What is Medicaid
Medicaid is a joint federal and state program that helps pay medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered Medicare, like personal care services. If you qualify for Medicaid in your state, you automatically qualify for Extra Help paying your Medicare prescription drug coverage.
How does it work?
Each state decides how to run its program, what counts as income and resources, who’s eligible, what services are covered, and the cost for services, as defined in federal law. As a result, Medicaid programs can vary by state and territory. Some states use different names for their Medicaid programs, like Medi-Cal in California or TennCare in Tennessee.
How can I get Medicaid
If you have limited income and resources you should apply for Medicaid in the state where you live. The rules for counting your income and resources vary by state. Resources include money in a checking or savings account, stocks, and bonds. There are also special rules for those who live in nursing homes and for diaabled children living at home. If you apply and are approved for Medicaid, you’ll get an approval letter, and you also may get a card to use when you get health care services.
How do I know if I qualify
In addition to having limited income and resources, there are other requirements you’ll have to meet for your state. When you apply, you may be asked these questions to help determine your eligibility
- How old are you?
- Are you pregnant?
- Are you or is your child under the age of 19?* Or, are you the caretaker of a child with Medicaid?
- Are you disabled?
- Are you blind?
- Are you a U.S. citizen or an immigrant who meets certain requirements?
*In some states, the age to qualify as a child under Medicaid may be up to 21 for vertain coverage groups, like foster care children.
Note: You may qualify under Medicaid “spend down” rules even if your income in more than Medicaid income levels in your state.
What do I pay
What you pay for coverage depends on your state’s rules. You may have to pay a small part of your health care costs (like a copayment). If you qualify for both Medicare and Medicaid, most of your health care costs will be covered, and you’ll get extra help paying for prescription drugs through Medicare.
Medicaid generally covers:
- Inpatient hospital services
- Outpatient hospital services
- Pregnancy-related services
- Vaccines for children
- Medical and surgical services provided by a dentist
- Doctor services
- Prescriptions drugs
- Nursing facility services
- Family planning services and supplies
- Rural health clinnic (RHC) services
- Home health services
- Laboratory and X-ray services
- Pediatric and family nurse practitioner services
- Nurse-midwife services
- Federally-qualified health center (FQHC) services
- A board range of services for children under 21
- Necessary transportation to and from medical providers
Note: States can choose to cover more services than those listed above. Check with your State Medical Assistance (Medicaid) office for a list of what your state covers. Visit www.medicare.gov/contacts, or call 1-800-MEDICARE (1-800-633-4227) to get your state Medicaid office phone number. TTY users should call 1-877-486-2048. Visit www.medicaid.gove or www.healthcare.gov to learn about coverage options for you and your family.
What is 'spend down'
Even if your income exceeds Medicaid income levels in your state, you may be eligible under Medicaid “spend down” rules. Under the “spend down” process, some states allow you to become eligible for Medicaid as “medically needy,” even if you have too much income to qualify. This process allows you to “spend down,” or subtract, your medical expenses from your income to be eligible for Medicaid.
To be eligible as “medically needy,” you measurable resources (like savings accounts and certificate of deposits) also have to be under the resource amount allowed in your state. Call your state Medicaid office to see if you qualify and learn how to apply (see “Where can I get more information?”).
Know your rights
- If you’ve been denied Medicaid benefits and disagree and with decision, you may file an appeal.
- People with Medicaid have the right to have their health records kept private.
- The law requires Medicaid to cover and arrange for all medically-necessary, Medicaid-covered services to Medicaid-eligible children, even if the state’s Medicaid program wouldn’t normally cover the services.
Where can I get more information