Understanding Medicare and Medicaid

Understanding Medicare and Medicaid

Medicare and Medicaid are similar in that they are government supported health programs, but they are different in several respects: they are funded and administered by different branches of government, they provide different benefits packages, and they serve different groups. Understanding these differences can be challenging for health and social services providers.

Smart Policy Works brings decades of experience to help unravel the complex rules around eligibility and benefits for these critical health programs for seniors, families with children, pregnant women, children, persons with disabilities, and now low-income populations. Our continuing education helps organizations create new opportunities for clients and patients.


UNDERSTANDING MEDICAID – Medicaid is a joint federal-state program that provides healthcare to roughly 68 million people. It covers healthcare and related services for economically disadvantaged populations including low-income children, families, seniors, and low-income people with disabilities. Medicaid also provides benefits not typically covered by other insurers, including health related employment supports and long-term services and supports.

Medicaid 101: Introduction to Eligibility and Benefits

Our Medicaid 101 training provides an overview of eligibility rules and groups, program benefits, and the Affordable Care Act’s Medicaid expansion program. SPW offers in-person training sessions, and we can customize our content for specific states or by populations. Technical assistance may be required for this training session. (3 hours)

Target audience: This is a good entry-level training for new staff at health and social service providers, entry-level care coordinators and case managers


Medicaid 201: Understanding Medicaid Funded Long-term Services and Supports

Medicaid is the primary payer for long-term services and supports (LTSS). Over the past 20 years, spending priorities within LTSS have shifted as more people want the option to receive care in their own home rather than in an institution. This shift has pushed policy towards home and community-based services (HCBS) such as personal care and rehabilitative services, and away from institutional care delivered in nursing facilities and intermediate care facilities. This training explains the range of services and supports allowable under Medicaid and the various Medicaid waiver programs used to authorize these services. SPW offers in-person training sessions for this course, and we can customize our training for specific states or by populations. (2 hours)

Target audience: Experienced health and social service providers, care coordinators, case managers, and leadership; participants should already have experience working in Medicaid or LTSS systems


Medicaid-Funded Employment Supports

It is a little-known fact that Medicaid funds employment services and health-related employment supports for populations that are categorically eligible for Medicaid, such as people who meet or exceed the federal disability standard. States can use different mechanisms under Title XIX to fund employment, including State Plan Amendments and waiver programs. There are also 43 Medicaid buy-in programs across the country where people with disabilities can earn income and still have access to benefits and services under Medicaid. SPW offers in-person training sessions for this course, and we can customize our training for specific states or by populations. Technical assistance may be required for this training session. (2 hours)

Target audience: State vocational rehabilitation, mental health providers, social services and health providers


Medicaid Policy Training and Support

Medicaid is a care delivery solution that is as complex as the populations it is mandated to serve. States offer a myriad of Medicaid options to their residents and those options can change when state and federal priorities change. Our staff can train on specific facets of Medicaid so that the people you serve get the best information to support their health and wellness. Examples of customized trainings include:

  • Medicaid Spend-down – How Does it Work?
  • Understanding Integrated Health Homes and Social Determinants of Health
  • Integrating Employment Services into Care Coordination Planning

Target audience: Social services and health providers, case managers, care coordinators


UNDERSTANDING MEDICARE – Medicare is a federal health insurance program for people 65 and older, and certain people under 65 with disabilities and those with end-stage kidney disease. Unlike Medicaid, which every state has the ability to customize, Medicare benefits are uniform across the country, with several plans or “parts” each of which covers a specific set of services – such as Medicare Part D, which covers prescription drugs. Understanding how these parts combine to cover a person’s health, along with add-on products such as Medicare Advantage, can be confusing for beneficiaries and for the organizations trying to help them access insurance coverage.


Medicare 101: Introduction to Eligibility and Benefits

Our Medicare 101 training provides an overview of the four major parts that make up Medicare – Parts A, B, C and D. This training helps participants understand the basics, including what Medicare does and does not cover, and what deductibles, co-pays and co-insurance may be required for many health services and devices. (3 hours)

Target audience: Social services and health providers, case managers, care coordinators


Medicare 101 for Employers

Learn how to help employees 65 and older navigate Medicare. Medicare is a complex benefit system that covers millions of Americans, many of whom are full-time employees who have health coverage through their employer. This training is designed to help human resources professionals understand how to best help your employees 65 and over navigate Medicare enrollment. (2 hours) It will help you understand:

  1. What happens when a full-time employee turns 65.
  2. What does Medicare require from all new enrollees.
  3. What options employees have when it’s time to enroll in Medicare, including how to access Medicare’s special enrollment period.
  4. When employer-sponsored health insurance can act as important co-insurance – and when it cannot.

Target audience: HR professionals, benefits managers, case managers


Medicare 201: Coverage for Working Adults with Disabilities

Many organizations and agencies exist to help adults with disabilities find and maintain work without undermining or losing vital Medicare coverage. This training will explain the intersection of employment and Medicare for people with disabilities so VR professionals and providers of health/social services can help workers with disabilities continue on the path towards fulfilling work and economic security. (2 hours)

Target audience: VR professionals, benefits managers, case managers, social service and health providers


Learn more  about our trainings   •   Request a training   •   Contact us  to discuss a training