Government Support

The following information will help patients with ALS and their caregivers seek out financial and/or government support for ALS medical care.

Medicare

The federal government offers financial assistance to individuals unable to pay all or part of their medical expenses. Most of this medical coverage is offered under Medicare. There are several different eligibility options under Medicare, and the amount of coverage varies by the category for which a person qualifies. Persons over 64 years of age, regardless of whether they are eligible for social security, may be eligible for Medicare. Individuals who do not meet the qualifications for Medicare may be able to pay a fixed monthly fee and "buy into" the program.

Today, in most parts of the country, people who qualify for Medicare can choose to receive services through a traditional plan or a group plan such as a health maintenance organization (HMO). These differ in the way benefits are delivered, how and when payment is made, and the amount that the patient has to pay. Medicare does not usually pay for home care except on a short-term basis. Hospice services are usually covered by Medicare.

For up-to-date information on Medicare options in your area, call your local Medicare office. Your ALSA or MDA chapter/support group may be able to offer guidance in choosing a plan. For more information on Medicare, log on to www.medicare.gov.

Medicaid

Medicaid is administered by local social service districts under the supervision of the State Department of Social Services. To qualify, an individual must be 65 years of age or older or on supplemental security income (SSI). (See below for additional information on SSI.) Although Medicaid is administered by individual states, the federal government requires that certain hospital, x-ray, laboratory, doctor, and nursing fees be covered. Home care services are paid for under the Medicaid program.

For information about eligibility requirements, call the Medicaid district office listed in the telephone directory under State Human Services. Coverage differs from state to state but usually follows Medicare policies. Most states pay for home medical equipment and many pay for prosthetics and orthotics. Communication aids are paid for by a growing number of states. Medical necessity must be proven to qualify for assistance. For more information on Medicaid, log on to www.cms.hhs.gov

Social Security and Supplemental Security Income (SSI)

Some ALS patients may be eligible for social security or SSI disability benefits. ALSA and the MDA may have suggestions for filing a successful application. A person is eligible for social security in any of the following situations:

• He or she is unable to work because of an illness or injury that is expected to last a year or longer
• He or she is 62 years of age or older and plans to retire
• He or she is within 3 months of age 65, regardless of plans to retire
• His or her spouse dies and the spouse was eligible for social security or was receiving social security
• The person, his or her spouse, or dependent child suffers permanent kidney failure

To apply for SSI, an individual must be over the age of 65, blind, or disabled. SSI defines "disabled" as having a physical or mental condition that prevents a person from performing gainful work, is expected to last for at least 12 months, or is expected to result in death. Individuals' applications are also reviewed to see if certain financial requirements are met. If an individual's application for Social Security or SSI is turned down, he or she may challenge the decision.

For further information about social security or SSI, contact the local social security office or log on to www.ssa.gov.

Veterans Administration (VA)

Veterans over the age of 64 (or any age if already on a pension) may be eligible for financial assistance. Call the local Veterans Administration office for more information or log on to www1.va.gov/health. Funding for wheelchairs or other assistive medical equipment is dependent on an individual's eligibility for medical care, social services, income support, or vocational assistance from any of a number of different sources. Several programs approved by the federal government will pay for home medical equipment. Others, such as job training programs, are federal/state partnerships operated by state agencies. Some private organizations also offer financial help. Foundations, corporations, and trust funds are potential sources of direct financial assistance.

Government Resources

Many other governmental departments and agencies can help ALS patients with legal matters, education, employment, and financial and social support. These include:

US Department of Health and Human Services: www.hhs.gov

From this Web site you can also access information on:

Healthcare Financing Administration
Office for Civil Rights
Administration on Aging
Administration on Children and Families/Community Services
National Rehabilitation Information Center www.naric.com

National Council of Disability: www.ncd.gov

These agencies can also be reached in the "blue pages" or government section of the telephone book.