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Government Subsidized Prescription Drug Benefits

Programs offered by local or state government agencies that pay all or a portion of the monthly costs for prescription drugs required by people who meet eligibility requirements for the programs. In some cases, the individual receives a discount card that can be presented to the pharmacist. The individual pays the co-payment amount and the pharmacist bills the sponsoring agency for the remainder. Specific mechanisms and eligibility requirements may vary by jurisdiction.

• Service code: NL-5000.2600
• 88 providers

Medicaid

A combined federal and state program administered by the state that provides medical benefits for individuals and families with limited incomes who fit into an eligibility group that is recognized by federal and state law. Each state sets its own guidelines regarding eligibility and services within parameters established at the federal level. Many people are covered by Medicaid, though within these groups, certain additional requirements must be met. Eligibility factors include people's age, whether they are pregnant, have a disability, are blind, or aged; their income and resources (like bank accounts, real property or other items that can be sold for cash); and whether they are U.S. citizens or lawfully admitted immigrants. Families who are receiving benefits through TANF and individuals who receive SSI as aged, blind and disabled are categorically eligible groups. The rules for counting a person's income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes, for people served under the Medicaid Waiver program, for people served by Program of All-Inclusive Care for the Elderly (PACE) programs and for children with disabilities living at home. Medicaid makes payments directly to a person's health care provider; and some recipients may be asked to pay a small part of the cost (co-payment) for some medical services. Most states have additional "state-only" programs to provide medical assistance for specified low-income persons who do not qualify for the Medicaid program.

• Service code: NL-5000.5000
• 172 providers

Nursing Home Transition Financing Programs

Programs that are designed to assist institutionalized residents, or those about to be discharged from a hospital to a nursing home, to return to the community to live in a less restrictive setting. Some transition programs are funded using Medicaid and therefore require that eligible participants be Medicaid recipients. Other programs have been created using state or local funds. The programs typically provide case management and, unless other funding sources are available, provide funding for and link program participants to existing home and community based services, home modification programs, assistive technology equipment, assisted living facilities or other supported housing options and/or other needed services.

• Service code: NL-5000.6500
• 3 providers

State/Local Health Insurance Programs

Programs that provide health insurance for people who do not qualify for Medicaid, do not have access to insurance provided by an employer or cannot afford privately purchased health insurance. Services covered by these programs vary by state but generally include hospitalization, physician services, emergency room visits, family planning, immunizations, laboratory and x-ray services, outpatient surgery, chiropractic care, prescriptions, eye exams, eye glasses and dental care. Other services may include alcohol and drug treatment, mental health services, medical and equipment and supplies and rehabilitative therapy. Eligibility requirements also vary. Included are state and/or local government health insurance programs which may be administered by the state or at the local level, and public/private partnerships between state and/or local government entities and health insurance companies or other private organizations. Health care is generally provided through participating managed care plans in the area.

• Service code: NL-5000.8000
• 12 providers