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© 2003, The Guiding Light Foundation
MEDICAID
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 services departments.
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.
Medicaid providers (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)
Rent receipt
Utility receipts
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 companies.
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 Medicaid?
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 situation.)
Pregnant Women
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, click here.
Some Medicaid Resources
CMS's Plan and Provider Home Page
Medicaid Drug Rebate Program
Medicaid Information for Consumers
Care Planner--Centers for Medicare and Medicaid Services
Children's Health Insurance Program
Medicaid Long Term Care Application
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 available.
Disclaimer: The material in this site is provided for personal, non-commercial, educational and informational purposes only and does not constitute a recommendation or endorsement with respect to any company or product. Guiding Light Foundation makes no representations and specifically disclaims all warranties, express, implied or statutory, regarding the accuracy, timeliness, completeness, merchantability or fitness for any particular purpose of any material contained in this site. You should seek the advice of a professional regarding your particular situation.
