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Medicaid and Public Health Insurance for People With Multiple Sclerosis

Medically reviewed by Amit M. Shelat, D.O.
Posted on April 13, 2021

Health care costs associated with managing and treating multiple sclerosis (MS) can add up quickly, and they can represent a serious financial burden for people with the condition and their caregivers. If you are struggling with the costs of MS treatments, you may benefit from Medicaid or other types of public health insurance.

Medicaid is a state-operated health insurance program for people of low income, families and children, pregnant women, the elderly, and people with disabilities. Depending on your personal circumstances and the state where you live, Medicaid may be an option for covering treatment for multiple sclerosis including disease-modifying therapies like costly prescription drugs, physician services, and rehabilitation.

Medicaid and Medicare

“Medicaid provides comprehensive health coverage to nearly 9 million non-elderly people with disabilities, and to 10 million low-income Medicare beneficiaries who rely on Medicaid to fill Medicare’s gaps, including many people living with MS,” according to the National Multiple Sclerosis Foundation.

Although Medicaid programs operate within federal guidelines, they are run at the state level, and so the rules and regulations differ by state. Some states have distinct names for their Medicaid programs, such as Medi-Cal in California and TennCare in Tennessee.

Compared to individual or private health insurance plans, Medicaid has a lower monthly cost, or premium. You will also pay lower copays for doctor visits, and you’ll have lower deductibles, which are the maximum costs that you are responsible for before your insurance plan starts to help.

It is possible to receive assistance with covering your health care costs from both Medicaid and Medicare. Medicare is a federal health insurance program that is mainly for people over 65 or for those under 65 who receive Social Security disability benefits. If you’re unable to work due to MS, you may qualify for Social Security disability benefits. After you’ve received these benefits for at least 24 months, you may qualify for Medicare. If you are or plan to be enrolled in Medicare, and your household income is determined to be low-income, you may also qualify for Medicaid. If you are enrolled in both programs, Medicare is the primary payer, and Medicaid may cover additional costs not covered by Medicare.

If you are enrolled in Medicare but do not qualify for Medicaid, you may have other options for assistance with health care costs. There are four Medicare Savings Programs — all state-administered — that provide varying levels of assistance with Medicare payments and out-of-pocket costs, like monthly premiums.

How Do You Enroll in Medicaid?

Enrollment rules and eligibility criteria for Medicaid differ by state. Medicaid, in general, is usually available to people of a certain income level, pregnant women, families, some seniors, and people with disabilities. Following the passage of the Affordable Care Act, the majority of states have expanded Medicaid to also cover low-income adults.

In states like Illinois or Vermont, for example, you may qualify for Medicaid if you’re an adult with an income at or lower than 133 percent of the federal poverty level. However, in states like Texas or Florida that have not expanded Medicaid to cover low-income adults, you cannot qualify for coverage as a low-income adult. However, you may still qualify if you have a disability.

You may enroll in Medicaid at any time of the year through your state’s Medicaid website or over the phone. There is no enrollment period for Medicaid. To learn more about enrolling in Medicaid in your state, navigate to your state’s Medicaid website. You could also check if you qualify for Medicaid by filling out a health insurance application on the U.S. federal health insurance website, HealthCare.gov. If you or a member of your household is determined to qualify for Medicaid, you will be contacted by your state agency to continue the enrollment process.

Medicaid Coverage for MS

The treatments and therapies covered by Medicaid vary by state. However, under federal law, there are mandatory benefits that state Medicaid programs must cover, including the following:

  • Inpatient hospital services — These can include surgeries or overnight stays for relapses.
  • Outpatient hospital services — Some surgeries and emergency services fall under this category.
  • Nursing-facility services — Such services may include physical and occupational therapy following a hospitalization or surgery.
  • Home health services — This refers to medically necessary in-home services, such as assistance from a skilled nurse.
  • Physician services — Visits to your doctor, for example, are covered.
  • Rural health clinic services — These cover services from certified health care facilities in rural communities. The clinics can be public, nonprofit, or for-profit.
  • X-ray and laboratory services — This includes the various lab tests a person living with MS may need to undergo during treatment.

Medicaid programs are not mandated to cover prescription drug costs, but many of them do in some capacity. In reviewing your state’s Medicaid plan, you should review its formulary (list of covered drugs) to see which medications are covered. You should also check other key factors before enrolling in an insurance play, like whether your physicians and neurologists are included in the plan, so that the cost you pay for doctor visits, or copays, will be decreased.

Insurance for Children With MS

If you have a child with MS and you need help paying for their health care, there are several options for assistance. If you qualify as low income, you may be eligible for a Medicaid family plan that will help to cover health care costs for you or your family members. You may check if anyone in your family is eligible for Medicaid by creating an account on HealthCare.gov. Your state agency will then contact you if you or your child is eligible to enroll.

Families that earn too much to qualify for Medicaid may be eligible for the Children’s Health Insurance Program (CHIP). CHIP is another public insurance program that helps cover costs of medical care, prevention, and wellness for children. The program provides comprehensive health care coverage for services including:

  • Immunizations
  • Doctors visits
  • Prescription drugs
  • Inpatient and outpatient hospital care
  • Emergency services.

CHIP works closely with Medicaid programs, and so their rules and coverage differ by state too. You may apply and enroll at any time during the year. There is no enrollment period for CHIP.

Connect With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 166,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Are you living with MS and using Medicaid or other public insurance programs? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on April 13, 2021
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Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Elizabeth Wartella, M.P.H. is an Associate Editor at MyHealthTeam. She holds a Master's in Public Health from Columbia University and is passionate about spreading accurate, evidence-based health information. Learn more about her here.

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