What is Medicaid?
Medicaid is a government program that provides health-related services to qualified low-income individuals and families who otherwise could not afford adequate health insurance for themselves. It is managed by the Centers of Medicare and
Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services.
Why do I need it?
If you can’t afford adequate health insurance, Medicaid can help you get the medical services you need your family members or yourself.
Federally required and regulated services under Medicaid include:
• Inpatient hospital services
• Outpatient hospital services
• Prenatal care
• Vaccines for children
• Physician services
• Nursing facility services for persons aged 21 or older
• Family planning services and supplies
• Rural health clinic services
• Home health care for persons eligible for skilled-nursing services
• Laboratory and x-ray services
• Pediatric and family nurse practitioner services
• Nurse-midwife services
• Federally qualified health-center (FQHC) services and ambulatory services
• Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21
Outside of Federal requirements, states also provide optional services for their Medicaid programs. The most common optional services include:
• Diagnostic services
• Clinic services
• Intermediate care facilities for the mentally retarded/disabled (ICFs/MR)
• Prescribed drugs and prosthetic devices
• Optometrist services and eyeglasses
• Nursing facility services for children under age 21
• Transportation services
• Rehabilitation and physical therapy services
• Home and community-based care to certain persons with chronic impairments
Do I qualify?
Although Medicaid is overseen at the Federal level, each state administers its own Medicaid program and has its own eligibility standards. The states also determine the type, amount, duration and scope of services. States also set the rate of payment for their services. You must inquire with your own state’s Medicaid program to know specific program guidelines.
Medicaid is for people of lower income who satisfy requirements based on age, pregnancy status, disability status, other assets and citizenship.
States are also required to provide services to individuals that the federal government defines as categorically needy.
These include:
• Individuals who receive federally assisted income-maintenance payments and similar groups who do not receive cash payments
• Individuals who meet the requirements for the Aid to Families with Dependent Children (AFDC) program that was in effect in their state on July 16, 1996
• Children under age 6 whose family income is at or below 133% of the Federal poverty level (FPL)
• Pregnant women with family income below 133% of the FPL
• Supplemental Security Income (SSI) recipients
• Recipients of adoption or foster care assistance under Title IV of the Social Security Act
• Special protected groups such as individuals who lose cash assistance due to earnings from work or from increased Social Security benefits
• Children born after September 30, 1983 who are under age 19 and in families with incomes at or below the FPL
• Certain Medicare beneficiaries
How do I apply?
You must contact your State’s Medicaid agency when applying for the Medicaid program. Click here for more information on State Medicaid Agencies and their websites. For more information, please click on this link to be taken to the proper directory.