What is Medicaid | Everything You Need to Know About

What Does Medicaid Cover

Medicaid is a government-backed health insurance program designed for low-income families. It is a jointly funded Federal-State program offering benefits not typically covered by Medicare.

People with Medicaid insurance pay little or nothing to get all healthcare services. Everything you need to know about Medicaid health insurance, its eligibility, and the application process is given in this article.

Just take me to the Medicaid Coverage List

How Do States Determine Eligibility Criteria for Medicaid

Medicaid Health Insurance is a joint health insurance program with the federal and state governments. While Medicaid is a federal-state program, each state administers its program within federal guidelines, leading to variations in coverage and eligibility criteria across states. Health insurance helps people with low-income families who have limited resources to get access to healthcare services.

Medicaid was first launched in the 1960s and became legal in 1965. People often get confused between Medicaid and Medicare. Medicare is a different healthcare program designed for the elderly and disabled.

Since it’s a joint program of state and federal government, state governments receive funds from the federal government to distribute their services to eligible people. It is the largest healthcare program in the US.

Is Medicaid available for all

The Medicaid Program is not available for all US citizens. The program serves a specific group of people. The group of people who can apply for the Medicaid Health Insurance program is listed below:

  • Parents with low-income
  • Children of families with low-income
  • Pregnant Women with low-income families
  • Senior Citizens with low-income
  • Children in foster care

Medicaid eligibility is determined both by federal guidelines and state-specific regulations. The program is available to certain low-income individuals and families, with eligibility criteria varying by state. The state government can expand or reduce the group of people as it decides.

How do you get Medicaid Services

Medicaid payment models include Fee-for-Service, where providers are paid for each service; Managed Care, where organizations receive a fixed monthly payment per enrollee; and Alternative Payment Models, which may combine both aspects to encourage efficiency and quality of care. Here’s detailed information about the different ways in which one can get Medicaid Services.

1. Fee for Service

In this system, Medicaid providers are paid for the services offered to Medicaid insurers. The fees for different healthcare services are based on the government’s maximum price per unit.

2. Rate

Rate providers are paid a sum of rates, i.e., a threshold rate they submit to the authority annually. Rate providers can follow different reimbursement formulas to get paid for the services offered to Medicaid insurers. The rate formulas to get paid are daily, monthly, quarterly, and yearly.

3. Managed Care

Managed Care providers through Medicaid are provided monthly capitation payments for each enrolled member.

What types of Services are Covered Under Medicaid

Mandatory benefits under Medicaid include, but are not limited to:

  • hospital services,
  • nursing facility services,
  • home health services,
  • physician services,
  • rural health clinic services,
  • family planning services.

States also have the option to cover additional services under Medicaid. In addition, you can get many other optional services through Medicaid Health Insurance. You can get optional services at reasonable rates with the help of Medicaid insurance.

How to Apply for Medicaid

There are multiple ways you can apply for Medicaid health insurance. Individuals can apply for Medicaid through their state’s Medicaid agency or through the Health Insurance Marketplace. The application process can vary by state but generally involves submitting proof of income, residency, and other eligibility criteria. Or you can do the same online with the help of their website at Healthcare.gov.

The application process for Medicaid is simple. Anyone can do so by following three simple steps.

  1. Fill out an application form with the details and personal information given.
  2. A review of your financial condition to check your eligibility, as this program is for low-income families only.
  3. Personal care to check your physician eligibility.

After completing these three steps, you can wait for the final call or email.

You can apply in person through the HCS office. Just visit a local Home and Community Services office and request the application form to register for the Medicaid program. The authorized person will help you fill out the application process and with all the other help you might need throughout the process.

On the other hand, you can visit the official website to get more information about the Medicaid program and, depending on your state, apply for it.

While applying for the Medicaid Application, you might need the following documents.

Make sure you have all the documents listed below in your hands to complete the application process faster.

  • Proof of identification
  • Proof of residency
  • Social Security Number
  • Proof of income
  • Alien or immigration documents
  • Bank statements, life insurance, property tax statements
  • Proof of citizenship

You can get more information about the application process by visiting their official website.

Who is eligible for Medicaid Health Insurance

The eligibility criteria for each state are different. However, everyone must meet the criteria to complete the application process.

Applicants must be residents of the state where they apply for Medicaid. Eligibility criteria include being a low-income adult, child, pregnant woman, elderly adult, or a person with a disability, but specific eligibility thresholds vary by state.

Here’s the category of people who can apply for Medicaid Health Insurance.

  • Eligible low-income adults
  • Children
  • Pregnant women
  • People with disabilities

Medicaid Coverage List

Medicaid Coverage List
Bunion Surgery
Blood Pressure Monitors
Hearing Aids
Eye Contacts
Assisted Living
Breast Pumps
Wisdom Teeth Removal
Breast Reduction
Diabetic Supplies
Cataract Surgery
Dental Braces
Dental Implant
Weight Loss Surgery

Final Words:

Medicaid is a government-backed health insurance program. Medicaid provides plenty of benefits to insurers compared to the ones with private health insurance policies. The lower payment rates, no-cost healthcare services, and many other benefits make this program quite efficient for the needy.

Medicaid is designed to provide medical assistance to low-income individuals and families, ensuring access to essential healthcare services for those who qualify under state and federal guidelines. Check your eligibility criteria, get more information about the Medicaid program through your Home and Community Office Services, and apply for it to get its benefits. Medicaid is a must-have program for low-income families.

See Also

What Does Medicaid Not Cover

Alternatives to Medicaid

What is Emergency Medicaid

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