nine GHC primary care clinics in western Washington were selected. Subjects were identified using GHCs diabetes registry, which supports patient care . Patients are added to the diabetes registry based on 1) current use of any diabetic agent 2) a fasting glucose 126 mg/dl, confirmed by a second out-of-range test within 1 year 3) a random plasma glucose 200 mg/dl, confirmed by a second test within 1 year or 4) a hospital discharge diagnosis of diabetes at any time during GHC enrollment or two outpatient diagnoses of diabetes . Patients were screened by mail. A $3 gift certificate for a local store was used to encourage responses. Nonresponding individuals received two mailings and then were contacted by telephone, resulting in a 62% response rate.

Which Diabetes Services And Supplies Does Medicare Cover

Medicare Part B and Part D cover many diabetes services and supplies. You may first need to pay a deductible, copayment, or coinsurance. Some services are free if your doctor orders them.

Medicare Part B helps pay for

  • Women, Infants, and Children

The Social Security Administration can provide financial help through two programs

  • SSDI pays a monthly amount to people who cant work and have paid enough Social Security taxes. If an illness or injury keeps you out of work for at least a year, SSDI payments may be an option.
  • SSI pays a monthly amount to disabled children and adults who earn little and dont have many financial assets. A person who gets SSI may be able to get Medicaid and food stamps through the Supplemental Nutrition Assistance Program , too.

Read more about both SSDI and SSI and how to apply at or by calling 18007721213, TTY: 18003250778.

WIC serves mothers and children who are at risk for poor nutrition or hunger. This includes low-income women who are pregnant, breastfeeding, or recently had a baby, as well as infants and children up to age 5. Pregnant women who have gestational diabetes may qualify for help through the WIC program. WIC provides

  • supplemental foods

Learn more about WIC online, or call the WICs headquarters at 703-305-2062.

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Why Is Medicaid Coverage Beyond The Ssi Pathway Important For People With Disabilities

Even though their needs do not rise to the stringent SSI level, nonelderly Medicaid adults with disabilities but not SSI still report serious functional limitations that can affect their health, making coverage important. A majority of non-SSI Medicaid adults with disabilities report serious difficulty with cognitive functioning, and nearly half report serious difficulty with mobility.5 Two in five non-SSI Medicaid adults with disabilities report serious difficulty with independent living tasks, such as visiting a doctors office or shopping alone.6 Smaller shares report serious difficulty with vision , self-care tasks such as dressing or bathing , and hearing , compared to the other limitations that make up the ACS disability definition.7 Nearly half of nonelderly Medicaid adults with a disability but not SSI have multiple functional limitations, reporting impairment in two or more of the six ACS areas.8

Figure 2: Demographics of Nonelderly Medicaid Adults with a Disability But Not Receiving SSI, 2019

Travel To And From Work

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You may need to travel for your job, but your medical supplies wonât stop you from meeting this need. You can take diabetes supplies through security. This includes:

  • Insulin and products to dispense it, such as vials and pens
  • Unused syringes when you have them along with injectable medication
  • Lancets
  • Used syringes when you carry them in a hard-surface container to store used syringes and test strips
  • Liquids or gels

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How Limiting Is Your Diabetes

If you don’t meet the requirements of a listing, to determine whether your diabetes limits your functioning so much that you can’t work, the SSA will assess your residual functional capacity . Your RFC is a measurement of the level of activity that you can do despite your illness. For instance, an RFC can be for medium work, light work, or sedentary work. To determine your RFC, the SSA will review your medical history, your doctor’s opinion , and statements from you, your family, and your friends.

The SSA will look for information that shows how well you can use your arms and hands, stand, and walk. For instance, if you have peripheral sensory neuropathy that limits the sensation in your legs or feet, you may have difficulty walking or using foot controls. The SSA is also interested in whether you can focus on tasks, get along with others, and come to work on a regular basis. For instance, if you have poor control over your glucose levels during the day, the SSA might find that you are unable to concentrate for long periods of time. If you suffer from depression or extreme fatigue, your RFC might state that you are unable to perform work on a consistent and regular basis. If you have neuropathy in your legs from your diabetes, you might be unable to stand and walk for long periods of time. If you have blurred vision, your RFC should say that you can’t perform jobs in which vision is important.

Financial Help For Diabetes Care

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Diabetes management is expensive. According to the American Diabetes Association , the average cost of health care for a person with diabetes is $16,752 a yearmore than twice the cost of health care for a person without diabetes.1

Many people who have diabetes need help paying for their care. You can find help through private or government health insurance, local programs, patient support groups, and medicine-assistance programs. You can also find ways to save money on diabetes medicines and supplies.

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How Is Disability Defined

While SSI is sometimes used as a shorthand to identify people with disabilities, not all people with disabilities qualify for SSI. SSI is a monthly cash payment to help low-income people with disabilities pay for housing, food, and other basic needs. To qualify for SSI, individuals must have low incomes, limited assets, and an impaired ability to work at a substantial gainful level as a result of old age or significant disability. The SSI disability criteria are more stringent than other definitions of disability, such as those used in national surveys. The American Community Survey classifies a person as having a disability if the person reports serious difficulty with hearing, vision, cognitive functioning , mobility , self-care , or independent living .1 The ACS definition of disability is intended to capture whether a person has a functional limitation that results in a participation limitation and also is used in other federal surveys, such as the Current Population Survey and the Survey of Income and Program Participation.


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