Public Benefits and Entitlements

Securing and preserving public benefits are some of the most important needs of Project Guardianship clients

Not having benefits to support needs or the loss of benefits can lead to high-stakes crises and serious consequences — including for Medicaid, SSI/SSDI, Medicare, SCRIE/DRIE (rent exemptions), SNAP (food stamps), Section 8 (housing), and Access-A-Ride, etc. Navigating the application and recertification processes for government benefits and entitlements is time-consuming and may require overcoming some application and bureaucratic hurdles.  

Project Guardianship’s teams of benefits, case management, and legal and finance staff make sure that every client receives the full spectrum of benefits for which they are eligible.

Medicaid and Eligibility

Created in 1965, Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, pregnant women, seniors, and individuals with disabilities. Medicaid is funded jointly by the federal government and the states and is the single largest source of health coverage in the United States, covering over 70 million Americans. 

Each state operates its own Medicaid program under federal guidelines. Because the federal guidelines are broad, states have a great deal of flexibility in designing and administering their programs. As a result, Medicaid programs (including eligibility and benefits) can vary widely from state to state.

Federal law requires states to provide mandatory coverage to certain eligible groups. Low-income families, qualified pregnant women and children, and individuals receiving SSI are examples. 

Some states have expanded Medicaid programs to cover all people below certain income levels, and certain other groups. However, not all people with low-income are eligible for Medicaid. 

Medicaid is sometimes confused with Medicare, the federally administered, federally funded health insurance program for people over 65 and some people with disabilities. There is overlap between the two programs: nearly 10 million low-income seniors and people with disabilities are enrolled in both Medicare and Medicaid.

More Info on Eligibility 

Medicaid in NY State

Medicaid FAQs 

Medicaid Planning at Project Guardianship

As described above, some individuals may be ineligible for Medicaid based on their income and/or assets. For some Project Guardianship clients, with court approval, staff may set up a supplemental needs trusts (SNT) so that the client can become eligible for Medicaid, and so Medicaid can cover home care costs, while funds that are allocated to the trust can supplement other client needs for home maintenance such as rent, food, and clothing. An SNT may also avoid the risk of a person losing their eligibility for a government benefit with asset limits.

Medicare and Eligibility

Medicare is the national health insurance program to which all Social Security recipients who are either over 65 years of age or permanently disabled are eligible. Medicare is a national program and should not vary significantly from state to state.

Medicare should not be confused with Medicaid. The income and assets of a Medicare beneficiary are not a consideration in determining eligibility or benefit payments. 

Coverage under Medicare is similar to that provided by private insurance companies. Medicare will pay a portion (80%) of the costs of medical care, but a participant will be responsible for the remaining 20%, which include:

  • Premiums: A premium is a fixed amount that is paid to Medicare, to a private insurance company or to both, depending on your coverage. Most premiums are charged monthly and can change from year to year.
  • Deductibles: A deductible is a set amount that is paid out of pocket for covered services before the plan begins to pay.
  • Co-payments
  • Co-insurance

Premiums are paid outright. Deductibles, co-payments (co-pays), and co-insurance are ways that Medicare shares the costs of care with participants.

Medicare Parts A, B, C, and D

There are several basic parts of Medicare: A, B, C and D. Each part helps pay for certain health care services. Each part also has certain costs that will depend on what coverage is chosen. When you first enroll in Medicare, and during certain times throughout the year, you can choose what type of Medicare coverage you want.

Part A  (Hospital Insurance)

  • Inpatient hospital care
  • Inpatient skilled nursing facility care
  • Hospice care
  • Home health care

Part B  (Medical Insurance)

  • Services from doctors and other medical providers
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds, etc.)
  • Preventive services (like screenings, shots or vaccines, and yearly wellness visits)

Part C (Medicare Advantage / Supplemental Insurance)

  • Administered by private insurance companies contracted with Medicare, Medicare Part C will provide a participant with coverage for everything that Original Medicare (Part A and Part B) covers and then will pay for certain out-of-pocket costs (like co-insurance) depending upon the provider.
  • NOTE: Instead of Medicare Advantage, it is also possible to purchase Medigap supplemental insurance through a private insurer).

Part D  (Drug Coverage / Supplemental Insurance)

  • Prescription drugs (including some shots or vaccines)
  • Part D drug coverage is optional
  • A participant can join a Part D Medicare drug plan at additional expense
  • Part D drug coverage is administered by private insurance companies

US Government, Medicare Site

Medicare and You Handbook