Medicaid eligibility and benefits overview

Medicaid, which reaches more than 64.5 million Americans, is the largest provider of health insurance in the United States. Created under the Social Security Amendments of 1965, the program is available to low-income individuals in fifty US states and counties, Colombia and the United States. It is a collaboration between the federal and state governments to provide coverage for essential health care services.

Understanding how it works will help you make the most of its benefits.

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What Medicaid Covers

Medicaid doesn't necessarily cover everything, but it does cover a lot. The federal government requires that certain services be offered to all Medicaid recipients.

These mandatory services include the following :

  • Nursing in community health centers and rural clinics
  • Nursing care for people 21 years of age and older
  • Care provided by physicians, nurse midwives, and nurse practitioners
  • Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services
  • Family planning services and supplies
  • Home health care for persons eligible for nursing facility services.
  • Visual and laboratory services
  • Transportation for medical reasons

However, all states have the capacity to expand these services, and they often do. These additional services may include, but are not limited to :

Who can get Medicaid?

Many low-income people could not afford health insurance without help from the government. This is where Medicaid comes in. The U.S. Department of Health and Human Services (HHS) determines the Federal Poverty Level (FPL ) annually, and these values are used to establish eligibility standards for Medicaid.

All states cover specific categories of people, including low-income families, children, pregnant women, the elderly, and people with disabilities. The federal government sets the standard, but individual states can extend coverage beyond these limits, for example, to anyone with income below a certain level. States can increase the income threshold to include more people. You can learn more about what your government program covers at Medicaid.gov .

Impact of the Affordable Care Act

The Affordable Care Act (ACA or Obamacare ), passed in 2010, had a significant impact on Medicaid eligibility as it proposed expanding Medicaid to the states. In exchange for federal funds, the states agreed to extend Medicaid coverage to all people with income. up to 133% of the FPL, regardless of other factors. (People without children will no longer be excluded from coverage). The rest of the states continue to follow traditional Medicaid guidelines.

Immigration status and eligibility

Being a US citizen guarantees that you can get Medicaid if you meet other requirements. The same cannot be said of people in an immigrant situation.

Qualified non-citizens are generally eligible for Medicaid if they meet state income and residency requirements. Often the residency requirement is five years after obtaining lawful permanent residence status (green card) .

There are exceptions for refugees and asylum seekers, currently or before they become lawful permanent residents (green card holders).

Illegal immigrants may only be eligible for emergency assistance, not all Medicaid benefits.

Medicaid vs Medicare

Both health care programs are regulated by CMS, but there are many differences between them.

Health insurance

  • Execution status

  • It offers assistance to the elderly and people with disabilities.

  • Offers help to low-income people of all ages, regardless of their health status.

  • It provides its beneficiaries with long-term care in a nursing home.

More than 8 million people are eligible for both Medicaid and Medicare. These people have a double right . Medicaid helps them pay for services that Medicare doesn't cover.

How to sign up for Medicaid

Signing up for Medicaid is easy at Medicaid.gov. Alternatively, you can contact your local Medicaid office to apply over the phone or make an appointment in person. If you are eligible, you will want to register as soon as possible to take full advantage of the benefits.

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