Medicaid was first established in 1965, and since then it has undergone numerous modifications and expansions. Even since then, it continues to be one of the healthcare industry’s least understood subjects.
Medicaid is often misunderstood as Medicare, especially with the government health insurance program for those over 65.
Did you know that over 80% of the US population can qualify for Medicaid? Due to the ACA’s Medicaid expansion, 13 million people are now qualified to receive financial aid for medical care.
We are here to give every bit of detail on the Medicaid program, what it does, who it is for, and what it might mean for you.
Let’s get started with..
What is Medicaid?
Medicaid is a joint federal-state program that provides medical insurance to those who qualify.
Despite federal regulations, individual states are responsible for administering their own Medicaid programs.
A significant portion of their Medicaid costs are also covered by the federal government.
Each state develops and administers its own Medicaid program to serve its citizens who qualify for the program, in accordance with federal guidelines.
The federal government mandates a minimum level of service provision, but states have the option of providing more extensive care and/or covering more residents.
For those who meet the program’s financial requirements, Medicaid can provide access to affordable health care to them.
Let’s Learn More About Medicaid :-
Each state sets its own policies regarding who is eligible for health insurance, the types of plans available, and how providers like doctors and hospitals are compensated.
This is due to the fact that Medicaid management and administration resides solely within the purview of each individual state.
The facts state that a minimum of 50% of state spending is matched by the federal government, with some states receiving as much as 83%.
While every state offers Medicaid, participation is voluntary.
Why is Medicaid a good option?
In addition to the Affordable Care Act, Medicaid has contributed to a decrease in the percentage of Americans who lack health insurance.
In 2013, before the ACA took effect, 44 million people lacked health insurance.
As of 2017, the figure had fallen to 27.4 million.16
If not for Medicaid, many people in the United States would go without health coverage.
This is because people with low incomes are less likely to have access to health insurance through their employers, and they also have a harder time affording private health insurance in the open market.
Medicaid has allowed many people who would not have been able to afford even basic medical care (such as regular doctor’s visits or medication) to receive treatment, which has statistically been shown to improve their health as a whole.
Who Is Eligible For Medicaid?
Depending on your income and the number of people in your family, Medicaid may cover all or part of your medical expenses.
Medicaid is a federal program that each state participates in to help cover medical costs for low-income families and individuals, including those who are pregnant, over the age of 65, or have a disability.
All adults with incomes below a certain threshold are eligible for the program in some states.
- Before anything else, you should research whether or not Medicaid has been proposed in your state.
- The chart you’ll find below can help you determine your potential Medicaid eligibility based on your state’s expansion policies and your family’s income.
You may now be eligible for Medicaid even if you were previously told that you did not meet the requirements.
There are two ways to check if you are eligible for Medicaid :-
- Look up at the Medicaid page for your state online. Select your state from the menu at the top of the page. Seeing if you are eligible to apply is as easy as filling out the form below. You may be eligible for immediate coverage.
- Go to the Health Insurance Marketplace and fill out an application.
Who Does Medicaid Serve?
Medicaid programmes target specific demographics, such as:
- Women in poverty who are expecting a child
- Children from low-income families
- Children in need of foster care
- Individuals with Disabilities
- Seniors living on a tight budget
- Parents or caregivers with limited financial resources
States have the option of extending eligibility to groups like low-income individuals who may or may not be parents.
How To Apply For Medicaid?
To apply for Medicaid as an adult, contact your local HCS office or apply online through the state’s website.
The application procedure consists of three main stage :-
- Application submission
- Expenses and income will be analyzed to figure out how much help you can get.
- Eligibility for medical services is dependent on the results of a personal care needs assessment.
You Can Submit An Application In Person Or Through The Mail
Get a Long-Term Care/Medicaid for old, blind and physically disabled, Blind, and Disabled Coverage by calling or visiting your neighborhood HCS office.
You can also get this form by visiting the Health Care Authority’s website.
Submit An Online Application
Look for an online resource for enrolling in a long-term care plan. Please state that you are requesting information about long-term care services.
Important Details You Need To Know
The following are examples of required details :-
- A number assigned by the Social Security Administration.
- Mandatory proof of identity.
- Income verification.
- Information on available assets such as bank statements, property tax statements, life insurance).
- Legal proof of immigration or non-citizenship.
- Documentation of citizenship status if applying for federal healthcare programs like Medicare or SSI is required (SSI).
- Reference materials for the long-term care insurance application procedure.
What Does Medicaid Cover?
When it comes to medical care, Medicaid has you covered from head to toe. This includes visits to the doctor, hospital stays, nursing home care, and even home health aid.
Medicaid serves the purpose of helping people with their medical costs who don’t make a big living and to qualify for the same, an individual must make 133% less than the federal poverty line.
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Being said that, Medicaid covers the following care services listed..
What Care Services Are Covered By Medicaid?
Each state determines Medicaid benefits.
Some services are considered “mandatory benefits” because they are mandated by federal law and must be provided by the states.
Additional Medicaid benefits and services may be provided at the discretion of individual states. Optional advantages are what the name implies.
In the list below, you can see which Medicaid benefits are required by law and which ones are up for debate.
Government-Mandated Medicaid Covers
- Care for hospitalized patients
- Medical care provided to people outside of hospitals
- Services for early and routine diagnosis and treatment
- Rehabilitation Centre Services
- In-home medical care
- The Assistance of a Medical Doctor
- Medical care for those living in rural areas
- Healthcare provided by a clinic recognized by the federal government
- Medical testing and imaging facilities
- Planned Parenthood and Related Services
- Medical care during childbirth provided by a nurse
- Services provided by licensed pediatricians and nurse practitioners
- Access to a dedicated maternity care facility (when licensed or otherwise recognized by the state)
- Transportation to a healthcare facility
- Counselling to help pregnant women quit smoking
Medicaid Benefits That Are Not Mandatory
- Treatments that require a doctor’s prescription
- Services provided by a clinic
- The Benefits of Physical Therapy
- Rehabilitative measures in the form of occupation
- Treatment for Communication Disabilities
- Care for the respiratory system
- Alternative medical evaluations, tests, and therapy
- Services related to the feet and ankles (podiatry)
- Professional care for eyes
- Dental care paid for by Medicaid
- Prosthetics Dentures
- Care based on chiropractic techniques.
- Alternative medical care
- Home health care providers
- Individual attention
- Clinical management
- Care for the elderly in psychiatric hospitals
- Intermediate care for people with intellectual disabilities, including the provision of related services.
- Access to Community-Based Services under the State’s 1915 Home and Community-Based Services Plan (i).
- Aid for Tuberculosis
- Adolescent and young adult inpatient psychiatric care.
- Services provided at a religious nonmedical health care facility, emergency hospital services by a non-Medicare certified hospital, and critical access hospital services are also authorized (CAH).
- Chronically Ill Members’ Primary Care Providers (Health Homes) under Section 1945.
What Is The Maximum Income For A Single Person To Get Medicaid?
An individual’s monthly income cannot exceed $861 or a couple’s monthly income cannot exceed $1,281 in order to qualify for Medicaid through SSI.
Furthermore, there are constraints on the available resources.
If you’re single, your monthly income cannot be more than $2,000, and if you’re married, it cannot be more than $3,000.
Waivers For Treatment In The Patient’s Home Or Community
Here are the maximum annual incomes that qualify for these exemptions : –
- The monthly fee for receiving a waiver due to Old or disability is $2,523.
- The monthly cost of receiving an ILW is $2,523.
- Financial assistance for people with intellectual disabilities is $2,523.
- The cost of the Adult Technology Assisted Waiver Program is $2,523.
- The monthly monetary allowance for these exemptions is $2,000.
How Do I Check My Medicaid Status?
The federal government funds the programme, but the states run it.
You need to meet certain requirements, such as a certain age, income level, or disability status, in order to qualify.
There is a 90-day waiting period after submitting an application for Medicaid before a decision is made by the state agency.
In the meantime, you can contact your local Medicaid office, look up their contact information online, or check your account status via phone.
Getting Access To Your Online Account
You can use your state’s Medicaid website to manage your account or check your status even if you applied for Medicaid over the phone or in person.
To sign up for Medicaid in your state, visit the Medicaid website for your state and look for the “Register” or “Sign Up” button.
If you create an account on a website, soon afterward the site will ask you to confirm your email address by sending you a confirmation email.
To confirm your email address, open the message in your inbox and click the provided link. After that, you’ll be prompted to sign in.
Getting In Touch With The Medicaid Office In Your State
Your identity must be confirmed by the caseworker before you can have any further communication about your application.
In some jurisdictions, you may be asked to provide the case number associated with your application.
In some jurisdictions, you won’t get a case number until after the state has made a final decision on your eligibility.
Additional information for identity verification may be requested, such as the last four digits of your SSN.
Visiting A Local Medicaid Office
It is necessary for a caseworker to confirm your identity before proceeding with our conversation about your application.
In some states, you’ll need to provide the application case number.
In some jurisdictions, you won’t get a case number until after the state has made a final decision on your eligibility.
The last four digits of your Social Security number, among other pieces of information, may be required to confirm your identity.
What Is The Difference Between Medicare And Medicaid?
There are some significant differences between Medicare and Medicaid : –
- Medicaid is a government health insurance programme for low-income families and individuals.
- Medicaid is a federal programme, but individual states are responsible for administering it.
- Medicaid is available to people of all ages. Children, families, pregnant women, people with disabilities, and the elderly may all be eligible for Medicaid’s wide range of benefits.
- If you are 65 or older, or have certain health problems, you may be eligible for Medicare, a government health insurance programme.
- An individual’s or a spouse’s employment history is used to determine eligibility.
- They may be eligible for low- or no-cost hospital insurance, and they must pay a premium for comprehensive medical and pharmaceutical coverage.
- One does not need to meet any kind of income requirement in order to be eligible for Medicare.
How Do I Qualify For Dual Medicare And Medicaid?
To be “dual eligible” means to be eligible for both Medicare and Medicaid, which may help pay for the majority of your medical bills.
Many Medicare plans have unique options for people who are eligible for both Medicare and Medicaid.
Dual Special Needs Plans are one such example (D-SNP).
A person must meet dual coverage requirements (either partial or full) in order to receive both Medicare and Medicaid benefits.
Individuals who receive Medicaid assistance may be eligible for partial dual coverage.
Different types of coverage might include : –
- Paid-in-full Part A Premium (if applicable)
- Insurance premium for Medicare Part B
Full-dual enrollees may receive all of the benefits for which partial-dual enrollees are eligible, as well as additional benefits, such as long-term care services.
Medicaid’s eligibility criteria vary by programme and are tied to the beneficiary’s FPL.
Helping people afford their medications is one such programme.
What Is A Dual Specific Needs Plan (D-SNP)?
Medicare Advantage (MA) plans known as Dual Special Needs Plans (D-SNPs) offer care coordination and wrap-around services, as well as specialized medical treatment, to people who are eligible for both Medicare and Medi-Cal.
Eligibility categories are not standardized across states, so some states may have different minimum requirements than those listed here.
Please visit the Medicaid website for more details on the various types of Medicaid eligibility.
How To Find A Doctor That Accepts Medicaid?
The Centers for Medicare & Medicaid Services is a good resource for finding a doctor who accepts Medicaid patients and their insurance.
You can search by a doctor’s last name or group practice name, medical specialty, condition, body part, or organ system.
If you enter a specialty and location on a tool, it will provide a list of professionals or group practices offering that service, complete with informational profiles, maps, and directions to their offices.
The only doctors who are included in the List are those who are Medicaid-approved.
Medicaid is a federal programme, but each state administers its own programme and keeps its own registry of providers who accept Medicaid.
If you need more information, call or visit the office of your health insurance provider or the state agency in charge of Medicaid in your area.
Medicaid Look Back Period
Financial records of Medicaid applicants are only looked at for a limited time period.
Although the Medicaid eligibility rules vary from state to state, the applicants for long-term care benefits must have no more than $2,000 in assets and their financial history must go back at least five years (60 months) from the date of the application.
Read also, How Can You Avoid Medicaid Look Back Period For 5 To 7 Years?
Medicaid has a look-back period of 5 years (except in California, where it’s only 30 months).
The number and recipients of an applicant’s gifts during the review period are irrelevant (with certain exceptions discussed later on).
A penalty period of Medicaid ineligibility will be incurred if a senior’s money or assets changed hands for less than FMV within the five years prior to the application date.