What Is Medicaid?

What is Medicaid and how does it work? Give this article a thorough read to find out.

Medicaid offers health insurance to a vast majority of Americans, including qualified adults with a low salary, pregnant women, youngsters, old people and individuals with disabilities. As per government necessities, the Medicaid program is managed by states. This program is supported and financed mutually by states and the federal government. In addition to this, the Medicaid program is the primary source of long term health insurance for Americans. By far most Medicaid enrollees do not have access to other reasonable health care coverages too. Medicaid covers a wide exhibit of healthcare services and restricts out-of-pocket expenses for the enrollees.

Medicaid funds almost a fifth of all personal medical care spending in the U.S., giving important financing to clinics, doctors, nursing homes, community health centers and occupations in the medical care area. Title XIX of the Social Security Act and a huge committee of government guidelines administer the program, defining federal Medicaid necessities and state choices and specialists. The Centers for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS) is answerable for implementing Medicaid.

Medicaid is a state-worked program that gives clinical consideration inclusion to certain people with a low pay and families with restricted assets. It’s likewise a huge part of the medical care system in the United States: As of September 2018, almost 73 million individuals were signing up for Medicaid, and in 2017, the program represented 17% of public medical care uses.

Deciding if you’re qualified for Medicaid can be troublesome, not to mention figuring out what the program covers and how to apply. This article clarifies a portion of those points and addresses whether Medicaid might be a possibility for covering care-related costs for seniors. If you want to know more about what is Medicaid, then you have come to the right place. We have gathered all relevant information to help you figure out. So, what are you waiting for? Without much further ado, let us dive right in!

What is Medicaid?

The term Medicaid alludes to a general health care coverage program that gives medical care inclusion to families with a low salary and  families and kids, pregnant ladies, the old, and individuals with disabilities in the United States. The program is mutually subsidized by the federal government and individual states. It is worked at the state level which implies that inclusion and administration differ enormously from one state to another. In addition to this, Medicaid is only accessible to people and families who meet certain salary based requirements. Beneficiaries are U.S. residents, lasting inhabitants, or legitimate workers. Roughly 70.6 million individuals were covered by Medicaid as of September 2020.

The government gives a part of the financing for Medicaid and sets rules for the program. Moreover, Medicaid programs fluctuate from one state to another. They may likewise have various names, similar to “Clinical Assistance” or “Medi-Cal.” Medicaid assists these individuals in paying for the expenses that are related to clinical and long term custodial consideration. Children who need low cost care yet their families procure a lot to fit the bill for Medicaid, are covered through the Children’s Health Insurance Program (CHIP), which has its own arrangement of rules and necessities.

The Medicaid program has a few parts:

  • Clinical service through Medicaid incorporates most basic types of medical services. Medicaid health advantages cover similar medical care benefits as compared to Medicare, just as certain administrations that Medicare doesn’t cover. Medicaid may likewise pay Medicare charges, deductibles, and copayments for individuals who have signed up for the two projects.
  • A different piece of Medicaid covers long term nursing home care.
  • Special Medicaid-financed programs cover long term, in-home individual consideration. Salary and resource qualification rules for these long term, at-home consideration programs are generally significantly looser than for standard Medicaid programs.
  • In certain states, a Medicaid-related program can pay a portion of the expenses of helped living.

Understanding Medicaid

Medicaid was endorsed into law in 1965 by President Lyndon B. Johnson and approved by Title XIX of the Social Security Act, which likewise made Medicare. It is an administration supported protection program for people of all ages whose assets and pay are deficient to cover medical care. Medicaid doesn’t give medical services straightforwardly to people. All things considered, it covers their visits to the primary care physician, clinic stays, long term clinical consideration, custodial consideration, and other health related expenses.

Individual states settle on who fits the bill for inclusion, the sort of inclusion, and the way toward paying medical care laborers and clinics. That is on the grounds that each state is mindful to oversee and control its own Medicaid program. The government matches state spending and the matching rate differs by state from at least 50% to a limit of 83%. States are not needed to take part in Medicaid, albeit all states do.

The program is the biggest source of financing for health related administrations for low-pay people in the U.S. Complete Medicaid spending came to be almost $613.5 billion in 2019, representing 16% of the country’s medical care bill. The central government took care of 64.5% of the bill while singular states paid 35.6%. Medicaid inclusion has regularly incorporated the accompanying groups:

  • Low-pay children and their folks
  • Pregnant women
  • Individuals with disabilities
  • Adults over the time of 65

Qualification for Medicaid was extended to incorporate adults younger than 65, given their livelihoods fell under 133% of the federal poverty level (FPL), according to the Patient Protection and Affordable Care Act. Children represent 38% of enrollees with about 18% of the all out cost. By examination, individuals with handicaps represent 14% of enrollees with about 36% of all out costs.

How does Medicaid work?

When you meet all requirements for Medicaid, you’ll get a clinical card and advantages that you can similarly use as health care coverage inclusion through some other safety net provider. Deciding whether you’re eligible for Medicaid or not can be unpredictable. In the first place, people who are qualified for Medicaid inclusion may have it as their only healthcare insurance or related to another arrangement (counting Medicare). Government law necessitates that Medicaid be viewed as the “payer after all other options have run out.”

That doesn’t mean you can’t depend on Medicaid benefits in the event that you have them. What it implies is that Medicaid will pay after some other payer has paid a lot of the services given. For instance, on the off chance that you have Medicare or any kind of private medical services inclusion, Medicaid will consistently be the optional payer. Medical services suppliers will charge the essential payer first, and Medicaid will at that point think about the case and may pay any funds receivable after the essential payer has paid.

People who meet all requirements for Medicaid frequently don’t need to pay a month to month premium for the advantages, yet there are a few exemptions. In specific cases, on the off chance that somebody is accepting Social Security benefits, an ostensible derivation might be produced using those advantages, contingent upon all out assets and pay, to help supplement the expense of Medicaid inclusion.

Something else, the program gives 100% inclusion to most clinical costs and doesn’t need installment of expenses or deductibles. Moreover, medical care suppliers who acknowledge Medicaid can’t charge the patient for any extra charges after Medicaid has settled the case, as they can with Medicare. The lone special case for this is sometimes where state Medicaid plans cover “discretionary” clinical benefits that are not covered under Medicare.

A few people confound Supplemental Security Income (SSI) with Medicaid since individuals with SSI consequently have Medicaid. The reverse isn’t correct. SSI is governmentally subsidized by tax revenues. It is intended to help the matured, visually impaired, and debilitated who have practically no pay so they can meet their fundamental requirements for food, apparel, and shelter. Medicaid projects may likewise be different in each state. To discover precisely which Medicaid and Medicaid-related projects work in your state – including what they cover and who’s qualified – contact a neighborhood office of your state’s Medicaid program.

To track down a nearby Medicaid office, go to the government’s Benefits.gov site and pick your state from the dropdown menus. Additionally pick the “Medicaid and Medicare” subcategory. This will take you to a page with data about your state’s Medicaid program and contact data for neighborhood workplaces.

Apply for Medicaid

The Affordable Act gives states the alternative to extend their Medicaid program. Individuals with wages simply more than $16,000 can qualify in states that have expanded Medicaid. On the off chance that you figure out that you might be qualified for Medicaid, it’s a smart thought to apply. While the guidelines are not quite the same as state to express, the fundamental cycle for joining is comparable. You can apply for Medicaid through the Health Insurance Marketplace or directly with your state Medicaid organization. To apply through the Marketplace, visit the application site to make a Marketplace account and complete an application.

Go to Healthcare.gov

Healthcare.gov isn’t only for purchasing a private arrangement. You can likewise see whether you meet all requirements for Medicaid. You will be posed a progression of inquiries in regards to your month to month pay, your family size, and where you live. In view of your answers, healthcare.gov will tell you whether you may meet all requirements for Medicaid.

Fill out the application

Healthcare.gov will consequently divert you to your state’s site to begin an application in the event that your state is running its own Marketplace. Else, you can begin an application on healthcare.gov that will naturally be sent to your state’s Medicaid office for an assurance on whether you qualify. You can apply for Medicaid and CHIP any season, not simply during Marketplace Open Enrollment.

Collect the required documents

Your state should see some close to home and monetary data to ensure you are qualified. The particulars shift from one state to another. However, you may have to submit:

  • A tax bill for your home
  • A copy of your birth certificate
  • A pay stub to demonstrate the amount you earn
  • Bank statements
  • Your Social Security number
  • Other personal data

Double check the rundown to ensure you have all that you require. In the event that you have a disability, it can take more time to handle your application. You may need to hold as long as 90 days. You may likewise need to stand by longer in the event that you don’t get all the administrative work in on schedule. Attempt to give everything immediately. In the event that you don’t fulfill the time constraints or don’t give what is required, Medicaid may dismiss your application. At that point you’ll need to apply once more.

Medicaid eligibility

It mostly relies upon where you reside. Taking all things together states, you can qualify dependent on pay, family size and status, incapacity and different components that may shift by state. However, when the Affordable Care Act was authorized, states had the chance to grow Medicaid qualification dependent on pay alone, utilizing the norm of Modified Adjusted Gross Income (MAGI). With this framework, each state’s pay standard is set as a level of the government neediness level. Different necessities can incorporate citizenship, movement status, and state residency.

Certain gatherings of individuals getting Medicaid through another program additionally may in any case need to qualify under the old rules, and resource or asset tests are as yet required while applying for long haul senior consideration. Resource restrictions depend on whether the individual is single or hitched with an at-home companion. Meeting these impediments is the most troublesome standards while applying for Medicaid to cover long haul senior consideration.

Single, unmarried seniors looking for Medicaid inclusion to cover long haul care can’t have countable resources that surpass a specific sum. Furthermore, those people can’t have a pay that surpasses a predefined sum each month. Likewise, wedded people with an at-home mate can’t have consolidated countable resources that surpass a specific sum each month. Notwithstanding, the Medicaid candidate is permitted to keep a predefined measure of pay each month. Qualification for Medicaid shifts by state, yet candidates commonly should meet the entirety of the accompanying:

  • An occupant of the state in which you are applying, and
  • Whose monetary circumstance would be described as low pay or extremely low pay, and
  • A resident of the United States or certain certified non-residents, like legal lasting occupants.

Visit your state Medicaid page to see any extra alternatives for inclusion it might give, like cutoff points on age, pregnancy, or nurturing status.

What does Medicaid cover?

Each state’s Medicaid program covers fundamental clinical consideration in a similar way that Medicare Part A and Part B do. This incorporates:

  • Inpatient medical clinic care
  • Inpatient momentary talented nursing or recovery office care
  • Doctor services
  • Outpatient medical clinic or center consideration
  • Research center and X-ray services
  • Temporary home medical services (given by a home medical care organization)
  • Ambulance service
  • Doctor prescribed medications for individuals not covered by Medicare

For these essential administrations, neither Medicaid nor the medical services supplier may charge the patient any copayment. State Medicaid projects may decide to cover discretionary clinical benefits past those recorded previously. In the event that a state Medicaid program covers a discretionary clinical benefit, the patient might be charged a little co-payment. The discretionary inclusion offered and the copayments for each optional service differ from one state to another yet may include:

  • Eye assessments and glasses
  • Hearing tests and hearing aids
  • Dental care
  • Preventive screenings
  • Active recuperation (past what is offered under Medicare)
  • Non-crisis transportation to and from clinical treatment
  • Some physician endorsed drugs not covered by Medicare
  • Some nonprescription medications, including certain nutrients
  • Chiropractic care

What does Medicaid not cover?

Medicaid covers an expansive scope of clinical consideration, however the program by and large doesn’t cover certain things and administrations. For instance, Medicaid doesn’t take care of physician recommended drug costs. Be that as it may, the individuals who are qualified for Medicaid might have the option to get their expenses paid through Medicare Part D, Medicare’s physician recommended drug plan. The following are some extra medical care related costs not covered by Medicaid:

  • Normal or yearly physical checkups
  • Over-the-counter drug prescriptions or supplements
  • Custodial care, or help with day to day activities
  • Missed appointments
  • Dental services
  • Cosmetic surgeries
  • Clinical benefits given outside of the U.S.

More information on the administrations that are not covered by Medicare, together with some special cases for those rejections, can be found on the Medicare site. The Medicaid site incorporates a list of things and administrations all states should cover, just as a rundown of advantages that states may decide to cover or not cover.

Income allowed for Medicaid medical coverage

Medicaid inclusion is accessible just to individuals with low pay. Precisely how much pay is allowed relies upon the state where you reside. Altogether states, if your pay falls underneath the qualification standard for the government’s Supplemental Security Income program, known as SSI, you’re likewise qualified for Medicaid clinical service. Discover more on state-explicit pay limits.

This sum is about $770 each month in what’s known as “counted” pay. Yet, a lot of your actual pay probably won’t be counted toward this figure, so you ought to consider applying for Medicaid, regardless of whether your month to month pay is a lot higher. Notwithstanding, it is suggested you talk with a Medicaid planning professional before applying, should your pay surpass that sum.

In the event that either partner in a marriage applies for Medicaid, the pay of the two companions (if living respectively) is checked by Medicaid when choosing qualification. Likewise, if a Medicaid candidate gets free lodging and regular meals from family or companions, or has charges consistently paid for them, Medicaid may think about this as pay when choosing qualification.

In numerous states, Medicaid clinical consideration inclusion is additionally accessible to individuals whose pay is higher than the state’s Medicaid qualification level in the event that they likewise have normal clinical costs that aren’t paid by another program or protection. This class of individuals is known as “restoratively poor.” So on the off chance that you have any standard hospital expenses that aren’t covered by Medicare or other protection, you actually might be qualified for Medicaid inclusion, regardless of whether your pay is above and beyond the ordinary Medicaid limit. Once more, Medicaid arranging experts can be of help with the present circumstance.

Assets allowed for Medicaid medical coverage

An individual applying for Medicaid clinical service is permitted around $2,000, and a wedded couple living in a similar house can have $3,000 in real money, investment funds, or different resources, in addition to various different resources that are prohibited from Medicaid qualification rules. The genuine permitted sum can differ by state. Discover really in regards to state explicit data. Excluded resources include:

  • A house that the candidate lives in
  • A car, now and then restricted to a specific reasonable market resale esteem
  • Individual property and family merchandise for normal everyday use, here and there restricted to a specific reasonable market resale esteem
  • Wedding and wedding bands
  • Extra security with a complete assumed worth (money give up) of close to $1,500, and term disaster protection with no money give up esteem
  • Extraordinarily reserved memorial service and entombment asset of up to $1,500, in addition to an internment space

An individual who needs to apply for Medicaid clinical service can part with or move any measure of resources to qualify. Medicaid clinical service qualification doesn’t have any of the guidelines or punishments with respect to move of resources that apply to Medicaid nursing home inclusion.

Advantages of Medicaid

Medicaid has assisted with decreasing the quantity of individuals without health care coverage and the ACA has leveled further. In 2013, the prior year significant arrangements of the ACA went live, an expected 44 million individuals didn’t have health care coverage. By 2017, that number dropped down to 27.4 million.

Numerous Americans would be without health care coverage if Medicaid didn’t exist. This is so in light of the fact that low-pay people frequently don’t approach protection through their positions, and buying private medical coverage in the commercial center is just not reasonable. Medicaid has given admittance to medical services that has measurably shown upgrades in the general prosperity of people who in any case would not be covered for even straightforward specialist visits or medicine.

Medicaid benefits change by state, however the Federal government orders inclusion for an assortment of administrations, including:

  • Hospitalization
  • Lab administrations
  • X-rays
  • Doctor services
  • Family planning
  • Nursing services
  • Nursing office facilities
  • Home medical care for individuals qualified for nursing office facilities
  • Clinic treatment
  • Pediatric and family nurse professional administrations
  • Midwife services

Each state likewise has the choice of including extra advantages, like physician recommended drug inclusion, optometrist administrations, eyeglasses, clinical transportation, exercise based recuperation, prosthetic gadgets, and dental administrations. Medicaid is likewise regularly used to support long haul care, which isn’t covered by Medicare or by most private health care coverage approaches. Truth be told, Medicaid is the country’s biggest single wellspring of long haul care subsidizing, which regularly takes care of the expense of nursing offices for the individuals who exhaust their investment funds to pay for medical services and have no different way to pay for nursing care.

Medicare vs. Medicaid

Individuals regularly confound Medicare and Medicaid, yet the two projects are distinctive in various manners, including the following:

  • Government medical care is governmentally subsidized utilizing citizen dollars and is accessible to all people age 65 and more established, and to more youthful people who meet explicit handicap necessities. All seniors meet all requirements for Medicare inclusion, yet whether you pay for specific components of the inclusion relies upon how long you paid into the Medicare/Social Security framework through finance charges.
  • Medicaid is a governmentally supported program, which implies some administrative duty dollars go toward assisting states with subsidizing their projects. Be that as it may, the projects are worked at the state level, so certain components of each program might be unique.
  • Meeting all requirements for Medicaid did not depend on Social Security benefits or even age. Regardless of whether you fit the bill for the state-run inclusion relies upon your pay and assets.

On the off chance that somebody meets all requirements for both Medicare and Medicaid, Medicare covers the majority of that individual’s clinical benefits. However, there are various clinical benefits that Medicare doesn’t cover, and a state Medicaid program may cover those costs. Likewise, Medicare in some cases doesn’t take care of an individual’s doctor’s visit expenses totally, in any event, for covered administrations. Your cash based costs as a Medicare recipient can incorporate Medicare expenses, deductibles, and copayments, just as the expense of some doctor prescribed medications not covered by a Medicare Part D physician endorsed drug plan.

On the off chance that Medicare Part A or Part B covers a clinical benefit yet leaves some piece of the expense neglected, Medicaid will pay that additional sum for somebody who’s selected the two projects. Somebody with both Medicare and Medicaid should try out a Medicare Part D arrangement to get their physician recommended drugs covered, yet Medicaid may cover a few medications excluded from Medicare Part D plans.


Now that you have read this article, you know all about what is Medicaid. Remember that even after you are discovered to be qualified, Medicaid will audit your case routinely. You may need to submit more monetary data. On the off chance that your conditions change – for example, if your pay goes up – you may lose your Medicaid qualification. You may then have the option to purchase a private protection plan through your state’s commercial center regardless of whether it’s not during the yearly open enlistment time frame.

Charles Bains

Charles Bains

Charles Bains started his insurance career as a marketing intern before pounding the pavement as a commercial lines agent in Orlando, FL. As an industry journalist, his articles have appeared in a variety of trade publications. His insurance television career, short-lived but glorious, once saw him serve as the expert adviser on an insurance-themed infomercial (yes, you read that correctly). Having recently worked for various organizations, coupled with his broader insurance knowledge, Charles is able to understand our client’s needs and guide them accordingly. He is a gem for Insurance Noon as his wide area of expertise and experience have been beneficial in conducting further researches to come up with solutions and writing them in a manner which is easy for everyone including beginners to comprehend.

Leave a Reply