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A Quick Medicaid Program Overview

Your health care needs are important. People who can't afford to pay for medical care are given the opportunity to receive needed care through Medicaid, or medical help from your state. Programs will vary from state to state because each state sets its own rules and regulations. Medicaid is not for everybody; you will have to meet certain eligibility and income requirements to qualify.

What is Medicaid?

Medicaid is a combined federal and state program designed to pay medical costs for people with a limited income and resources. Eligibility will be determined by an evaluation of your circumstances and income.

Medicaid Eligibility Details

Federal and state laws regulate the income and eligibility requirements for the Medicaid program. To see if you qualify you will need to contact your State Medical Assistance (Medicaid) office. Some eligibility factors that will be considered include pregnancy, disability, age, blindness, income and resources, and U.S. citizenship. Your resources include bank accounts, real property, and other assets or items that can be sold for cash. Income and resource counting will vary from state to state.

If you or a family member lives in a nursing home or if you have a disabled child living at home, Medicaid has special rules for such cases. Sometimes children qualify even if the parent does not because the eligibility is based on the child's status and not that of the parents.

Is someone else's child living with you? Then that child should be eligible for Medicaid. Your income and resources do not count for that child.

Eligibility will begin three months prior to the application for those who would qualify during that period. When your circumstances change in such a way to make you non-eligible, eligibility will cease within the same month that you report the change. Failure to report increases in income or a change in status can produce negative results with future eligibility.

How Does Medicaid Work?

Medicaid typically sends a full payment directly to your health care providers. Most of the time, you won't even see a bill. Depending on your state's requirements, you may have to pay a co-payment for some medical services.

Medicaid and Medicare

Medicare doesn't cover everything. That's where Medicaid comes in for those who are eligible. Almost all of your health care costs will be covered if you have both programs. The programs are designed to help you get healthy and/or stay healthy.

What Doesn't Medicaid Cover?

  • Medical assistance is not available to everyone.
  • Medicaid does not provide health care services under any circumstances unless they are in a designated eligibility group.
  • For a complete list of Medicaid coverage and exclusions, you will need to see you state Medicaid guide or ask your state caseworker.
  • If you have a low income and meet any of the descriptions above, you should check with your local Medicaid office to see if you qualify for assistance. Don't delay in getting the health care that you or a family member is in need of. Let a caseworker evaluate your situation even if you are doubtful about your eligibility. You can also check the Web for additional information.