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Medicaid, the single largest source of health coverage in the United States, provides health coverage to almost 75 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities.

Medicaid is a federal program, but it is administered by the states. To participate in Medicaid, federal law requires states to cover certain groups of individuals, such as low income families and individuals receiving Supplemental Security Income (SSI). States may choose to cover other groups, such as individuals receiving home- and community-based services.

Funding for the Medicaid program comes from both the federal government and the individual state governments. Currently, the federal government gives each state a specified percentage of its program expenditures. This Federal Medical Assistance Percentage (FMAP) is based primarily on the per capita income of the state receiving assistance, so it can vary widely from state to state. For example, a rich state like New Jersey might receive $1 from the federal government for every dollar it spends on Medicaid while a poor state like Mississippi would receive $3 for every dollar it spends. The FMAP is adjusted every three years to account for changes in the economy.

Conservatives have long argued that Medicaid would be more efficient if states received a lump sum—a block grant—from the federal government and could then manage the programs as they saw fit. President Ronald Reagan proposed block grants in 1981, Speaker Newt Gingrich in 1995, and President George W. Bush in 2003. President Clinton agreed to block grants with the Temporary Assistance for Needy Families (TANF) program. Now that Donald Trump is President, and Republicans have control of both the House and the Senate, block grants are back on the table.

Proponents claim this could save the government billions of dollars and give the states more opportunity to be creative with their programs. Critics are afraid that people will not have access to the care they need. They are concerned that the states would cut benefits or force beneficiaries to take on more cost-sharing. Most of the Medicaid spending is on the elderly and disabled, with Medicaid paying for the care of almost two-thirds of the people in nursing homes, and critics are afraid they will suffer the most. In addition, they claim hospitals and clinics that treat large numbers of Medicaid beneficiaries will likely have to adjust their services and staff.

Of course, this is all speculation right now as no details on a block grant plan are available. But they may be coming soon. Republicans have placed a high priority on repealing and replacing Obamacare. That, and portions of a block grant proposal, could be accomplished through a process called budget reconciliation. Because it would only require 51 votes in the Senate, a Republican plan could pass without Democrat support. If a block grant plan for Medicaid is included, look for details on the implementation and see how the critics’ concerns are addressed.

If you were injured or became seriously ill while serving in the military, you may be eligible for VA disability compensation. In 2017, eligible veterans can receive up to $3,458 per month tax-free, depending on the level of disability and number of dependents.

According to the VA’s website, disability compensation is paid to veterans who are at least 10% disabled because of injuries or diseases that were incurred in or aggravated during active duty, active duty for training, or inactive duty training. A disability can apply to physical conditions, such as a chronic knee condition, as well as mental health conditions, such as post-traumatic stress disorder (PTSD). You must also have been discharged under other than dishonorable conditions.

Medical evidence of a current physical or mental disability and its relationship to an injury, disease or event in military service is required. However, under some circumstances, the VA may conclude that certain current disabilities were caused by service, even if there is no specific evidence for your claim. For example, the cause of a disability is presumed for veterans who:
* are former POWs;
* have chronic/tropical diseases that become evident within a specific period of time after discharge;
* were exposed to ionizing radiation, mustard gas or Lewisite while in service;
* were exposed to certain herbicides, such as by serving in Vietnam; and
* served in Southwest Asia during the Gulf War.

The benefit amount is determined on a case-by-case basis and is graduated, on a scale of 10% to 100%, according to the degree of the veteran’s disability. Compensation may also be paid for disabilities that are considered related or secondary to disabilities occurring in service and for disabilities presumed to be related to circumstances of military service, even though they may arise after service. The degrees of disability are also designed to compensate for considerable loss of working time.

If you have dependents, an additional allowance may be added if your combined disability is rated 30% or greater. Your compensation may be offset if you receive military retirement pay, disability severance pay, or separation incentive payments. More information about disability compensation benefit amounts can be found on the VA’s Compensation Rates page.

Claims can be submitted online, in person at a regional VA office, or through an accredited agent or representative. All supporting documentation should be submitted with your claim, including medical evidence and how the disability has affected your life; separation documents; and dependent records (such as marriage and children’s birth certificates). A change in family status can affect your benefits. Be sure to notify the VA immediately of a marriage, birth, divorce, death, parent moving in with you, or child aging out of dependent status.

If you have trouble with your VA claim I can help

The Veterans Administration provides an important benefit program for veterans who have service-connected disability. The program is called “Compensation” and is different from the non-service-connected “Pension” program that elder law attorneys often discuss with wartime veteran clients or their surviving spouses. Like the pension program, VA compensation comes in the form of income-tax-free money payments to the veteran, who must have received a discharge other than dishonorable, or certain of their family members. The big difference from the pension program, however, is that VA compensation entirely flows from the linkage between the veteran’s disability and his or her military service. http://www.publichealth.va.gov/exposures/compensation.asp

For most veterans, the key issues in accessing VA compensation benefits have been proving service connection for the disability, and then dealing with the disability level rating that the VA assessment system applies to the particular veteran’s case. Often veterans who prove service connection are nonetheless frustrated by their disabilities being rated in seemingly unreasonably low percentages, such as 30% disabled rating, with the result that their compensation benefits may not be adequate to sustain them despite the actual disabling effects on their lives.

It is important to be aware that the surviving spouse of a compensation recipient may be eligible for a benefit called DIC, Dependency and Indemnity Compensation. DIC applies to the surviving spouse of a veteran who died of his or her service-connected disability, or who received VA compensation for a period of 10 years prior to death not caused by the service-connected disability. For more information about DIC, see the VA website at http://www.va.gov/opa/publications/benefits_book/benefits_chap12.asp

Click here to view basic eligibility for VA Pension

Study after study confirms that nearly everyone will face at least a temporary disability sometime during their lifetime. More specifically, one in three Americans will face at least a 90-day disability before reaching age 65 and, according to the definitive study in this area, depending upon their ages, up to 44% of Americans will face a disability of up to 4.7 years. On the whole, Americans are up to 3.5 times more likely to become disabled than die in any given year.

In raw numbers, over 37 million Americans, or roughly 12% of the total population, are classified as disabled according to the 2010 census. Perhaps surprisingly, more than 50% of those disabled Americans are in their working years, from 18-64. For example, in December 2012, according to the Social Security Administration more than 2.5 million disabled workers in their 20s, 30s, and 40s received SSDI (i.e., disability) benefits.

Sailors and Marines facing administrative separation for any reason will have mental health issues taken into account when officials determine their discharge characterization and disability evaluation status under a new policy rolled out by Navy Secretary Ray Mabus in June, 2016.

Starting immediately, diagnosed mental health conditions will take precedence over misconduct issues when determining the conditions of a Marine or sailor’s discharge, if the mental health issue is believed to have contributed to the misconduct, according to officials. These troops may be referred into the disability evaluation system, allowing them to retain key veterans’ benefits.

The change makes the Navy the first military service to consider mental health issues when conducting administrative separations, according to a June 1 news release. It acknowledges that post-traumatic stress disorder or traumatic brain injuries received in combat that may contribute to troops’ negative behavior or altered job performance.

Service members who believe this change in policy may affect their separation characterization or disposition can file a petition for relief through the Board of Correction for Naval Records.

There is no statute of limitations for those wishing to appeal, she said. For PTSD, TBI and other mental health conditions, an “appropriately privileged military health care provider” will be consulted to determine whether the condition contributed to the actions or conduct for which the sailor or Marine is being separated.

Service members may face administrative separation after demonstrating patterns of misconduct, poor performance of duties or non-performance, failure to conform to weight and fitness standards, and drug use, among other reasons. The military also sometimes separates those who have been accused of serious crimes so that the civilian justice system can prosecute them.

For troops with diagnosed mental health issues facing a discharge other than honorable, according to the release, their case must first be personally reviewed by the first general or flag officer in their chain of command for a final determination.

Discharge status has a significant impact on veterans’ benefit eligibility: other- than-honorable, bad conduct, and dishonorable discharges disqualify troops from all benefits, while a general discharge may limit eligibility for certain benefits, like the GI Bill.

Marine and Navy veterans who believe their own discharge status might have been affected by this updated review process can appeal, said Lt. Kara Yingling, a Navy spokeswoman.

For Mabus, this is the latest in a series of significant department-specific social changes that have characterized his tenure. Last July, he increased maternity leave for sailors and Marines from six weeks to 18 — a dramatic move that was overridden in January by a Defense Department-wide policy change that granted 12 weeks’ leave to troops in every service.

“It is one of the great maxims of naval history that Sailors and Marines are the sea services’ greatest advantage and most important asset. For more than a decade, we’ve asked a tremendous amount of our people and their families,” Mabus said in a statement. “In turn, we have a responsibility to support their needs, whether they are serving the Navy and Marine Corps mission around the globe or transitioning from uniformed service to civilian life.”