All about Medicaid

What is Medicaid?

Medicaid is a joint federal and state program that allows Americans to receive free or low-cost health insurance. Together with the Children’s Health Insurance Program (CHIP), over 72.5 million people including children, seniors, parents, pregnant women, and those with disabilities, are receiving health coverage through this program.

Who is eligible for Medicaid?

Eligibility is partly dependent on whether your state has expanded its program.

• In all states, you can qualify based on income, household size, disability, family status, and other factors.
• In states that have expanded coverage, you can qualify based on your income alone. If your household is below 138% of the Federal Poverty Level (FPL), you qualify.

Even if your state hasn’t expanded coverage, and your income is below the level to qualify for financial aid with a Marketplace plan, you should complete a Marketplace application.

Should I apply for Medicaid?

Before you apply, we recommend browsing individual or family Affordable Care Act (ACA) plans through W3LL to see if you are eligible for a subsidy. If you qualify, you can enroll in coverage for little to no cost!

In states that are expanding Medicaid, tax credit eligibility ranges from 138% to 400% of the FPL.

In states that are not expanding Medicaid, tax credit eligibility ranges from 100% to 400% of the FPL.

If you are not eligible for subsidized Marketplace coverage, don’t stress – almost everyone with incomes below 138% of poverty are eligible for Medicaid.

How can I apply for Medicaid?

You can apply through the Health Insurance Marketplace directly or with your state Medicaid agency, depending on the state.

What is covered by Medicaid?

Medicaid covers a wide array of mandatory benefits, which states are required to provide under federal law. These are:

• Inpatient hospital services
• Outpatient hospital services
• EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
• Nursing Facility Services
• Home health services
• Physician services
• Rural health clinic services
• Federally qualified health center services
• Laboratory and X-ray services
• Family planning services
• Nurse Midwife services
• Certified Pediatric and Family Nurse Practitioner services
• Freestanding Birth Center services (when licensed or otherwise recognized by the state)
• Transportation to medical care
• Tobacco cessation counseling for pregnant women

States can also choose to offer optional benefits as well, including:

• Prescription Drugs
• Clinic services
• Physical therapy
• Occupational therapy
• Speech, hearing and language disorder services
• Respiratory care services
• Other diagnostic, screening, preventive and rehabilitative services
• Podiatry services
• Optometry services
• Dental Services
• Dentures
• Prosthetics
• Eyeglasses

What’s the difference between Medicaid and Medicare?

Medicaid serves low-income individuals of all ages by providing health coverage at little to no cost. It is jointly funded by the federal government and each state and is administered by each state’s own Medicaid office.

Medicare is a health insurance program for people age 65 or older, and those under 65 with certain disabilities. This program is paid for by a trust that enrollees pay into throughout their adult lives and is the same no matter where in the U.S. you live.

Sources:

https://www.medicaid.gov/medicaid/eligibility/index.html

https://www.medicaid.gov/medicaid-and-you/index.html

https://www.hhs.gov/answers/medicare-and-medicaid/who-is-eligible-for-medicaid/index.html

https://www.benefits.gov/benefit/606#Eligibility_Checker

https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/