© 2003, The Guiding Light Foundation
Medicaid was created to
help low-income individuals and families with health care they could not
otherwise afford. Although a federal program, it is administered by state human
Medicaid is administered by
the Centers for Medicare and Medicaid Services (CMS), (formerly known as the
Health Care Financing Administration (HCFA).
State Income requirements
can be as low as $600 per individual and $800 per family, so this program is
definitely aimed at those living below poverty level, one of the primary
criticisms about qualifying for Medicaid.
(doctors, hospitals, and pharmacies) are prohibited from requiring their
patients to pay any additional charges. If a provider tries to charge you,
report them immediately to your caseworker.
To apply for Medicaid,
contact your state human services department. You will need:
Your birth certificate
Drivers license or state identification card with photo
Proof of income (pay stubs or other source of income for the last three months)
Proof of checking and savings account balances (recent month's statements)
Proof of ownership of stocks and bonds
Proof of any pension plan
Proof of dependent children (birth certificates)
At your initial
appointment, your caseworker will give you a list of required documents. The
more you have available, the faster your claim can be processed..
The process of approval can
take two weeks to over a month depending on how soon you provide the paperwork,
how busy the caseworker is, and how urgent your need is.
If you qualify for
Medicaid, you will be given a Medicaid medical insurance card to present
to providers. NOTE: Obtaining a replacement takes time so hang onto this card
like it's gold.
Not all medical providers
accept Medicaid., so check with physicians first before showing up for an
appointment. All state- and federal-funded facilities are required to accept
Medicaid. All pharmacies accept Medicaid. Some do not do so happily, but they
have no choice. They may refuse to order in drugs they do not carry because the
reimbursement from Medicaid is much less than that from private insurance
If your income is too high
to qualify for pure Medicaid, you can enter into their "Spend-Down
Program." In this program, you spend a set amount of your income for
medical expenses each month and then Medicaid takes over the remainder.
Typically the amount you pay is quite high, but if your medical expenses are
eating up your entire income, it is a viable option.
Who is eligible for
Many groups of people are covered by Medicaid. Even within these groups,
though, certain requirements must be met. These may include your age, whether
you are pregnant, disabled, blind, or aged; your income and resources (like
bank accounts, real property, or other items that can be sold for cash); and
whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for
counting your income and resources vary from state to state and from group to
group. There are special rules for those who live in nursing homes and for
disabled children living at home.
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 5-year
limit that applies to lawful permanent residents). Eligibility for children is
based on the child's status, not the parent's. Also, if someone
else's child lives with you, the child may be eligible even if you are not
because your income and resources will not count for the child.
In general, you should apply for Medicaid if your income is low and you
match one of the descriptions below. (Even if you are not sure whether you
qualify, if you or someone in your family needs health care, you should apply
for Medicaid and have a qualified caseworker in your state evaluate your
Apply for Medicaid if you think you are pregnant. You may be eligible if you
are married or single. If you are on Medicaid when your child is born, both you
and your child will be covered.
Children and Teenagers
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 low, 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.
Person who is Aged, Blind, and/or Disabled
Apply if you are aged (65 years old or older), blind, or disabled and have low
income and few resources. Apply if you are terminally ill and want to receive
hospice services. Apply if you are aged, blind, or disabled; live in a nursing
home; and have low income and limited resources. Apply if you are aged, blind,
or disabled and need nursing home care, but can stay at home with special
community care services. Apply if you are eligible for Medicare and have low
income and limited resources.
Some Other Situations
Apply if you are leaving welfare and need health coverage. Apply if you are a
family with children under 18 and have very low income and few resources. (You
do not need to be receiving a welfare check.) Apply if you have very high
medical bills, which you cannot pay (and you are pregnant, under 18 or over 65,
blind, or disabled). For detailed explanations of eligibility
requirements by states,
CMS's Plan and Provider Home Page
Medicaid Drug Rebate Program
Medicaid Information for Consumers
Care Planner--Centers for Medicare and
Children's Health Insurance Program
Medicaid Long Term Care
Several State and
Federal Program self-eligibility, confidential pre-screening apllications
In addition to administering the
Medicaid program, CMHS also administers related quality assurance programs, and
other programs. It ensures its beneficiaries are aware of the services for which
they are eligible, services are accessible, and that they are provided in an
effective manner. CMS ensures that its policies and actions promote efficiency
and quality within the total health care delivery system. Questions concerning
Medicare or Medicaid can be made to the above number or sent by mail or
electronic mail to the agency.
Medicaid will also provide
transportation to and from medical appointments by taxi or wheelchair-accessible
van if you are unable to drive or do not have a car, and bus passes are also
Back to Medicare/Medicaid
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