6 Things to Know About Medicaid

The federal government created Medicaid to provide health coverage to millions of low-income Americans. The main difference between Medicare vs. Medicaid is that the latter provides health care to qualifying individuals of all ages and not just seniors. Even though this is a federal program, states oversee distributing benefits to eligible applicants. For this reason, the program receives funds from the federal government and the states.

Federal guidelines also require states’ Medicaid programs to cover certain groups of individuals. Medicaid eligibility for low-income families or beneficiaries of Supplemental Security Income are some examples of mandatory eligibility groups according to federal guidelines. Some states may also offer automatic coverage to specific groups. As such, this and other eligibility requirements vary in each state, while some stay fixed and abide by federal rules.

You can learn more about Medicaid, the program’s eligibility requirements and how to apply and find a service center by reading the information below.

What is Medicaid?

The federal government authorized Medicaid in 1965 along with Medicare to serve and provide health coverage to millions of families, children, seniors and people with disabilities. While Medicaid eligibility contains mostly income requirements, people that apply for benefits under this program must also meet other requirements. Moreover, the health care program also serves as an extension of services of Medicare, as it covers some services that Medicare does not include or covers just partially.

People who qualify for Medicare and Medicaid may fall under the category of dual eligibility. This group of applicants is most likely to receive coverage for the entirety of their health care expenses. Some of the services that the program covers include:

  • Nursing home care.
  • Home-based services.
  • Community-based services.
  • Personal care.

Individuals should apply for Medicaid if they or a loved one requires health care of any kind. Each state has qualified caseworkers to help candidates determine their eligibility for care benefits under the program.

2. Learn About Medicaid Requirements

Eligibility requirements for Medicaid vary from state to state and follow federal guidelines. Medicaid eligibility guidelines expanded after the Affordable Care Act, providing coverage to nearly all applicants younger than 65 years of age. States distribute the program’s benefits to applicants based on their income level against the Federal Poverty Line (FPL). 

Currently, the program offers coverage to children meeting at least 133 percent of the FPL, and some states even offer higher coverage. For adults, states have the option of covering applicants with incomes at or below 133 percent of the FPL.

Moreover, to determine Medicaid eligibility, states use the Modified Adjusted Gross Income (MAGI) to establish a candidate’s financial qualifications that enable them to receive benefits. Medicaid income limits are set based on information regarding an applicant’s taxable income and filing relationships to verify the eligibility of possible beneficiaries. The technique also excludes an asset or resource test present in previous eligibility requirements. Some candidates that apply for Medicaid might not need to satisfy the MAGI requirements due to a current disability or having senior status. 

On the other hand, applicants must also meet Medicaid eligibility requirements that are non-financial. Some non-financial requirements include residency requirements such as being a resident of the state in which one is applying in. Furthermore, applicants must also be citizens or qualifying noncitizens to apply for benefits.

Some eligibility groups may also follow an age requirement, parenting status, or pregnancy. Applicants in the following categories might be eligible for Medicaid:

  • Applicants younger than 19 years of age or of 65 years of age or older
  • Pregnant applicants
  • Disabled applicants
  • Adults without dependent children
  • Eligible immigrants

3. How to Apply for Medicaid

Applicants should check if they qualify for benefits before applying for Medicaid, but they should still apply even if they are unsure if they are eligible. Essential Medicaid eligibility requisites that applicants must have in mind include the following:

  • Age
  • Family size 
  • Income levels

Once an applicant has gone over these requirements, he or she can apply for Medicaid and make sure to have the necessary information at hand at the time of applying. Applicants can complete the Medicaid application by contacting their local benefits office. They can also fill out an application through the health insurance marketplace of their state. 

When an applicant completes his or her Medicaid application and submits all the necessary documents and information, he or she will receive a notice regarding his or her benefit eligibility. Applicants must fill out a new Medicaid application every year to stay in the program. 

Appeals to the Medicaid Application

Medicaid applicants can also file an appeal in case the agency denies their application for benefits. However, each state has a different system to handle Medicaid application appeals and might delegate the, to the Exchange Appeals Entity. In some instances, other state agencies might process an applicant’s request depending on his or her specific situation.

4. About Medicaid Benefits

The benefits in the Medicaid program fall into two main categories that are mandatory benefits and optional benefits. The federal law that provides the Medicaid definition and eligibility guidelines also include a list of mandatory benefits. As for the optional benefits, federal law allows each state to provide coverage for benefits under this category. Some significant mandatory Medicaid benefits include:

  • Inpatient and outpatient hospital care.
  • Laboratory and X-ray services.
  • Transportation to medical care.
  • Family planning services.
  • Home health services.
  • Physician services.

On the other hand, optional benefits under the program that some states might provide coverage to include but are not limited to:

  • Occupational therapy.
  • Clinic services.
  • Personal care.
  • Hospice.
  • Physical services.
  • Dental, podiatry and optometry services.

5. How to Access to Medicaid Benefits

There is a Medicaid location in every state. The Centers for Medicare and Medicaid Services (CMS) are also in charge of providing health coverage of the program’s beneficiaries. The CMS offers essential information, materials and different resources to help applicants and recipients learn about their benefits and have proper access to care.

6. Learn About Additional Resources on the Medicaid Application

Besides the application, the Medicaid website offers additional information on “how to apply for Medicaid” to guide individuals through the process. Information on the Medicaid application is also available in person at a Medicaid service office and other welfare program locations.  Every state has a benefits location where applicants can apply, file a complaint and obtain additional information.