Medicaid is typically, a health insurance program funded by both federal government and state governments, individually. This program is intended to provide health coverage for low-income individuals and families, residing in the US.
This article focuses on Medicaid, its benefits, eligibility requirements, application, and some other programs.
In fact, state governments manage this program, following the rules of the federal government. Hence, the administration and coverage vary widely from state to state.
Generally, the federal government provides half of the funds while state governments provide the remaining half. The funding ratio may also vary depending on the administration in every state.
The families and also the individuals, who meet certain criteria are eligible to enroll in this program. As of September 2020, Medicaid covered about 70.6 million people in the US. In other words, this program provides coverage to 1 in 5 Americans.
What Is The History of Medicaid?
Both Medicaid and Medicare were started as a part of the well-known Social Security Act (1965). Although the states are not required by law to take part in the Medicaid program, all states do.
Through this program, the states can provide coverage to children and their caretakers, whose families meet low-income criteria. This program also covers people with disabilities such as blind, deaf, etc. However, the federal government has made the requirements and rules more strengthened, over time.
What Are The Medicaid Eligibility Requirements?
Although the federal government funds this program, state governments administer Medicaid. Hence, they have their own set of regulations pertaining to this program. Therefore, the asset levels and income levels allowed to enroll varies from state to state.
Make sure to check your eligibility threshold before applying to enroll in Medicaid.
In general, Individuals having cash or assets worth more than $2000, apart from basic necessities like residence, vehicle, etc. cannot apply for this program.
Married couples, whose income exceeds 138% of the federal poverty level, either individually or combinedly are not eligible for this program. Moreover, if 50% of their joint asset value exceeds $130,380 (as of Jan’ 2021), they are ineligible to apply.
However, these limits may change based on the rules of specific states.
If you are a disabled person, you need to provide a medical certificate to avail the benefits of Medicaid. However, there are certain exceptions including:
1.) Woman with cervical cancer, breast cancer, etc.
2.) Individuals diagnosed with tuberculosis
3.) Human trafficking victims
Who Can Benefit from Medicare?
The following groups of people can benefit from Medicaid:
Seniors (65 and above) and also pregnant ladies, satisfying low-income requirements
People under 65 years of age, having low income
Children and also their caregivers, including parents with low income
Children residing in foster care units
Moreover, the states may extend or reduce the coverage to some other group of people, if they decide.
What is CHIP?
Children, whose families do not qualify for Medicaid, can get coverage from another program called the Children’s Health Insurance Program (CHIP). However, this program does not cover the caretakers or parents of children.
In some states, this program also covers certain groups of people such as pregnant ladies.
PPACA (Patient Protection and Affordable Care Act)
In 2010, President Barack Obama signed ACA (Affordable Care Act), popularly known as Obamacare. According to this law, all legal residents of the US, whose income does not exceed 138% of the federal poverty line are eligible for Medicaid coverage, in participating states.
The law further worked to expand both eligibility and federal funding for this program. However, the U.S. Supreme Court excluded the mandatory participation of states in expansion programs to receive the established funds for Medicaid
Therefore, the following states opted out of the expansion program, as of March 2021:
What Is D-SNP (Dual Special Needs Plan)?
Typically, some people may have both Medicare and Medicaid coverages. Such people can get extra benefits from D-SNP (Dual Special Needs Plan). In fact, these plans work in synchronization with the Medicaid health plans. They also provide more benefits than original Medicare plans.
How to Apply for Medicaid Coverage?
There are a number of ways you can apply for this program. For example, you can sign up from:
3.) Your state’s medical agency website
4.) Local Medicaid offices in your state.
Incomplete information is one of the common reasons behind the denial of coverage, to most people. Hence, fill out the application completely and submit the following documents
Legal documents regarding citizenship
Age proof (Driving License or Birth certificate)
Residential proof (Copies of the lease, mortgage, utility bills, payment receipts, etc.)
Income and also the asset documents
Medical records for proving disability (if applicable)
Other health coverage documents (if applicable)
Get Help for Filling the Forms
Although you can fill the forms yourself, two experts can help your chances of getting coverage increase.
1.) An attorney who has a good understanding of Medicaid regulations of your state and also holds specialization in elder law.
2.) A financial advisor, who can advise you on your assets and income, pertaining to the Medicaid requirements.
Which Care Services are Covered by Medicaid?
In general, Medicaid covers some mandatory benefits in any state, as required by federal law. Additionally, the states may provide extra benefits called optional benefits, if they choose to.
Some of the mandatory benefits include:
1.) Inpatient and outpatient hospital services
2.) Medical care transportation
3.) Nursing facility services, Nurse midwife services, and also certified family and pediatric nursing services
4.) Physician services
5.) Home health services
6.) Health clinic services (Rural)
7.) Health center services (Federally qualified)
8.) EPSDT services
9.) X-ray and Laboratory services
10.) Birth center services (Recognized or licensed by the state)
11.) Family planning services
12.) Tobacco cessation counseling services (for pregnant women)
Similarly, some of the optional benefits include
1.) Clinic services
2.) Prescription drugs
3.) Occupational therapies (movement and thinking)
4.) Physical therapy
5.) Respiratory care services(breathing)
6.) Optometry services (vision)
7.) Podiatry services (foot care)
9.) Dental services
10.) Hearing, speech, and language disorder services
Although prescription drug coverage comes under optional benefit, all the states include them in some form, as of 2020