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to meet costs of medical care are personal belongings; tools and livestock used to produce food for home consumption; equipment, stocks of goods, tractor, truck, and similar property if used in a business to produce net cash income; $2,000 cash surrender value of life insurance. All other resources may not exceed a reserve of $1,000, single person or married couple living together. (Includes cash, bank accounts, stocks and bonds; idle tools, machinery, or livestock not used in producing food for home consumption or in a business; real property which is not producing a profit.). Benefits from health and hospital insurance policies will be taken into account in determining amount which can be paid from MAA program.

Person must be in need of hospital care to begin within 30 days of date of application.

Recovery provisions.—No provision.
Relative responsibility.-No requirement.
Deductible. —None.

Scope of medical care provided. - Hospitalization limited to 15 days within a fiscal year; for acute illness or major injury. For elective cataract surgery or for diagnosed cancer only if treatment is not available from some other sources.

Physicians' services: Medical doctor or osteopath, a maximum of $15 for routine office calls, after each period of hospitalization if made within 30 days following patient's discharge from a period of hospital care; must be directly or indirectly related to the hospitalization.

Additional provisions.-Eligibility for MAA, once determined, continues for a 12-month period unless there is some known change in eligibility status. Old-age assistance

Program.-During 1961 began vendor payments for nursing home care for OAA recipients (previously provided through the money payment and subject to maximums on such payments, including subsistence), initiated hospital care and limited physicians' services similar to those available under MAA.

Lien and recovery.—No provision.

Relative responsibility.-- Ability of relatives to support is determined in each individual case (no State legislation prescribing such responsibility); if relative claims the applicant as a dependent for income tax purposes, he is presumed to be responsible for providing more than one-half” of the support of such applicant.

Residence requirement.-One year immediately preceding application.

Scope of medical care provided.- Vendor payments are made for hospital care for acute illness and major injury up to 30 days per fiscal year; nursing home care; and physicians' services (medical doctor or osteopath) in office, home, or nursing home during a period not to exceed 30 days following patient's discharge from hospital care, for conditions related to hospitalization. Within the money payment which includes subsistence items, an amount may be budgeted for special nursing care in the recipient's place of residence other than a medical institution.

Money payment to recipient.--Administrative maximum on money payment to recipient is $75, based on a legal maximum in terms of amount of Federal matching of State expenditures.


Aged in population (April 1, 1960), 194,400 Medical assistance for the aged

Program.-Services began in September 1961 following an appropriation for the program made by the 1961 legislature.

Eligibility.-Income: Cash income for single person not to exceed $1,200 annually; for family, $1,500.

Assets: (1) Real property: May have home or an equity in home not to exceed $7,500. Value of other real property must come under the maximum on personal property. (2) Personal property, including value of nonhome real estate, livestock, motor vehicle, tools, equipment, and cash surrender value of life insurance. Household furnishings are excluded. Applicant may have a cash reserve up to $300 for one person and an additional $300 for dependents, with a family maximum of $600. Total value of all other property and resources may not exceed $2,500.

Recovery provisions.- No provision.
Relative responsibility.No requirement.
Deductible. - None.

Scope of medical care provided.Hospital care limited to 30 days within a fiscal year, 60 days for cancer or first-, second-, or third-degree burns; nursing home care as recommended by physician; physicians' services in office or clinic only; services of ophthalmologist for treatment of eye conditions including surgery; dental care. Drugs not provided.

Additional provisions.- Need for medical care is determined concurrently with eligibility; when additional service is needed, review or reapplication is required; not applicable to persons receiving continuing care, whose cases are reviewed annually. Old-age assistance

Program.-Since September 1960, added to scope of medical care for which vendor payments are made: dental care, statewide clinic services. Prescribed drugs provided through clinics or to patients in nursing homes, are included for some months, then withdrawn from vendor payment plan.

Lien and recovery.—No provision.

Relative responsibility:--Ability of relative to contribute to support of applicant is determined in accordance with a combined family income scale. However, a relative who claims an applicant (or recipient) as a dependent for income tax purposes is expected to be contributing $300 a year toward his support.

Residence requirement.-Legal: 3 years during the 5 years immediately preceding application, with last 1 year continuously. Or, by administrative interpretation: 5 years of the past 9 years immediately preceding application with 1 year immediately preceding application.

Scope of medical care provided.--Vendor payments are made for hospital care as certified by physician, up to 30 days a year; 60 days for cancer or first, second, or third degree burns; nursing home care; physicians' services in office or clinic only; services of ophthalmologist for treatment including surgery; dental care. Prescribed drugs up to $10 a month are provided within the money payment and subject to the State maximums.

Money payment to recipient.- Maximum of $70.


Aged in population (April 1, 1960), 1,376,000 Medical assistance for the aged

Program.—Legislation enacted in 1961, effective January 1, 1962, provides basis for program. Services began in that month. Program is designed “to supplement the financial ability of counties to meet the health needs of aged persons.”

Eligibility.-Income: Average monthly income over the next 12 months is not expected to exceed the cost of his medical care plus the cost of his maintenance as determined by the standard of assistance for old-age assistance. . (Maximum standard for basic items and special needs is $171 a month.) If an individual is married, income is the combined separate income of the person plus his share of the "community income” of the couple.

Assets: (1) Real property: May have home owned and occupied. Value of other real property of applicant or applicant and spouse is limited to $5,000 assessed value less encumbrances if yielding a reasonable return which is used to meet needs. (2) Personal property limited to $1,200 less encumbrances, if single; if spouse also recipient, total is $2,000 less encumbrances; plus automobile needed for transportation with market value up to $1,500. Term includes net value of idle real property.

Eligibility is determined after an initial period of 30 days of hospital or nursing home care in a licensed medical institution, when physician estimates that such care will continue beyond 30 days. (Days may be cumulative if person is readmitted to a certified facility within 10 days of leaving such a facility.) Certification continues for a 12-month period. Holders of a valid certificate who require noninstitutional services may be certified for such services if eligible.

Recovery provisions.—No provision.
Relative responsibility.No provision.

Deductible.No deductible but MAA is not applicable until after initial period of 30 days of hospital or nursing care in a licensed medical institution. This provision applies to institutional and noninstitutional care. Hospital coverage available during first 30 days for care provided in county or county-contracted facilities or for nursing home care upon transfer from such facilities. An individual incurring $2,000 of expenses for care while hospitalized may be covered from the time he exceeds the $2,000 deductible even if this occurs prior to the end of the initial 30-day period.

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Scope of medical care provided.—Institutional care is available in hospital or licensed nursing home beginning after the first 30 days of care in such home, including all related services, inpatient physicians' calls and restorative and rehabilitative services; noninstitutional care is available after discharge from a period of institutional care and includes a full range of services including dental care, drugs, prosthetic applicances, physicians' services, rehabilitative services, diagnostic and therapeutic laboratory procedures, and home nursing care.

Additional provisions.-Eligibility for MAA once determined continues for a 12-month period and persons who require noninstitutional services may be certified for such services on the basis of the previously established 30-day period of hospital or nursing home care. Old-age assistance

Program.—Added to the scope of medical care services dental care and home nursing; extended prescribed drugs and eye care.

Lien and recovery. — No provision.

Relative responsibility.- Ability of an adult child to contribute to support of parent is determined in relation to "relatives' contribution scale” based upon the net monthly income and number of dependents, beginning with $400 a month; allowance made for certain taxes and expenses of employment of such relative in computing his net income.

Residence requirement.-One year (immediately preceding application) and 5 of last 9 years (maximum requirement permitted by Federal law).

Scope of medical care provided.- Vendor payments are made for practitioners' services, dental care, and prescribed drugs. Other services, provided through the money payment to the recipient, are inpatient hospital care and nursing home care, both limited to the period prior to eligibility for MAA. Under specified circumstances, either vendor payment or money payment may be used to meet costs of sickroom supplies, home nursing care, X-rays, restorative and rehabilitative services, prosthetic appliances, equipment, and ambulance.

Money payment to recipient.—Maximum on money payment to recipient may be as high as $171 if the person has no other income and has certain "special needs” as defined by the State.


Aged in population (April 1, 1960), 242,600 Medical assistance for the aged

Program.-State legislation authorizing a program of MAA was enacted in the 1961 session, to become effective April 15, 1962. The program was begun at that time.

Eligibility.-Income: All income is considered available to meet costs of medical care except: (1) Person receiving medical care but not resident in medical facility, if single, or married and not living with spouse, $1,550 a year, plus an amount not to exceed $150 if it is applied to payment of annual premium on personal health insurance; if married and living with spouse, $2,200, plus $250 if it is applied to payment of annual premium on personal health insurance. (2) Applicant receiving care in medical facility, spouse living outside such facility, $1,800 a year may be retained for the personal or other expenses of the spouse, plus $250 for annual premium if paid on personal health insurance of both spouses, or up to $150 if only one spouse is covered by such insurance.

Assets: (1) Real property: May own home; sale value of real property not used as a home, should be determined prior to certification of eligibility for MAA with provisions for exceptions under specified circumstances. (2) Personal property: Total may not exceed $900 for single person or if married and living apart from spouse; or $1,300 if married and living with spouse. Excluded from consideration is cash surrender value of insurance up to $500 for beneficiary, and $500 for spouse.

Medical benefits, which are available to applicant from sources such as personal health insurance plans, workman's compensation, Veterans' Administration, and private employee welfare programs, are primary resources for meeting medical needs which must be utilized before determining extent or kinds of services to be paid for through MAA.

Recovery provisions.-Provision for filing claim by the State against the estate of the deceased recipient for the amount of assistance received; no recovery until after the death of a surviving spouse, if any.

Relative responsibility.-Extent to which a legally liable relative (spouse and adult children) is a financial resource is determined in accordance with agency policy (including a cost-of-living scale); the contribution finally determined as within the ability of the relative to provide is assumed to be available to the applicant.

Deductible. - Applicant is responsible for the first $100 of costs incurred for medical service for each calendar year; this will be waived for the recipient of OAA who is in a chronic or convalescent hospital, chronic disease hospital, or rest home with nursing supervision and is transferred to MAA. (Such medical service has been removed from scope of medical care provided under OAA.) The legislative session of 1963 is being asked by the State agency to rescind this requirement of first $100 of cost each calendar year to be paid by applicant.

Scope of medical care provided. - (1) Institutional care: Hospital care, general hospital including physicians' and surgeons' services; nursing home care as given in (a) chronic disease hospital, (b) convalescent hospital, (c) rest home with nurse supervision. (2) Noninstitutional care: Physicians' services, home, office, or within a medical facility; outpatient hospital and clinic services; visiting nurse services; prescribed drugs.

Recipient in medical facilities such as listed above under “nursing home care" may receive, in addition, dental care; sickroom supplies; prosthetic, surgical, and orthopedic appliances; eyeglasses; hearing aids; transportation; services of practitioners other than medical doctor, i.e., osteopath, optometrist, chiropractor, chiropodist (podiatrist), naturopath, or treatment of spiritual practitioner.

Nursing home care in the kinds of institutions specified has been withdrawn from the scope of OAA and transferred to MAA. Special provision is made to meet nonmedical budgeted needs (personal care and needs, and special needs, including health and life insurance premiums and temporary_maintenance of rental facilities or own home) through State funds without Federal financial participation.

Additional provisions.-Eligibility is established concurrently with the need for medical care. The eligible applicant is given an identification card which certifies to his eligibility for medical care under the MAA program, but does not authorize payment for medical service bills for specific services. Reviewed in relation to the applicant's income available at that time to meet medical need, including insurance resources. For persons receiving long-term care, eligibility once established is reviewed annually and reapplication is not necessary. Old-age assistance

Program.-Since September 1960, no significant change has been made in eligibility for or scope of the generally comprehensive medical care services available under OAA.

Lien and recovery.--State has preferred claim against estate, secured by lien against real property, to the extent that such estate is not needed for support of the surviving spouse, parent, or dependent children of the deceased recipient.

Relative responsibility.-Ability of adult children living outside the household to contribute to support and the amount of their contributions are determined in individual situations on the basis of the applicable cost of living scale and a specific responsibility factor. Needs of a self-supporting spouse residing outside the household are determined in accordance with public assistance standards plus certain additional allowances, income in excess of these needs is "budgeted as income available for support of the applicant.”

Residence requirement.--No durational requirement. Must be resident at time of application.

Scope of medical care provided.Vendor payments for costs of medical care are used for hospital care (prior to April 15, 1962, for nursing home care also), practitioners' services, dental care, prescribed drugs, nursing services in own home or in medical institution, restorative services, prosthetic appliances, transportation to secure medical care, and special equipment. Allowance is made in the money payment to recipient for premium for individually held hospital insurance policy, of Blue Cross or equivalent coverage and cost.

Money payment io recipient.-- No maximum on money payment to recipient to meet total needs according to State's standard of assistance.


Aged in population (April 1, 1960), 69,100 Medical assistance for the aged

Program.-Services began during the first quarter of 1963 based upon provisions in an appropriation act in 1962 authorizing expenditure of funds for medical assistance to the aged.

Eligibility.-Income: May not exceed $175 per month for single person; family income not to exceed $200 for 2, $235 for 3, on up to $500 for 10 persons.

Assets: (1) Real property: Applicant may own homestead. Other real property “titled in the name of one or more members of the family group” renders applicant ineligible if owned outright, unencumbered, and refinanceable. If encumbered and meets one of the following terms, does not make person ineligible: (a) Any value, carrying two mortgages, not refinanceable; (b) value (determined by doubling assessed value) under $5,000, one mortgage, not refinanceable; (c) value (as above) $5,000-$10,000, 50 percent or more of first mortgage unpaid, not refinanceable; (d) value (as above) over $10,000, 75 percent or more of first mortgage unpaid, not refinanceable. (2) Personal property: Liquid assets not to exceed $500, excludes household furniture and clothing; personal property used in prosecution of a business, profession, or calling; or property “determined unavailable to pay for costs of hospital services.”

Participation in costs: Person or his responsible representative must sign contract to meet terms of payment set after evaluation of ability to pay part of costs of needed care. No payment required if liquid assets are at or below $300, other resources not available, and monthly income is below minimum scale ranging from $150 for 1 person to $350 for 10 persons supported by family income. Liability for such payment in any one month for hospital services during the month shall not exceed the sum of (1) excess income over minimum scale, (2) excess of liquid assets over $300, and (3) other resources. Payments made by patient or others in his behalf are deducted from bills submitted.

Recovery provisions.—No provisions for recovery from estate of deceased recipient.

Relative responsibility.— No provision.
Deductible.- None; see “Participation in cost," above.

Scope of medical care provided. - Hospital in patient and outpatient care in specified public and voluntary hospitals under contract to the Department of Public Health; District of Columbia Village Infirmary services; nursing services in the home by visiting nurse or public health nurse; home care for patients requiring continuing medical and nursing attention as available by home care service of Department of Public Health; transportation; appliances and prosthetic devices; drugs and biologicals not provided as part of in patient, outpatient, or home care program, through pharmacies under contract with DPH; dental and podiatry services at clinics of DPH; home psychiatric services as available through the DPH; health maintenance services through centers of DPH.

Additional provisions. -Eligibility and need for medical care are determined concurrently. Old-age assistance

Program. --Since September 1960 the District of Columbia has added hospitalization and home nursing to the scope of medical care.

Lien and recovery. -Amount of assistance plus 3 percent simple interest constitutes claim against estate (not secured by lien). Claim not enforceable against surviving spouse.

Relative responsibility. -Ability of legally responsible relatives (in OAA, children and grandchildren) living within the District of Columbia to contribute to support is computed in accordance with scales of income and number of dependents, with allowances made for taxes and certain defined family expenses.

Residence requirement. –One year immediately preceding application.

Scope of medical care provided. - Vendor payments for medical care are used for hospital care, in a hospital administered by or having a contract with the District of Columbia Department of Public Health, home calls by physicians under contract to the District of Columbia Department of Public Health, dental care prescribed drugs other than those available without charge from the District of Columbia Pharmacy operated by the Department of Public Health; nursing care in own home from Visiting Nurse Association; sickroom supplies, prosthetic appliances; transportation, and special equipment; within the money payment, provision is

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