Government Assistance
The following information will help patients with ALS and their caregivers seek
out financial and/or government support for 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
http://www1.va.gov/health/.
Funding for wheelchairs or other assistive medical equipment is dependent upon an
individual's eligibility for medical, 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 website you can also access information on:
- Health Care 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.