The similarity in names of these two government-sponsored health programs has always led to a certain amount of confusion about which is which, what’s covered under each of the two programs, and who is eligible for each of them. The point of similarity began with the origins of the two programs, since both were created in 1965, and both are paid for through taxpayer funding.
Stated succinctly, Medicare is a program which is intended to provide medical care for elderly persons on a long-term basis, whereas Medicaid provides coverage for people whose income is below a certain threshold. To gain a clearer understanding of what each of these two provides in terms of healthcare coverage for individuals, continue reading the details below.
This federal healthcare program is firmly associated with Social Security, and is available to all American citizens age 65 and above, although it does also include individuals with specific identified disabilities. Medicare has nothing to do with income level, and eligibility is strictly determined by age and disability status. It is comprised of four distinct parts as follows: Part A includes ordinary hospitalization coverage, Part B covers medical insurance, Part C allows for the possibility of supplemental insurance for medical conditions not covered by Parts A and B, and Part D covers costs for prescription drugs.
Funding for Parts A and B comes from Social Security income deductions and payroll taxes, whereas Parts C and D are paid for by the individual participants. Part D is actually a recent addition, included in the program in 2006, when it was recognized that the cost of prescription drugs were spiraling out of control.
Medicaid is a program jointly funded by state and federal organizations to assist low income families with medical costs as well as with expenses related to long-term custodial care. The federal government funds up to 50% of every state’s Medicaid program cost with the actual contribution dependent on the particular state and its financial status. The implications of this are that there is a completely different Medicaid program for every state in the union, because the federal funding for each state can be entirely different.
A major difference between Medicare and Medicaid is that everyone above 65 is eligible for Medicare, whereas eligibility for Medicaid carries certain restrictions. These eligibility rules vary from state to state, but in general they all set forth guidelines of income levels to determine who is eligible and who is not.
There are some other eligibility guidelines relative to families, children, disabled, elderly, pregnant women, and guardians of children. Some of the services covered by Medicaid include: family planning, x-rays, clinic treatments, nursing facility services, dental services, laboratory services, hospitalization, doctor services and home healthcare for those who require it.
Medicare Chronic Care Management Program
While there are a number of restrictions established for paying ordinary costs associated with telehealth, there are no such restrictions which are required by the Medicare Chronic Care Management Program. This program was put in place so that medical professionals could offer better care to patients who have two or more chronic medical conditions requiring treatment.
Patients can be located anywhere in the country, and can receive services from any medical facility whatsoever, as well as in the privacy of their homes or office places. Medicare does require that the care provided to elderly patients be administered by physicians, physician assistants, registered dietitians, nutrition professionals, clinical nurse specialists, nurse practitioners, social workers, clinical psychologists, and nurse midwives. The types of health services delivered to a patient via telemedicine must be one of the following: video-conferencing, remote patient monitoring, store-and-forward, or mHealth monitoring.
Medicaid Reimbursement for Telemedicine
As noted above, there are literally 50 different Medicaid policies with respect to each state in the union, and that means there are 50 different policies for coverage under Medicaid. There are only two states which do not provide any coverage for live video conferencing under Medicaid, which means that 48 of the states do have coverage.
Remote patient monitoring is paid for in 19 states under the Medicaid program, while the other 31 do not subsidize remote patient monitoring. There are 30 states which provide Medicaid coverage for either a video transmission, a facility fee, or both of them together. Only 12 states provide for store-and-forward under the Medicaid program, excluding those states which only reimburse for teleradiology.
The bottom line on all this is that if you’re trying to find out whether you would receive Medicaid coverage for your telemedicine sessions, you’d be well advised to contact your state agency for a clarification. As long as there are 50 different funding programs for the Medicaid program itself, there will also be 50 different programs for coverage of telemedicine.