MEDICAID FREQUENTLY ASKED QUESTIONS
What is Medicaid?
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.
What is the Children’s Health Insurance Program (CHIP)?
The Children’s Health Insurance Program (CHIP), provides health coverage to eligible children through both Medicaid and separate CHIP programs. CHIP is administered by states according to federal requirements. CHIP was created in 1997 and is funded jointly by states and the federal government.
Who May Apply for Medicaid?
Elderly (65 years old and older), Blind, Families with Dependent Children up to 20 years old, Permanently and Totally Disabled Individuals, and Adults (21 – 64 years old.
The income and resources will be reviewed and assessed based on the following criteria:
Medicaid Covered Groups:
- Temporary Assistance to Needy Families
- Old Age Assistance (Persons Aged 65 and over)
- Aid to the Blind
- Aid to Permanently & Totally Disabled
Categorically Needy Medicaid:
- Children below 21 years of age, and caretaker relative
- Aged Individuals (65 years & over)
- Blind
- Disabled
- Pregnant Women
Medicaid Expansion (New Eligibility Group)
- Adults (21 to 64 years old)
Where are applications for Medicaid Accepted?
Please visit or call the Bureau of Economic Security (BES) offices located at any of the following Department of Public Health & Social Service offices below Monday to Friday, 8:00 am to 5:00 pm, Closed on the weekends and GovGuam Holidays:
NORTHERN PUBLIC HEALTH (Dededo)
Telephone Number: (671) 635-7429 / 7439 / 7484 / 7488 & (671) 635-7396
Districts Covered: Dededo, Harmon, Tumon, Tamuning and Yigo
CENTRAL PUBLIC HEALTH (Tamuning), 2nd Floor, RANCARE Building
Telephone Number: (671) 300-8853 / 8867
Districts Covered: Agana Heights, Agat, Asan, Barrigada, Chalan Pago,
Hagåtña, Maina, Mangilao, Mongmong-Toto-Maite,
Toto-Maite, Ordot, Piti, Santa Rita and Sinajana
SOUTHERN PUBLIC HEALTH (Inarajan)
Telephone Number: (671) 828-7524 / 7534 / 7537 / 7539 / 7542
Districts Covered: Yona, Inarajan, Merizo, Talofofo, and Umatac
When does eligibility begin for Medicaid?
When all qualifying requirements are met, eligibility begins on the first day of the three (3) months preceding the month of application submission. The income and resources will be reviewed and assessed for eligibility and for the preceding months.
When shall I use Guam Memorial Hospital Authority (GMHA) Emergency Room?
After clinic hours, in an emergency situation (accident, severe pain, bleeding, difficulty breathing, or any other condition that if not treated immediately will endanger your life, or health), go to the emergency room of GMHA for medical services. However, Medicaid will not be responsible for payment if you use the emergency room for non-emergency care.
Will Medicaid pay for the medical bills I already have?
If you have accumulated those bills within the three (3) months before you filed your application and the bills are for types of services listed on this brochure and do not require prior authorizations, Medicaid can pay for them. This is not an automatic benefit. Your income and resources for that period are subject to review.
How are medical bills paid?
All payments covered by the Medicaid Program are made directly to the hospital, clinics, dentists and other providers. Should you have paid for the bills, Medicaid WILL NOT reimburse you.
What benefits does Medicaid provide?
- Ambulance & Medical Transportation*
- Audiological Examination and hearing Aids*
- Birthing Center Services
- Clinic Services
- Dental Services*
- Diabetes and Related Services and Supplies
- Durable Medical Equipment and Supplies*
- Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
- Family Planning Services and Supplies
- Home Health Services
- Hospice Care*
- Inpatient Services*
- Kidney Dialysis and Related Services
- Laboratory and Radiological Services
- Mental Health Services*
- Tuberculosis or Lytico (Amyotrophic Lateral Sclerosis) and Bodig (Parkinson’s Disease) and Related Services
- Off-Island Medical Care and Air Transportation*
- Optometrist Services, and Lens’*
- Other Practitioner Services
- Out-Patient Services
- Physician Services
- Prescription Drugs*
- Preventative Services
- Prosthetic Devices*
- Skilled Nursing Facility Services*
- Tobacco-Use Cessation Treatments*
- Voluntary Sterilization Services
*With Limitations
What services are not covered by Medicaid?
- Cosmetic Surgery
- Inpatient mental disorders and psychiatric services
- Private duty nursing services, Personal comfort or patient convenience items, any services requiring prior authorization, where authorization has not been obtained or has been denied.
- Admission primarily for rest care, custodial or convalescent care, etc.
- Non-emergency use of the emergency room
- Services inappropriate for the patient’s diagnosis
- Unskilled and homemaker services
- Immunizations and vaccines are readily available free of charge at the Public Health Clinic
- Chiropractor and Acupuncture services
- Eyeglasses with correction below plus or minus .50 diopters, or 10 cylinder axis, and contact lenses
- Speech Therapy
- Dentures not related to trauma
- Experimental drugs, vitamins/minerals, obesity control pharmaceuticals, food supplements, milk modifiers, infant formula, therapeutic diets, over the counter and FDA listed ineffective drugs
- Eyeglasses within two (2) years from the date of last purchased by the program
- Hearing aids within three (3) years from the date of last purchased by the program
- Intermediate Care Facility Services
- Rehabilitation Services
- Hospice Care
- Case Management Services
- Personal Care Services in the recipient’s home
- Off-Island cost of meals, ground transportation, and lodging for patients referred off-island for treatment and their relatives
What Dental Benefits are covered by Medicaid?
- Emergency dental services are provided for children 16 years old and below, and adults 55 years old and above. Beneficiaries must initially request these services at Public Health Dental Clinic.
- Dentures (limited as part of post-trauma treatment)
What covered services require Prior Authorization (PA)?
- Hospitalization at GMHA acute ward for more than 60 days
- Elective surgery for which you have to be admitted one or more days before the surgery is scheduled
- Medically indicated circumcision
- Physical, occupational, and inhalation therapy
- CT Scan, MRI, and MRA
- Abortion in special circumstances
- Refractive eye examination and eyeglasses
- Routine Physical examination
- Durable Medical Equipment
- Medical/Surgical Supplies
- Hearing Evaluation and Hearing Aid
- Sterilization
- Off-Island Medical Care and Air Transportation
- Home Care Services
Can a person with other insurance apply for Medicaid?
Yes. It is also the only allowable deduction, health insurance premium, to the gross income for eligibility. The income and resources will be reviewed and assessed for eligibility and adjustment.
The primary insurance must be billed first. Medicaid is the payer of last resort.