Medicaid, along with Medicare, is a health insurance program created as a part of the Social Security Act of 1965. It was designed to help individuals and families who could not afford to pay for health care. The program is mostly available to individuals who have low income. In order to qualify, the individual must meet certain eligibility requirements. Medicaid helps to provide coverage for many groups of people. Within some groups, certain state requirements must be met as well.
Mandatory Eligibility Groups
States are required to provide Medicaid coverage for most people who receive income assistance from the federal government. There are certain Medicaid mandatory eligibility groups. One of these is families with children who have limited income. These families must also be able to meet the eligibility requirements of their state's Aid to Families with Dependent Children (AFDC) program. Another group of eligible individuals are those who may receive Supplemental Security Income (SSI). For pregnant women and children younger than 6, the family's income must be below 133 percent of the federal poverty level.
Categorically Needy Groups
There are also certain categorically needy groups for Medicaid. Pregnant women and children, up until they turn the age of 1, whose family income is below 185 percent of the federal poverty level can be eligible. If a child is under the age of 21, he can be eligible for Medicaid if he is ineligible to receive AFDC, but income requirements must be met. Also, individuals living in institutions, but who have limited income can be eligible.
Pregnant Women, Children and Teenagers
Women should apply for Medicaid if they think that they may be pregnant. If a woman's income does not exceed 133 percent of the federal poverty level, then she may be eligible to receive Medicaid coverage regardless of her marital status. If a woman is on Medicaid when her child is born, then she and the child will still receive coverage.
Individuals can apply for Medicaid if they are the guardian or the parent of a child who is under the age of 18. To be eligible, the family must have a limited income. If a teenager is emancipated (living on her own), she may apply for Medicaid as well. A teenager can either apply on their own or have an adult apply for them. In some states, children can receive coverage until they turn 21.
Aged or Disabled Individuals
If an individual is over the age of 65, they may be eligible for Medicaid only if they have low income. If someone is terminally ill and requires hospice services, he can also apply. Medicaid is also there to help the individuals who are disabled.
Usually, these individuals are qualified to receive Medicare coverage as well. Medicare is a federal health insurance program for most individuals who are over the age of 65 and/or have certain disabilities. For most services, Medicare will pay 80 percent of the Medicare approved amount for services. If an individual receives Medicaid, the remaining 20 percent will be covered.
Coverage
Medicaid helps to provide coverage for many medical services that an individual may need, especially for the elderly or disabled. Some services that state Medicaid programs must provide coverage for are: dental services, doctor services, hospital services, lab fees, certified nurse practitioner and midwife services, home health care, nursing home care and family planning. Medicare directly sends payments to the individual's health care provider. In some states, individuals may be required to pay a small co-payment.
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