Medicaid Basics – requirements and benefits
Medicaid is a state and federal program that provides financial assistance with healthcare costs for low-income individuals and families. Started in 1965, Medicaid enables many U.S. citizens to access healthcare that they would not be able to afford otherwise. Each state has a Medicaid program that is typically administered by the state’s Department of Health and Human Services. Some states have their own names for their Medicaid programs, such as MaineCare in Maine and California’s Medi-Cal.
Medicaid is a “means tested” program, primarily income based, and often tied to the federal poverty level, or FPL. The federal government sets broad parameters and each state determines its own specific guidelines for qualification. Because the programs are state managed, the income level to qualify in one state may be higher than that in a neighboring state. In addition to income, most states look at assets and other household resources to determine eligibility for Medicaid.
Having limited income and resources is necessary for Medicaid eligibility, but applicants must also fall into one of the target groups in order to qualify. Eligible groups include children, pregnant women, parents of eligible children, disabled individuals, people with certain medical conditions, the elderly, and nursing home residents. States have specific Medicaid programs for each of these groups and U.S. citizenship is not necessarily required for Medicaid eligibility.
Spend-Down is a Medicaid program that allows certain people whose income and assets are too high to qualify for Medicaid to obtain assistance in paying for their medical costs. These are individuals who have healthcare costs that are so high that they cannot easily pay all of their expenses. The same groups that qualify for Medicaid can also apply for the Medicaid Spend-Down program, including pregnant women, the elderly, children, and disabled individuals. The program is not available to single adults or childless couples.
Medicaid allows beneficiaries to obtain medical, dental and hospital or clinic services of most kinds, including prescription medications. In some cases the services will be provided entirely free of charge, but beneficiaries in some states may pay a small co-pay for services used. Benefits are provided either through a managed care network or through a fee-for-service program. In both cases, Medicaid recipients are given a list of participating practitioners. More detailed information on Medicaid qualification and benefits can be found at the Centers for Medicare and Medicaid Services website, where there are links to each state’s program – link.