The rules continually change for companies and individuals that deal with Medicare. It can be hard to keep up, even for companies large enough to be able to pay people to do so.

Medicare is the federal program to help older citizens, but it also covers those who have permanent kidney failure and certain people with disabilities. The Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) administers Medicare. The nation’s largest health insurance program covers about 37 million Americans.

Medicaid is the state and federally funded “needs-based” medical assistance program administered by the Washington State Department of Social and Health Services (DSHS). Medicaid provides a range of medical programs to those eligible. Funded by tax dollars, Medicaid is available at no cost to eligible children, pregnant women, low-income families, elderly, blind or disabled individuals.

Each state can handle and process Medicaid in different ways as long as they comply with federal standards. The Medicaid program was created in 1965 with the passage of Title XIX of the Social Security Act. Since that time it has publicly financed health care coverage for low-income families and long-term care for the low-income elderly and disabled.

The cost of state Medicaid programs is divided between the state and the federal governments. The proportions are based on each state’s per capita income relative to the rest of the nation.

Medicare and Medicaid services will perhaps be needed more with proposed cuts in the state’s Basic Health program and the state’s continued economic malaise.

According to figures provided by Gov. Gary Locke, the biennium budget he proposes “saves $328 million by ending Basic Health Plan coverage for 59,800 childless adults and [removing] optional medical care programs for adult Medicaid patients.”

For Washington residents who may be calling for the first time, there are at least 20 phone numbers and Web sites to get answers. They can start with the Statewide Health Insurance Benefits Advisors at 800-397-4422.

SHIBA counselors can answer questions and help people understand their health care choices and help to choose a Medicare plan and possible additional health insurance.

The second place to look for which services are covered in Washington or any other state is at the official Medicare Web site, under “coverage” (www.medicare.gov/Coverage/Home.asp).

The third place to visit to complete the answers you haven’t received, yet, is http://medicare.custhelp.com. Such questions as “Who’s eligible?” and “How can I enroll?” are answered in simple language, with supporting information and phone numbers.

In addition the State Medical Assistance Office (800-562-3022) can answer questions about low-income programs (such as Medicaid) to help pay medical bills.

The Centers for Medicare and Medicaid Services Regional Office at 206-615-2354 will be able to direct any other inquiries to the right person or agency.

In Sept. 2002, the last month for which figures from the state’s Medical Assistance Administration are available, there were 28,326 Kitsap County residents received some type of state medical assistance.

The state’s Caseload Forecast Council shows small increases - 5 to 6 percent - for most medical insurance burdens. But the forecasts change depending on the rules.

For instance, one small change out of many is the new coverage for glaucoma testing and treatment under Medicare. That could potentially be used by many people. Getting good advice on what is covered and what may no longer be covered is key for everyone involved.

(Temple A. Stark is a free-lance writer living in Port Orchard. Reach him at writer@templestark.com).