Medicaid


About Medicaid

Medicaid is a public health program for low-income individuals and families, and individuals with specific disabilities. If you cannot afford health care, it is likely you qualify for Medicaid. It is state-administered, so services and coverage varies based on where you live in the US, and what is dictated as the income limit for that area. Medicaid pays for your health care services directly to the provider, and in some states some individuals will be asked to make a small co-payment. Medicaid has provided more health care to those who cannot afford it than any other organization in the country.

Qualifying for Medicaid

Eligibility criteria changes from state to state. In order to find out if you qualify for Medicaid, your health status, age, legal residency of the US, and your income and resources will all be evaluated. In most every state, six groups are considered mandatory for coverage under Medicaid.

  • Low-income parents
  • Children
  • Pregnant women
  • Elderly, blind and disabled individuals on SSI
  • Low-income Medicare beneficiaries

As a result of the Affordable Care Act, the income limit is now 133% of poverty level in states that chose to expand Medicaid. These states provide Medicaid coverage to all uninsured parents and adults without dependent children in addition to the groups listed above.

 

Medicaid Benefits

Mandatory:

Medicaid in all states provides a minimum benefit package, as mandated by federal law. The services considered by Medicaid as mandatory for coverage include:

  • Hospitals
  • Physicians
  • Family planning
  • Nursing facilities
  • Health centers

Optional:

Every state has the option of giving coverage for other services that the government has already designated. Some of the most common optional services covered by Medicaid are as follows:

  • Vision and eyewear
  • Dental
  • Mental health
  • Prescription medication
  • Home health care
  • Case management
  • Rehabilitation

 

 

Medicare-Aid

Medicare-Aid, or the Medicare Savings Program, is a program for individuals who have Medicare who qualify for Medicaid due to low income. This is especially helpful, as aging can sometimes make it difficult to maintain gainful employment. Medicare-Aid offers assistance with paying health insurance premiums, deductibles, and co-payments. You can be place in one of three levels of the program, depending on your income:

  • Comprehensive Medicare-Aid (MQB-Q), which provides coverage for Medicare Part A and Part B premiums, Medicare annual deductible, 20% Medicare co-pay, and Medicare hospital deductible. It also covers the first 20 days of a nursing home stay, so long term benefits would be necessary for those who plan to stay longer.
  • Limited Medicare-Aid (MQB-B) pays for the Medicare B premium only.
  • Limited Medicare-Aid Capped Enrollment (MQB-E) pays for the Medicare B premium, though this program has limited funds.

Medicare-Aid also provides Medicare Part A coverage for employed persons with a disability. Some can lose their right to having free Medicare Part A services as a result of going back to work. Medicare-Aid for Working Individuals with a Disability is a program for those who are under 65, have a disability, and qualify for Medicare Part A benefits.

 

Medicaid Resources