1   What Is Medicaid?

Medicaid is a health program for United States residents with low income. Medicaid is funded by the federal and state governments. Each state is responsible for the implementation of Medicaid services. The Medicaid program law was passed in 1965.

 2   Who Is Eligible for Medicaid?

State and federal law have established eligibility requirements for Medicaid recipients. You are eligible for Medicaid if you meet certain requirements having to do with:

-- your age. 
-- whether you are disabled.
-- whether you are blind.
-- whether you are elderly.
-- the amount of your income and assets.
-- whether you are a U.S. citizen or legal immigrant.

Income requirements are determined by state Medicaid programs, and may vary from state to state. States have some latitude in determining who is eligible for state Medicaid programs. State Medicaid programs that receive federal funding use the following eligibility requirements:

-- Individuals who are eligible for Aid to Families with Dependent Children (AFDC) are usually eligible for Medicaid.
-- Children under six years old with family income at or below 133% of the federal poverty level are eligible for Medicaid.
-- Women who are pregnant and whose family income is below 133% of the federal poverty level are eligible for some Medicaid services.
-- People who receive Supplemental Security Income (SSI), in many states, are eligible for Medicaid. 
-- People who receive adoption or foster care assistance (by means of Title IV of the Social Security Act) are eligible for Medicaid services.
-- People who may lose assistance from other programs (if earnings increase or Social Security benefits increase) may be temporarily eligible for Medicaid. 
-- Any child who was born after September 30, 1983, who is nineteen years old or younger, and whose family has income at or below the Federal Poverty Level is eligible for Medicaid. 
-- Certain other beneficiaries, as defined by the federal and state Medicaid legislation, may be eligible for Medicaid.

 3   What Does Medicaid Cover?

Medicaid services that are federally funded are required to offer the following services: 

-- Inpatient and outpatient hospital care 
-- Prenatal services
-- Children’s vaccines
-- Physician services
-- Nursing facility care 
-- Family planning assistance
-- Home health care for eligible persons
-- Lab and x-ray work
-- Pediatric and family nurse practitioner assistance
-- Services from a federally qualified health center, or ambulatory services from such health centers
-- Screening, diagnostic, and treatment services for those who are under age 21

If federal funding is available for state Medicaid programs to offer additional services, the following optional services may also be offered: 

-- Diagnostic services
-- Services at a clinic
-- Coverage at care facilities for the mentally disabled
-- Drugs and prosthetics that have been prescribed
-- Nursing facility services if needed for children under 21 years old
-- Transportation services
-- Rehabilitation and physical therapy
-- Home or community care for those with certain chronic impairments

State Medicaid programs have the latitude to determine the amount of Medicaid services, under broad federal guidelines.

 4   Is My Child Eligible for Medicaid?

Your child’s eligibility for Medicaid is determined by whether the child meets Medicaid criteria, not by whether you meet the criteria. See more about this at the Department of Health and Human Services Web site about Medicaid at http://www.cms.hhs.gov/MedicaidEligibility/.

 5   How Do I Apply for Medicaid?

Apply for Medicaid by contacting your state Medicaid office. The Gov Benefits.gov Web site at http://www.govbenefits.gov/govbenefits_en.portal?_nfpb=true&_pageLabel=gbcc_page_quicksearch&_nfls=false&mode=results&category=MED has a list of state Medicaid offices and links.

 6   How Does Medicaid Reimburse Me for My Medical Expenses?

Medicaid reimburses your health care providers directly. You may also be responsible for a co-payment in some cases. Co-payment circumstances and amounts are determined by the state program in which you are enrolled.

 7   How Soon after I Apply for Medicaid Will My Coverage Begin?

If you are eligible, your coverage may begin retroactively, for up to three calendar months before application. For example, if you are injured during the three calendar months prior to your application, and you can show that you were eligible for Medicaid during that time, Medicaid will cover those bills.

 8   What if I Have Low Income but Do Not Meet the Requirements for Medicaid?

Many states also have low income medical assistance programs. These are funded by the state and not at the federal level. They are called “state-only” programs.

 9   What Is the Difference between Medicaid and Medicare?

Medicare is the federally funded insurance program that is available to all Americans 65 years and older. If a person on Medicare also meets Medicaid eligibility requirements, that person will be covered by both programs.

 10   Where Can I Find Out More About Medicaid?

-- Gov Benefits.gov Web site:  http://www.govbenefits.gov/govbenefits_en.portal

-- U. S. Department of Health & Human Services Web site:  http://www.cms.hhs.gov/home/medicaid.asp 

-- Health and Human Services “Medicaid at a Glance”: http://www.cms.hhs.gov/MedicaidEligibility/Downloads/MedicaidataGlance05.pdf 

-- The National Council on Aging Web site:  http://www.benefitscheckup.org