What Is Medicaid?
The Medicaid program is a state operated and partially state funded program which helps many people who can't afford health care pay for some or all of their medical bills. Even though it is state operated the states must follow the federal guidelines. It is also partially federally funded. For a complete listing of the state, DC, and territorial Medicaid websites click on the button.
As part of the Affordable Care Act some states have expanded Medicaid out to everyone who makes less than 138% of the Federal Poverty Level. On the Medicaid state list you'll find which states expanded and which haven't. Click on the button.
Medicaid can make it possible for you to get the care that you need if you cannot afford to pay for your medical care.
Medicaid is available only to some people with limited income. An additional qualification in some states are low assets. They'll look at your bank accounts, real property, and/or other items that could be sold for cash. You must meet certain requirements in order to be eligible for Medicaid and these requirements will vary by state.
Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co payment) for some medical services. Most states have differing levels of Medicaid help.
When Does Eligibility Start?
Coverage may start retroactive to any or all of the three months prior to application, if the individual would have been eligible during the retroactive period.
When Does Eligibility End?
Coverage generally stops at the end of the month in which a person's circumstances change. For example, your income increases, your family size decreases, or you move out of state. Most states have additional "state-only" programs to provide medical assistance for specified people with limited incomes and resources who do not qualify for the Medicaid program. No Federal funds are provided for state-only programs.
What is Not Covered?
Medicaid does not provide medical assistance for all people with limited incomes and resources. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services for everyone. You must qualify for Medicaid. Low-income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds.
The income qualifications for people who are pregnant are more lenient so if you are pregnant you should check your state's website. It doesn't matter if you are married or not. Your new baby will automatically qualify for Medicaid for a period of time.
Children & Teenagers
You may apply for Medicaid if you are the parent or guardian of a child who is 18 years old or younger and your family's income is limited, or if your child is sick enough to need nursing home care, but could stay home with good quality care at home. If you are a teenager living on your own, the state may allow you to apply for Medicaid on your own behalf or any adult may apply for you. Many states also cover children up to age 21. Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not. However, there is a requirement that they must be a permanent resident for 5 years prior to becoming eligible.
Person who is Aged, Blind, and/or Disabled
If you are 65 years old or older, blind, or disabled and have limited income and resources you may be eligible for benefits. If you are aged, blind, or disabled; live in a nursing home; and have limited income and resources you may qualify. You may qualify if you are terminally ill and want to get hospice services.
Medicaid is tied to income. In some states a qualifying income is the poverty level where in others it will be 133% of the poverty level. Starting in 2014, states that have expanded Medicaid under the Affordable Care Act will qualify income up to 138% of the poverty level. Also, many states have different levels of Medicaid based on income. You can find out what percent your income is here.
Thirty five states plus the District of Columbia operate Medically Needy programs. This option allows states to provide Medicaid to certain groups of individuals who are not otherwise eligible for Medicaid. These programs are for people that have extensive health care needs yet have too much income to generally qualify for the state Medicaid program. The states in the follow list with the star (*) are the states that have a medically needy program. The program and the qualifications will vary by state so you'll need to check your state's website for information.