Medicaid is a state-controlled program for low-pay and handicapped U.S. residents and legal foreigners. Albeit numerous inclusion subtleties are dictated by individual states, each state should offer particular types of services, for example, specific doctor and hospital services. It is possible to be qualified for both Medicare and Medicaid. On the off chance that you figure you may qualify, you need to round out a Medicaid application. If you do qualify, Medicaid can help pay for your Medicare premiums, deductibles, or potentially coinsurance. Do you want to find out how to sign up for Medicaid? Well then, keep on reading!
Table of Contents
- 1 What is Medicaid?
- 2 Medicaid eligibility
- 3 Who qualifies for Medicaid?
- 3.1 Infants and Children
- 3.2 Children’s Health Insurance Program (CHIP)
- 3.3 Parents/Caretakers of Minor Children
- 3.4 Pregnant Women
- 3.5 Disabled Child Living at Home
- 3.6 Working Disabled
- 3.7 Aged, Blind or Disabled Receiving Supplemental Security Income (SSI)
- 3.8 Aged, Blind or Disabled Former Supplemental Security Income (SSI) Recipients
- 3.9 Aged, Blind or Disabled Residing in Nursing Facility or Participating in a Home and Community-Based Services (HCBS) Waiver Program
- 3.10 Emergency Services for Immigrants (who do not otherwise qualify for Medicaid)
- 4 How to sign up for Medicaid?
- 5 After the decision
- 6 Where do I go to apply for Medicaid?
- 7 What is the difference between Medicare and Medicaid?
- 8 Conclusion
What is Medicaid?
Medicaid in the United States is a government and state program that assists with medical services costs for certain individuals with restricted pay and resources. Medicaid additionally offers benefits not typically covered by Medicare, including nursing home care and personal care services. The fundamental distinction between the two programs is that Medicaid takes care of medical care costs for individuals with low wages, while Medicare gives health inclusion to the old. There are additionally dual health plans for individuals who have both Medicaid and Medicare. The Health Insurance Association of America portrays Medicaid as a federal insurance program for people of any age whose pay and assets are not enough to pay for medical care.
Medicaid is the biggest source of financing for clinical and health-related services for individuals with low pay in the United States, giving free health insurance to 74 million low-pay and disabled individuals (23% of Americans) starting from 2017, along with paying for half of all births in the US in 2019. It is a means program that is jointly financed by the state and federal governments and overseen by the states, with each state as of now having expansive elbowroom to figure out who is qualified for its execution of the program. As of 2017, the all-out yearly expense of Medicaid was simply more than $600 billion, of which the federal government contributed $375 billion and the states gave an extra $230 billion. States are not needed to take part in the program, albeit all have since 1982. By and large, Medicaid beneficiaries should be U.S. residents or qualified non-residents and may include low-pay adults, their children, and individuals with specific disabilities. Alongside Medicare, Tricare, and ChampVA, Medicaid is one of the four government-sponsored clinical protection programs in the United States. Medicaid, along with Medicare, is controlled by the U.S. Places for Medicare and Medicaid Services in Baltimore, Maryland.
The Patient Protection and Affordable Care Act (PPACA, or essentially ACA) fundamentally extended both qualification for and federal subsidizing of Medicaid. Under the law, all U.S. residents and qualified non-residents with income up to 138% of the federal poverty line, including adults without dependent kids, are equipped for coverage in any state that partook in the Medicaid program. Notwithstanding, the Supreme Court of the United States administered in National Federation of Independent Business v. Sebelius that states do not need to consent to this extension to keep on getting previously settled degrees of Medicaid funding, and a few states have decided to proceed with pre-ACA subsidizing levels and qualification principles.
The Affordable Care Act set up another technique for deciding income eligibility for Medicaid, which depends on Modified Adjusted Gross Income (MAGI). MAGI is utilized to decide financial eligibility for Medicaid, CHIP, premium tax credits, and cost-sharing reductions accessible through the health insurance marketplace. By utilizing one bunch of pay tallying rules and a single application across programs, the Affordable Care Act made it simpler for individuals to apply and select the proper program.
MAGI is the basis for deciding Medicaid pay eligibility for most youngsters, pregnant ladies, adults, and parents. The MAGI-based technique considers taxable income and tax filing connections to decide monetary eligibility for Medicaid. MAGI swapped the previous cycle for figuring Medicaid qualification, which depended on the strategies of the Aid to Families with Dependent Children program that finished in 1996. The MAGI-based philosophy does not take into account income disregards that differ by state or by eligibility group and does not consider a resource or asset test.
A few people are exempt from the MAGI-based pay checking rules, including those whose eligibility depends on visual impairment, disability, or age (65 and more established). Medicaid eligibility for people who are 65 or older, or who have a visual impairment or any disability, is usually decided through the income methodologies of the SSI program directed by the Social Security Administration (a few states, known as 209(b) states, utilize certain more prohibitive eligibility rules than SSI, but still generally apply SSI systems). Eligibility for the Medicare Savings Programs, through which Medicaid pays Medicare premiums, deductibles, or potentially coinsurance costs for recipients qualified for both the programs (frequently alluded to as dual eligible) is resolved through SSI methodologies.
Certain Medicaid eligibility groups do not need an assurance of income by the Medicaid organization. This coverage might be based on enrollment in another program, like SSI or the breast and cervical cancer treatment and prevention program. Kids for whom an adoption assistance agreement is essentially under title IV-E of the Social Security Act are automatically qualified. Young adults who meet the prerequisites for eligibility as a previous child care beneficiary are additionally qualified at any pay level.
To be qualified for Medicaid, people should likewise meet certain non-monetary eligibility models. Medicaid recipients for the most part should be residents of the state in which they are getting Medicaid. They should be either a citizen of the United States or certain certified non-citizens, like legal permanent residents. Likewise, some eligibility groups are restricted by age, or by pregnancy, or parenting status.
Effective Date of Coverage
When an individual is determined qualified for Medicaid, coverage will become effective either on the date of usage or the first day of the month of application. Advantages additionally might be concealed retroactively for up to 90 days preceding the month of application, if the individual had been qualified during that period, had the individual applied. Coverage for the most part stops toward the month’s end in which an individual no longer meets the prerequisites for eligibility.
Who qualifies for Medicaid?
You may be eligible for free or low-cost care through Medicaid, dependent on your income and family size. Medicaid provides health coverage for some low-income people, families, and children, pregnant women, the elderly, and people with disabilities, in all the states. In some states, the program covers all low-income adults below a specific income level. The following information has directly been taken from the official Medicaid website:
Infants and Children
- Covered group: infants and children
- Income limits: based on age, income, family size (refer to the MAGI income limit table)
- Age: up to 19 (0-18)
- Qualifications: Household income, tax filing status, and the relationships between household members must be considered in determining eligibility for each infant and child living in the home.
Children’s Health Insurance Program (CHIP)
- Covered group: uninsured children
- Income limits: based on age, the insured status of each child, family size, and family household income cannot exceed 209% of the federal poverty level (FPL) (refer to the MAGI income limit table)
- Age: up to 19 (0-18)
- Qualifications: A child must be determined ineligible for Medicaid before eligibility for CHIP can be considered. Children with current health insurance coverage at the time of application are not eligible for CHIP. The child’s age and family income factor into when a child may qualify for CHIP.
Parents/Caretakers of Minor Children
- Covered group: low-income parents, caretakers
- Income limits: not based on the FPL, (refer to the MAGI income limit table)
- Age: N/A
- Qualifications: Parents or caretakers must have children under age 18 living in the home, who are deprived of the support of one or both parents due to the disability of a parent, the death or continued absence of a parent, or have parent(s) who are unemployed or have very low income. Caretaker relatives must be within a certain degree of relationship to the children and have primary responsibility for children under age 18 in order to qualify. As a condition of eligibility, the adult must cooperate with child support enforcement requirements for each child deprived due to a parent’s continued absence from the home.
- Covered group: pregnant women
- Income limits: under 194% of the FPL, family size (refer to the MAGI income limit table)
- Age: N/A
- Qualifications: Pregnant women receive benefits two months postpartum and are automatically put on the family planning waiver for one year. Any child born to a Medicaid-eligible mother automatically gets Medicaid benefits until the infant reaches the age of one. The number of individuals within the family is increased by the number of babies expected when determining family size for Medicaid. Pregnant minors (under age 19) can qualify regardless of family income.
Disabled Child Living at Home
- Covered group: disabled children who require a level of care typically provided in a hospital or long term care facility
- Income limits: Only the child’s income and resources are considered. The limit is the current institutional maximum income limit and the resource limit is $2,000. For more information, view the Guidelines for Medicaid Eligibility for Disabled Child Living At Home brochure.
- Age: up to 19 years old (0-18)
- Qualifications: The child must be disabled and in need of an institutional level of care.
- Covered group: working disabled
- Income limits: income cannot exceed 250% of the federal poverty level and unearned income cannot exceed 135% of the federal poverty level. For more information, view the Guidelines for Persons Working and Disabled brochure.
- Age: no age restrictions, but individuals age 65 or over must be disabled
- Qualifications: The working disabled individual must work at least 40 hours per month. Those who earn more than 150% of the federal poverty level must pay a monthly premium to purchase Medicaid coverage.
Aged, Blind or Disabled Receiving Supplemental Security Income (SSI)
- Covered group: aged, blind or disabled (eligibility for this covered group is certified by the Social Security Administration
- Income limits: income limits change annually and are determined by the Social Security Administration. For more information, view the Guidelines for the Aged, Blind, and Disabled Receiving SSI or Former SSI Recipients brochure.
- Age: 65 or older; if under age 65 must be blind or disabled
- Qualifications: Individuals must be blind or disabled or age 65 or older. SSI recipients are automatically eligible for Medicaid.
Aged, Blind or Disabled Former Supplemental Security Income (SSI) Recipients
- Covered group: Certain Former SSI Recipients who lose SSI due to a qualifying event that permits Medicaid to continue. This category includes certain disabled adult children, widow(er)s within a certain age limit who do not have Medicare, and specific people who lose SSI because of a cost of living increase in their Social Security benefits. For more information, view the Guidelines for the Aged, Blind, and Disabled Receiving SSI or Former SSI Recipients brochure.
Aged, Blind or Disabled Residing in Nursing Facility or Participating in a Home and Community-Based Services (HCBS) Waiver Program
- Covered group: Aged 65 or over or under age 65 who are blind or disabled. The individual must be determined to be in need of a level of care that is provided by the nursing facility or HCBS waiver program.
- Income limits: monthly income that does not surpass 300% of the SSI Federal Benefit Rate. Individuals whose income surpasses the institutional limit may qualify, dependent on an Income Trust that obligates all income to the facility or to the Division of Medicaid. For HCBS waiver participants, income over the Medicaid limit is payable to the Division of Medicaid under the terms of an Income Trust. For more information, look at the Guidelines for Medicaid Eligibility for Aged, Blind, and Disabled Living in Nursing Facilities or Participating in a Home and Community Based Services Waiver Program brochure.
- Qualifications: Placement in a facility or HCBS waiver program should be medically required, and the individual should be income and resource eligible and should not have transferred assets within a five-year look back period and any later months in order to be eligible for Medicaid.
Emergency Services for Immigrants (who do not otherwise qualify for Medicaid)
- Covered group: non-qualified or undocumented immigrants
- Income limits: An immigrant must qualify for a covered group on all factors other than citizenship and immigration status. The income (and resource) limit for the covered group applies.
- Age: The age limit for the applicable covered group applies.
- Qualifications: Immigrants who have had an emergency medical service and who are determined eligible for a covered group, are covered solely for the date of service of the emergency.
How to sign up for Medicaid?
The Affordable Act provides states with the choice to expand their Medicaid program. Individuals with incomes just above $16,000 are eligible in states that have expanded Medicaid. If you think you may be eligible for Medicaid, it is a good idea to apply. Despite certain rules and guidelines being different in different states, the basic signing up process is very similar.
1. Go to Healthcare.gov
Healthcare.gov is not only for purchasing a private plan. You can likewise see whether you meet all requirements for Medicaid. You will be asked a few questions with respect to your monthly pay, your family size, and where you live. Depending on your answers, healthcare.gov will tell you whether you may meet all requirements for Medicaid.
2. Fill out the application.
In the event that your state is running its own Marketplace, healthcare.gov will consequently redirect you to your state’s site to begin an application. Else, you can begin an application on healthcare.gov that will automatically be sent to your state’s Medicaid office for assurance on whether you qualify. You can apply for Medicaid and CHIP any season, not simply during Marketplace Open Enrollment. You can download and print the form from your state’s Medicaid site. Moreover, you can likewise get it via the post office by calling 877-267-2323.
3. Gather documentation.
Your state will require some personal and financial information to ensure that you qualify. The specifics vary from state to state. But you might need to submit:
- Evidence of age (birth certificate or driver’s license).
- Evidence of all income sources (pay stubs or tax return, Social Security, Supplemental Security Income, Veteran’s benefits, retirement accounts, and any other income).
- Evidence of assets and other resources: include copies of bank statements or other financial resources if directed on your Medicaid application.
- Evidence of citizenship or foreign status.
- Evidence of other insurance: include a copy of your red, white, and blue Medicare card (or other insurance ID card) with your Medicaid application. Remember that state applications and instructions may vary. Check your state’s Medicaid application website to see if they ask for additional documentation.
- Evidence of residence (rent receipts or landlord statements, a copy of your mortgage, recent mail addressed to you at your current address): make copies to include with your application.
- Evidence of your disability: if you think you are eligible because you are disabled, you will need to include documentation as specified in your Medicaid application.
Remember to check twice to ensure you have everything you need. If you are disabled, your application process can take longer (up to 90 days). It can take even more time if you do not get all the paperwork in on time. Try to provide everything promptly. If you do not meet the deadlines or do not give what is needed, your application may be rejected by Medicaid. Then you will have to apply all over again.
4. Submit your Medicaid application.
Adhere to your state’s guidelines for submitting your application. Medicaid application choices may incorporate paper applications, online application entries, and also in-person applications at your nearby Medicaid office. States should react to customary Medicaid applications in 45 days (up to 90 days for disability applications). In the event that your Medicaid application is not approved, you have the right to appeal. On the off chance that your Medicaid application was turned down for missing data or documentation, get whatever is required and adhere to the guidelines on the denial letter to resubmit the application. In the event that you feel the disavowal of your application is inaccurate, give documentation to demonstrate otherwise. Your rights for appeal will be illustrated in your Medicaid application denial letter.
After the decision
If you are denied
A letter will be sent to you by Medicaid explaining why you have been denied. If you disagree, the letter will also mention how you can appeal the decision.
If you are found to be eligible
You’ll get a letter revealing to you when your inclusion begins. You may need to pick a Medicaid health plan immediately if your state utilizes private plans to give benefits. In the event that you do not pick a health plan in a certain time period, you will be allotted one. So in the event that you have a doctor or clinic, you like to utilize, ensure you pick a health plan with it in the network. When you pick one, you will get an ID card from the health plan. In certain states, you will likewise get a different Medicaid card. To utilize your Medicaid benefits, consistently carry the two cards with you and use them while paying for health care, for example, for meds or regular checkups. Check to ensure your PCP, hospital, and pharmacy acknowledge Medicaid or are in your Medicaid health plan’s network prior to making appointments or getting prescriptions.
Remember that even after you are found to be qualified, Medicaid will keep on checking your case routinely. You may need to submit more financial data. On the off chance that your conditions change – for example, if your pay goes up – you may lose your Medicaid eligibility. You may then have the option to purchase a private insurance plan through your state’s marketplace, regardless of whether it is anything but during the yearly open enrollment time frame.
Where do I go to apply for Medicaid?
You can apply for Medicaid via the Health Insurance Marketplace or directly with your state Medicaid agency. To apply through the Marketplace, you would first have to go through the application website to create a Marketplace account and complete an application.
What is the difference between Medicare and Medicaid?
Medicare is an approach intended for U.S. residents age 65 and more who experience issues covering the costs identified with clinical care and medicines. This program offers help to senior residents and their families who need financial help for medical requirements. Individuals younger than 65 living with specific disabilities may likewise be qualified for Medicare benefits. Each case is assessed dependent on eligibility necessities and the subtleties of the program. Those in the last phase of kidney disorders can likewise apply for the benefits of a Medicare strategy. There are two principal parts of Medicare to look over — Original Medicare and Medicare Advantage.
Original Medicare is a federally backed medical insurance option that many older Americans use as their primary insurance. It covers:
- Inpatient hospital services (Medicare Part A). These advantages include coverage for visits to the hospital, hospice care, and limited skilled nursing facility care, and at-home healthcare.
- Outpatient medical services (Medicare Part B). These advantages include coverage for preventive, diagnostic, and treatment services for health conditions.
Medicare Advantage (Part C) is an insurance option for individuals who need the inclusion of original Medicare yet with more inclusion choices. Medicare Advantage plans are offered through private insurance agencies. Large numbers of these plans cover services like prescription drug inclusion, dental, vision, and hearing aid that are excluded from original Medicare.
Medicaid is a program that joins the efforts of the U.S. state and federal governments to help families in low-pay groups with healthcare costs. These expenses may incorporate critical hospitalizations and therapies, along with standard clinical consideration. The program offers services to a huge number of adults, youngsters, and individuals with disabilities every year. In November 2020, 72,204,587 people were taken on Medicaid, and 6,695,834 youngsters were enrolled in the Children’s Health Insurance Program (CHIP).
Individuals who fit the bill for both Medicare and Medicaid are considered dual eligible. For this situation, you may have Original Medicare (parts A and B) or a Medicare Advantage plan (Part C), and Medicare will cover your prescription drugs under Part D. Medicaid may likewise cover other consideration and medications that Medicare does not, so having both will presumably cover the greater part of your healthcare costs.
Regardless of your state, you may fit the bill for Medicaid dependent on your pay, family size, disability, family status, and other elements. However, on the off chance that your state has expanded Medicaid inclusion, you can qualify dependent on your pay alone.
You should round out another Medicaid application each year to remain in the Medicaid program. The Medicaid application process might be simpler for you every passing year. For instance, on the off chance that they as of now have your birth certificate on record, they may not request it again with your next application. Nonetheless, information, for example, your pay or foreign status may change from one year to another, so you will be approached to give an update each time you renew your Medicaid application.
Research shows that Medicaid improves health results, health insurance inclusion, admittance to health care, beneficiaries’ financial security, along with providing financial benefits to states and health suppliers.