MIP FREQUENTLY ASKED QUESTIONS

 

What is Medically Indigent Program (MIP)?

Medically Indigent Program (MIP) is a 100% locally funded program established by P.L. 17-83 in October 1983 to provide financial assistance with health care cost to individuals who meet the necessary income, resource and residency requirements.

Who qualifies for MIP?

  1. A resident of Guam who has resided on Guam for a period of no less than six (6) months and who has been physically living on Guam within the last six (6) months of the year.
  2. Not eligible for Medicaid or Medicare coverage and have exhausted all benefits under Title XVIII, XIX of the Social Security Act; or State Children’s Health Insurance Program under Title XXI of the Balanced Budget Act of 1997;
  3. A child in foster care, age 18 years and below;
  4. Eligible to receive temporary emergency medical or other special care as provided in Section 2905.3 of the law.

What are the income and resource limitations?

Income limitation for full MIP coverage follows 100% of the Federal Poverty Guidelines that is updated and effective October 1st of each fiscal year.

What if my gross monthly income exceeds the gross income limitations?

The following applicant may still be eligible for the partial MIP coverage if the applicant’s gross income exceeds the gross income limitations:

  1. An applicant whose gross income does not exceed three hundred dollars ($300) of the Guam MIP Income Guideline.
  2. Individuals who are afflicted with tuberculosis, leprosy, lytico, bodig, end stage renal disease or insulin dependent diabetes mellitus may be eligible if the individual applicant’s gross income exceeds the gross income limitations by an amount not greater than one thousand dollars ($ 1,000.00).

Recipients under partial coverage will be responsible for sharing the cost of medical expense by payment of their liability.

What is my liability rate if I’m eligible for partial coverage for MIP?

The following is a table of the percentage of an applicant’s liability for program medical services rendered for each range of available income per month above the income guidelines:  

Regular MIP Afflicted with TB, Leprosy, Lytico, Bodig, ESRD or DM  (Insulin Dependent) Percentage Liability
$    1 – $  50 $    1 – $  167 7%
$051  – $100 $168  – $ 335 15%
$101  – $150 $336  – $ 502 22%
$151  – $200 $503  – $ 670 30%
$201  – $251 $671  – $ 837 37%
$252  – $300 $838  – $1,000 45%

LIQUID RESOURCES:  

The maximum allowable liquid resources of all member of the Medically Indigent Program shall not exceed the two thousand dollars ($ 2,000) household limitation.  These resources shall include but is not limited to the following:

  1. Cash on Hand
  2. Checking or Savings account
  3. Stocks and Bonds
  4. Shares in Credit Union
  5. Lump Sum Payments
  6. Time Certificates
  7. Other Investment  

VEHICLE, REAL PROPERTY AND OTHER RESOURCES:  

  • The entire value of one (1) licensed vehicle shall be excluded for one (1) parent household and two (2) vehicles shall be excluded for two (2) parent households.  All other vehicles shall be individually evaluated at Fair Market Value and that portion of the value which exceeds the current FSP vehicle disregard shall be attributed in full towards the household’s resource limit, regardless of any encumbrances on the vehicles.  
  • Primary house is excluded from real property including any surrounding land in which a client lives and owns or is buying.  The Agency shall exclude from “resources” consideration the necessary non-liquid income producing property, but not real property.  

Must an application be completed prior to the interview?

Yes.  An application for Public Assistance Program form must be completed and submitted to the Receptionist.  The Receptionist will set you up for an interview appointment to an Eligibility Specialist (ES). All required documents should also be submitted during the interview.  

Does the Head of Household have to be present during the interview?

Yes, but exception will be made.  If the head of household is incapacitated or unable to make it to the interview, the spouse or an authorized representative must be present.  

When will I be informed of my eligibility status?

The Eligibility Specialist (ES) has thirty (30) days from the date of interview to determine your eligibility.  

When does eligibility begin?

If eligible, eligibility begins on the first day of the month of application.  

If eligible, when do I get my MIP Card?

Your MIP card will be mailed to the address indicated in your application on the following month after you are determined eligible.  You should inform your ES of any change of address. If you do not receive your MIP card by the tenth (10th) of the month, you should inform your ES so a temporary MIP card can be issued to you.  

Do I have to apply every month?

No.  If you are fifty-five (55) years old and over with unearned or no income, you will be certified for twelve (12) months.  All other recipients are given a maximum of six (6) months eligible. You need to renew to continue your MIP coverage.

What Medical/Dental services does MIP pay?

In-patient services

  • In-patient hospitalization;
  • Semi-private room and board, or private room when medically necessary;
  • Coronary and intensive care;
  • Neonatal intensive care, intermediate Nursery care and wellborn nursery care;
  • Surgery and anesthesia;
  • Operating room, delivery room and licensed birthing center services;
  • Diagnostic laboratory services;
  • Diagnostic radiology, ultrasound and mammography screening services;
  • Renal dialysis treatment;
  • Physician services;
  • Emergency Room services
  • Acute physical and occupational therapy;
  • Respiratory therapy;
  • Prescribed drugs;
  • Podiatry services;
  • Care in an Intermediate Care
  • Ambulance services.  

Out-patient services

  • Physician evaluation and management services;
  • Laboratory diagnostic services;
  • Diagnostic radiology, ultrasound and mammography screening services;
  • Emergency room services for urgent and life threatening medical problems;
  • Prescription drugs;
  • Ambulatory surgical services;
  • Renal dialysis treatment;
  • Physical and occupational therapy;
  • Respiratory therapy;
  • Physical examination.  

Physician, Laboratory and Radiology Services

  • Physician, evaluation and management services (in-patient and out-patient);
  • Consultation services;
  • Specialty services.

Skilled Nursing Facility Services

Intermediate Care Services

Mental Health Services

  • Inpatient care;
  • Out-patient facility/day treatment;
  • Maintenance counseling;
  • Chemical dependency services;
  • Psychological and neuropsychological testing;
  • Mental illness coverage for patients diagnosed with mental retardation and mental illness to address mental illness concerns;
  • Generic Prescription Drugs

Optometrist Services and Lenses

Audio logical Examination and Hearing Aids

Orthopedic Conditions and Prosthetic Appliances

Voluntary Sterilization Services

Home Health Services

  • Home health visits by licensed practitioner or home health aid;
  • Prescribed medical supplies not otherwise available over the counter;
  • Intermittent equipment and appliances provided on a part-time/intermittent basis.

Durable Medical Equipment

  • Standard Wheelchair;
  • Standard Hospital bed;
  • Walker;
  • Bedside Rails;
  • Bedpans;  
  • Oxygen Related Equipment Only

Prescription Drugs

Physical and Occupational Therapy

Acupuncture Care and Chiropractic Care

Off-island Medical Care and Air Transportation

What are MIP medical benefit and limitations?

Acupuncture:  

  • 10 visits per contract period
  • $50.00 per visit

Air Fare:

    • Round trip air transportation to an eligible patient one (1) parent if the patient is a minor or one medical escort when medically necessary.

Audio logical examination:

    • $ 100.00 maximum per visit

Blood and Blood Products:

    • $50,000.00 maximum per year except hemophilia or hemophilia-related conditions

Cardiac Related Services:

    • 10% co-insurance

Chemical Dependency:

    • $10,000.00 per year

Corrective Lenses:

  • $100.00 maximum every 2 years

Eye Examination:

  • $50.00 maximum once a year

Hearing Aid:

  • 500.00 maximum per hearing aid

Home Health Services:

  • Limited to 100 days per year

Hospice Care:

  • 180 days maximum

Off Guam Medical Care:

  • $175,00.00 per year including airfare and escort fees

Orthopedic services and Appliances:

  • $50,000.00 maximum per year; 10% co-insurance on all services

Pharmaceutical Prescriptions:

  • Limited to thirty (30) days supply at one time except birth control pills 90 days supply; limited to generic drug only with $2.50 copayment per prescription filled

Physical Examination (PE):

  • $5.00 co-payment for each PE related services

Physical Therapy:

    • First 20 visits full coverage, 50% coverage required thereafter

Radiology:

    • 10% co-insurance on all services

Radiation Therapy:

    • 10% co-insurance on all services

Renal Dialysis:

    • Limited coverage to first twelve (12) months.  Premium payments and co-insurance thereafter

Skilled Nursing Facility:

    • 180 days maximum per year


Well Child Care:

    • Six (6) visits per year up to age two (2) excluding visits for immunization   

Medical exclusions are:

  • Voluntary abortions, abortions and interrupted pregnancy that are not medically necessary;
  • Elective cosmetic surgery, except as provided for in the Women’s Health Act;
  • Custodial care, domiciliary care, private duty nursing services or rest cures, unskilled services, except as provided for in hospices;
  • Personal comfort or convenience items;
  • Any services not medically necessary for the diagnosis or treatment of a disease, injury or condition;
  • Non-emergency use of Emergency Room;
  • Over the counter drugs not listed in the Drug Formulary;
  • Experimental drugs, treatments or procedures;
  • Fertility procedures, reversal of sterilization and services related to artificial conception
  • Treatment, services and supplies related to sexual dysfunction
  • Trans-sexual surgery and related services;
  • Mental health services for a person with mental retardation;
  • Motorized limbs;
  • Services for any incarcerated person;
  • Care or services furnished by immediate relatives or members of the patient’s household;
  • Health care services, which are provided and reimbursed by other local or federal programs, MIP is the last resort payer;
  • Speech and language therapy;
  • Tissue and organ transplants and other related services during and after transplant;
  • Treatment and services for artificial weight reduction, including gastric bypass, stapling or reversal, or liposuction;
  • Treatment for injuries sustained in the commission of an illegal or criminal act, including driving under the influence;
  • Any work related injury, subject to compensation pursuant to the Workers Compensation Law;
  • Care for military service connected disabilities to which the patient is legally entitled to government benefits or care;
  • Physical therapy services determined not to result in significant and demonstrable improvements in the patient’s ability to function independently;
  • Occupational therapy, acupuncture and chiropractic services related solely to specific employment opportunities, work skills or work settings;
  • Any diagnostic service requiring prior authorization, which has not been obtained or has been denied;
  • Off-island emergency medical services;
  • Off-island living expense;
  • Benefits and services not specifically listed as covered.

What are MIP Dental Benefits and limitations?

  • Emergency dental services (restoration, extraction and root canal treatment) which are necessary to alleviate severe pain and annual routine dental treatment (dental examination and cleaning) are covered for all persons age seventeen (17) and above.  
  • MIP clients are responsible for twenty percent (20%) of the cost of each treatment.

Dental exclusions are:

The following dental services or procedures shall not be covered by MIP:

  1. Cosmetic or cosmetic related treatments;
  2. Treatments initiated while no on existing plan;
  3. Services or treatments not in accordance with accepted dental therapeutics;
  4. Any services not listed in American Dental Association’s procedure codes;
  5. Any treatment or services related to temporomandibular joint dysfunction syndrome (TMJ/TMD) or disease, including but not limited to crowning, wiring or repositioning of teeth;
  6. Posterior composites;
  7. Broken appointment fees;
  8. Dental implants and implant prosthesis;
  9. Ordontics or orthodontic-related treatments.

What MIP services require Prior Authorization?

  1. In-patient hospital services if confinement exceeds sixty (60) days.
  2. CT Scan or MRI diagnostic services;
  3. Elective or specialized surgical procedures;
  4. Physical and Occupational therapy;
  5. Eye Examination and Corrective lenses;
  6. Off-island medical care and Air transportation;
  7. Physical Examination;
  8. Acupuncture and Chiropractic Services

What should I do if I need Prior Authorization for MIP?

Visit the Prior Authorization Office on the 2nd Floor, Mangilao Public Health Room 219, for on-island prior authorization.  The following documents are needed to facilitate the issuance of prior authorization for services for In-patient hospital services if confinement exceeds sixty (60) days, CT Scan or MRI diagnostic services, Elective or specialized surgical procedures, Physical and Occupational therapy and Eye Examination and Corrective lenses.

  1. Physician’s prescription;
  2. Physician’s justification for the prescribed medical services.  

For off-island medical care, visit the Prior Authorization Office, Mangilao Public Health, 2nd Floor Room 236.

What off-island medical treatment does MIP cover?

All medical treatments or procedures that are not available in Guam, are covered by MIP provided a prior authorization is obtained before the treatment is rendered.

What airfare assistance can MIP provide for its recipients?

Round trip air transportation will be provided to MIP recipients when all criteria for off-island care have been met.  One (1) parent or guardian will be covered if the patient is a minor, seventeen (17) years of age or below. Air transportation and per diem will also be provided for medical escort (registered nurse or physician) when the MIP Advisory Council certifies it as being necessary to accompany and assist the patient while on referral.  The referring physician shall provide a written request of the reasons for the medical escort.

 

Translate »
Skip to content