One often overlooked resource on the NeedyMeds website is our listings of Government Programs. These programs are state-specific, and help needy families and individuals with the cost of healthcare. We regularly update this database, which includes State-Sponsored Programs, Medicare Information, Medicaid Sites, State Health Insurance Assistance Program information, and Federal Poverty Level and Tax Return Request Form guidelines and information. If you are not having luck finding a PAP or co-pay program for your medication or particular disease, there may be a Government Program there to help.

State Sponsored Programs

Programs that are created, sponsored, or funded by a state, county or local government are considered State Sponsored Programs. These programs provide a variety of types of assistance ranging from medical care, financial assistance, health insurance, prescription assistance, assistance with medical supplies and much more. We list these programs on our website by state. Simply choose your state from the drop-down menu

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Here at NeedyMeds we regularly refer people to their state’s Medicaid program, and in today’s blog post we are going to explain exactly what Medicaid is and how it functions. Are you currently enrolled in Medicaid? Share your experience with us in the comments section.

How is it Financed?

Medicaid, sometimes called Medical Assistance, is a joint federal and state entitlement program for people with limited income that helps to pay for medical costs. It receives a combination of funding from both the state and federal government. The amount paid to each state by the federal government, also known as the Federal Medical Assistance Percentage or FMAP, varies depending on multiple criteria, notably per capita income. From Medicaid.gov,The regular average state FMAP is 57%, but ranges from 50% in wealthier states up to 75% in states with lower per capita incomes. FMAPs are

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We’ve been getting a lot of questions from our readers about how the resources we list on our website, especially the pharmaceutical patient assistance programs, will be affected by the Affordable Care Act. While we are still far away from having all the answers, we do have some additional information we can provide you after attending a recent PAP Conference. The overarching consensus is that PAPs will continue to exist to help those in need that fall into the gaps.  Here is an overview of what we learned at the CBI PAP 2014 Conference, held in Baltimore on March 6-7.

Background

→ There are currently no shared processes between programs.

→ Open Enrollment ends March 31st

  • Negative image of Affordable Care Act in the media.
  • For those working with the disabled – visit the National Disability Navigator Resource Collaborative for resources http://www.nationaldisabilitynavigator.org.
  • Many advocates are having trouble enrolling the population that has been uninsured for a long time, as they are not informed about how health insurance works at all.

→ Medicaid Donut Hole

  • In the states that have not expanded Medicaid, there are going to be folks too poor to be eligible for subsidies under the marketplace and not poor enough to qualify for Medicaid in their states.

→ Not everyone between 100% and 400% of Federal Poverty Level are eligible for subsidies. This, for example, can depend on age.

Pharma Priorities and Considerations

→ Priorities are to contain costs, increase quality, encourage innovation while enhancing patient access.

→ Legal Considerations.

  • Anti-kickback statute – always a legal issue for companies. Pharmaceutical companies cannot induce (or even appear to induce) patients to use a certain drug.
  • November 2013
    • HHS Secretary Kathleen Sebelius wrote a letter saying that plans purchased on a state or federally run market place are not counted as government sponsored programs.
    • Absent further guidance – these plans are going to be treated as private plans by Patient Assistance Programs (PAPs), foundations, etc.

    → Lingering question – what happens when someone doesn’t pay or defaults on their premium? There is currently a grace period to

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One of the most popular sections of the NeedyMeds website is our listing of Free, Low-Cost, and Sliding-Scale clinics. As health care has become more and more expensive, the need for low-cost health care has increased. Many people living in more rural parts of the country have a very limited number of options to see a doctor, and depending on their insurance status the number of available “in-network” doctors is even lower. Many people do not regularly see their doctor, only seeking help when a more serious condition arises. It can be a scary situation to be uninsured and have an unforeseen medical problem come up.

Free, Low-Cost, or Sliding Scale?

We list three different types of clinics on NeedyMeds.org. The first are free clinics which are of no cost to the patient (self explanatory). The second are low-cost clinics which usually have a low flat-fee for all patients or types of visit. The third are sliding-scale clinics. The price for these clinics is based on the patient’s ability to pay, and is usually derived from their income and family size as it relates to the federal poverty level.

What

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The Children’s Health Insurance Program (or CHIP) is a national program available in every state. Many families find themselves above the income limit to be eligible for Medicaid but still unable to afford health insurance. CHIP aims to assist these families in getting healthcare coverage by providing children under the age of 19 whose family income is too high to qualify for Medicaid with health insurance at low or no cost. The program is available throughout the nation but requirements vary by state, and the program goes by various names as well. The income limits vary by state and range from as low as 175% of the Federal Poverty Level (FPL) to as high as 300% of the FPL. States operate CHIP as either an expansion of Medicaid, a separate program entirely, or as some combination of the two.

Financing

  Signed into law in 1997, CHIP is funded jointly by the federal government and individual states. The federal government matches a percentage of the amount each state funds. This percentage is

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