Medicaid is a health insurance program designed for people belonging to the low-income, limited-resources group who qualify for the eligibility guidelines established by federal and state law. It is funded by both the federal government and the states, but each state administers their own Medicaid program.
Below you will find Frequently Asked Questions about Medicaid:
Why is Medicaid different for every state?
Medicaid is a joint program by the federal government and the states to provide medically needy people with the means to receive medical care, who would otherwise not be able to afford it. Medicaid recipients are composed of the elderly, the disabled and pregnant women.
The Federal government provides approximately 50% of the costs for Medicaid while the remaining costs are shouldered by each state. This is why every state is given authority with regards to establishing eligibility standards and the benefits they provide. Only one state agency is in charge of the Medicaid program in each state, but the program is managed in many states by county and city governments.
Who is eligible for Medicaid?
In general, low-income families are covered by Medicaid. However, even within the low-income, limited-resources group, there are certain requirements set forth by individual states that must be met to qualify for Medicaid. These may include a person’s age, health status (pregnant, disabled, elderly, blind), income and resources (such as bank accounts, real estate property aside from the house of residence or other items that may be put up for sale), and whether or not a person is a U.S. citizen or a legal immigrant. Each state has varying rules for counting a person’s income and assets. Additionally, there are particular rules for those residing in nursing homes and disabled children residing at home.
A child may be qualified for coverage, as long as he is a U.S. citizen or a legal immigrant, even if his parents are not. There is, however, a 5-year limit in relation to permanent legal residents.
You should apply for Medicaid if you or anyone in your family needs medical care, your income is low and if your situation in life is consistent with any of the described below. Seek the help of a qualified caseworker in your state to assess your situation.
Pregnant Women. Married or single women who are pregnant may be eligible for Medicaid coverage. A child born to a woman who is under Medicaid coverage will be covered as well.
Children and Teenagers. You are encouraged to apply for Medicaid coverage if you are a parents or guardian of children 18 years old and below, earning low wages, or if you are the parent of a sick child who needs nursing home care, but is able to stay home with good quality care. The state may also allow you to apply for Medicaid on your own behalf if you are a teenager and living on your own; otherwise an adult may apply for you.
Aged, Blind and/or Disabled Persons. Those who are aged 65 and above, blind or disabled and have low income and limited resources are also encouraged to apply. People who are aged, blind, disabled; living in a nursing home; with a low income and limited resources; people who are aged, blind, disabled; needing nursing home care but are able to live at home with home- or community-based care services are also encouraged to apply. As well, those who are terminally-ill, wishing to receive hospice services; and people who are eligible for Medicare that have low-income and limited resources may be qualified for Medicaid.
Other Situations. Those leaving welfare and need medical coverage; families with children under 18 with very low income and limited assets; people with very high medical bills that they cannot afford to pay (and are under the age of 18 or over the age of 65, blind, disabled or pregnant) may also qualify for Medicaid and are encouraged to apply.
What documents will I need to provide when applying for Medicaid coverage?
You will usually need to provide the following:
- Verification of income (pay stubs, award letter, copy of check reflecting gross income)
- Proof of citizenship/qualified alien status
- Valid social security number (SSN)
- Proof of assets/resources (bank accounts, stocks, etc.)
- Proof of pregnancy (for pregnant women applicants)
Check with your state’s Medicaid office for the complete list of required documentation as this varies from state to state.
What services does Medicaid cover?
Medicaid coverage varies by state. There are set mandatory services and other optional services. However, children have a right to all medical services covered by Medicaid that are necessary for their health, under the federal law known as Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT).
Usually, states are required to cover the following services:
- Hospital services (inpatient and outpatient)
- Laboratory and x-ray services
- Routine check-ups
- Doctor’s visits
- Nursing home and home health care for people 21 years old and above
- Family planning services and supplies
- Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT) for children below 21 years old
Other optional services typically covered:
- Prescription drugs
- Hearing aids
- Dental care
- Vision care
- Intermediate care facilities for those with mental retardation
- Clinic services
Are adult children responsible for their parents’ medical bills?
States are not allowed to use the income or assets of non-spouses under Federal law when determining eligibility for Medicaid. However, in some states, there are laws mandating children to become responsible for their impoverished parents but these only apply for costs not covered by Medicaid.
Are healthy spouses held legally responsible for Medicaid expenses of sick spouses?
Federal law pertaining to Medicaid allows states to “deem” the earnings and assets of healthy spouses as accessible to the sick spouses; the degree of which determined by whether the sick spouse is living in a nursing home (or an equivalent facility) or at home. The regulations for this varies by state.
Will moving into another state bar me from Medicaid?
States must provide Medicaid coverage for qualified residents; length of stay residency is not a requirement.
Can I have both Medicaid and Medicare at the same time?
Recipients of Supplemental Security Income (SSI) from the Social Security Administration are consequently qualified for Medicaid and receive Medicare at the same time. In this case, Medicaid will pay for your Medicare premium, co-payments and deductibles. You should present your Medicaid and Medicare cards to your health care provider each time you obtain services.