I’m sorry I didn’t respond to this statement sooner, but I must have overlooked it.
Bill’s posting in early July said:
“His [Kent Thiry’s] answer isn’t complete because it leaves Medicaid out of the equation. Right now if someone has CKD5 and no insurance they will, in most states, have to spend down to qualify for Medicaid. After 33 months they’ll qualify for Medicare if they have enough quarters of work. Those with Medicare through disability or CKD5 vintage might still need Medicaid to pay the 20% not covered by Medicare - these are the so called dual eligibles: Medicare primary and Medicaid secondary.”
Those who have Medicaid and enough work credits to qualify for Medicare qualify for Medicare the month dialysis starts if they start a home training program prior to the 3rd full month. Those who don’t have enough credits to qualify for Medicare, can earn credits after they start dialysis.
If someone with Medicare qualifies for a program called Qualified Medicare Beneficiary, the state Medicaid program must pay the full amount of Part A and Part B deductibles and coinsurance for Medicare covered services. Workers with disabilities can qualify for Medicaid even if they have incomes of 250% of the federal poverty level under the Medicaid Buy-in program in those states that have chosen to offer this under Ticket to Work legislation.
http://www.cms.hhs.gov/apps/firststep/content/medicare_dualelig.html
BTW, some patients have individual plans when they start dialysis and some dialysis facilities have billed those plans primary as if they were obligated to pay primary under Medicare secondary payer. Only those with employer group health plans must meet a 30-month Medicare secondary payer period. Individual plans are not liable for primary payment for dialysis if they’re not paid for or sponsored by an employer. They should always be billed secondary to Medicare.
Coverage for patients who get jobs or employer group health plan coverage as a worker or dependent during the Medicare secondary payer (MSP) period will shift to the employer group health plan for the remainder of the MSP.
Finally, if dialysis facilities educated more patients about home HD, offered home HD and evening shifts for patients who don’t have partners for home HD, encouraged social workers to learn about programs that promote work, and gave social workers the time to help patients use the work incentive programs instead of mis-using them as financial coordinators, maybe more patients who have Medicaid only would have better coverage for dialysis and other healthcare needs and providers could be better off financially too. Why they haven’t figured this out is beyond my comprehension.