Medicaid

Medical Staff

Ensuring that all Americans have access to medical care has always been a goal for the United States government; hence the creation of the Medicaid system. The system was developed to provide financial support for health services to low-income and disabled citizens. The federally-funded program, which provides funds directly to care providers who treat Medicaid patients, is managed on the state level. Recently, some states have begun charging its recipients a premium or co-payment to help offset rising medical costs.

History of Medicaid

Medicaid became an official government program in 1965 when President Lyndon B. Johnson made it available for people who are unable to pay for their own medical insurance. Administered by the Centers for Medicare and Medicaid Services (CMS) under the direction of the Department of Health and Human Services, these benefits are provided to individuals through their state and local offices. Over time, these programs have grown to include a larger array of services and options to recipients. The growth, however, has put a financial strain on the many of the states' programs.

Eligibility

In the beginning, income was the main determining factor for becoming eligible for Medicaid. It did not take the government long to realize that many other people needed help getting good medical coverage, even if they were not considered low-income. There are three groups that program recipients fall into:

Categorically Needy

This group is determined by level of income. Eligibility is based on how income compares to the Federal Poverty Level (FPL). In 2011, a family of four is at the FPL if they earn $22,350 or less per year. Generally, children up to age 6 can be benefit recipients in a household that earns up to 133 percent of the FPL.

The categorically needy group also includes pregnant women and babies within income limits and individuals who receive supplemental security income for age or disability reasons.

Medically Needy

This category covers individuals who do not qualify based on income, but who have extensive medical issues. Currently, 35 states allow a medically needy categorically for Medicaid, but the coverage varies greatly by state. Pregnant women qualify for coverage in all 35 states. Some of the other coverage areas include blind and disabled people.

Special Groups

Medicare recipients, women with breast or cervical cancer, and individuals with tuberculosis may qualify for Medicaid assistance under this category. Services may also be available to disabled workers looking for job placement and training opportunities. These benefits are decided on a state-by-state basis.

What Is Covered?

Like all health insurance plans, coverage for certain treatments may require pre-approval or co-payments. Always check with your local Medicaid office if you are not sure about your coverage options. Generally, the following services are provided:

  • Hospital stays
  • Doctor and dental visits
  • Lab work and X-rays
  • Emergency services including transportation
  • In-home nursing care
  • Medical supplies
  • Nursing home stays
  • Psychiatric treatment

Some states also offer additional coverage for chiropractor care, dentures, and eyeglasses. You can learn more about your state's benefits by using the CMS Contacts Database.

Application Process

Applying for Medicaid can be done through your state's Department of Public Welfare. You may have a regional or county office locally that will handle the process and can provide you with the necessary paperwork as well as answer any questions you have. You may be able to complete the initial application on-line, but will then have a follow-up interview with your case worker. This can usually be done in a local office or over the phone.

For the application process and interview, you will need to gather a lot of information about your health and finances. This helps the caseworker determine if you are eligible. Items you should have on-hand include:

  • Identification with your current address
  • Recent pay-stubs and evidence of any other income
  • A list of all assets, including bank accounts, insurance policies, and vehicle and mortgage information
  • Copies of recent medical bills
  • Detail of your monthly debts

After the caseworker receives all your information, your case will be reviewed by the office. It may take a few weeks for them to make a decision, but if you do not qualify, there may be other programs in your state that you can apply for. Talk to your caseworker about other options you may have.

To get started, you can visit the government's Benefits.gov website, which has a questionnaire to help you determine what benefits you may be eligible for.

Medicaid