Understanding The Basics of Medicaid

Medicaid is a crucial government program providing healthcare coverage to millions of low-income individuals and families. Although it is so important, many people do not understand how it works, who qualifies, and what services it provides. This post will help with understanding the basics of Medicaid so individuals can better navigate the program.

What is Medicaid

Medicaid is a joint federal and state program designed to offer healthcare coverage to eligible low-income individuals, including children, pregnant women, elderly adults, and people with disabilities. Unlike Medicare, which is primarily for disabled individuals and those 65 and older, Medicaid eligibility is based on income and other factors.

Each state administers it’s own Medicaid program. The states must follow federal guidelines but have flexibility to expand coverage and determine eligibility criteria. In other words, Medicaid programs vary significantly from one state to another.

Click here to find coverage in each state

Who Qualifies for Medicaid

In general, Medicaid eligibility is based on income and size of household. Although, factors such as disability, age, and pregnancy are also condsidered when determining qualification. In states that have expanded Medicaid under the ACA (Affordable Care Act), individuals with incomes up to 138% of the federal poverty level (FPL) qualify for Medicaid coverage.

In general, Medicaid provides coverage for individuals who have income levels that meet state qualifications. Those who may qualify are:

• Individuals, families, children and elderly individuals with limited income
• Pregnant women
• Individuals with disabilities

Each state has an online portal or office where individuals can apply for Medicaid benefits. Usually they can go to their state’s health department or the federal Healthcare.gov website.

What Medicaid Covers

Medicaid provides comprehensive healthcare services that include the following:

• Hospital and emergency care
• Doctor visits and preventive care
• Maternity and newborn care
• Prescription medications
• Mental health and substance abuse treatment
• Long-term care services (this includes; nursing home care and home health services)
• Dental and vision care (coverage varies by state).

Although federal guidelines require the states to provide coverage for essential services, each state has the ability to cover additional services.

How to Apply for Medicaid

Each state has it’s own process to apply for Medicaid coverage. In general, it is pretty straight forward. We have listed some of the common steps for the application below:

Check Eligibility: Use the state’s Medicaid website or the federal Healthcare.gov website to verify qualification.

Gather Necessary Documents: Applicants will need proof of income, identification, Social Security numbers, and information about household members.

Submit an Application: There may be several ways to submit an application; online, in person, by mail, or over the phone. This depends on the state the enrollee is in.

Wait for Approval: Processing times vary, but applicants will receive notification about their status and coverage details.

Medicaid and Other Health Programs

Many Medicaid beneficiaries qualify for additional assistance programs, such as the Children’s Health Insurance Program (CHIP), which provides coverage for children in families with incomes too high for Medicaid but too low for private insurance. Many states also offer food and housing and utilities assistance programs.

There are also specific Medicare programs that provide Extra Help to beneficiaires.

Learn the difference bewtween Medicare and Medicaid

For those who qualify for both Medicare and Medicaid (dual-eligible individuals), Medicaid helps cover Medicare premiums, copays, and additional services that Medicare doesn’t fully cover, such as long-term care.

Medicaid plays an important role in ensuring access to healthcare for millions of Americans. Understanding the eligibility requirements, coverage options, and application process help individuals and families access the benefits available to them. Because Medicaid rules and benefits vary by state, it’s essential to check the local Medicaid office for accurate and up-to-date information.