What is Medicaid?
Aging Matters

The federal and state governments both run Medicaid and CHIP (Children's Health Coverage Basics). The details of the program differ between the states. Medicaid and CHIP give free or low-cost medical coverage to Americans, including people with small incomes, families, kids, pregnant women, older adults, and individuals with disabilities.


Medicaid also offers families with assistance that Medicare does not cover like skilled nursing home care and personal care services. Not all low-income persons qualify for Medicaid, and only about 40% of America's poor rely on it today.

Medicaid sends payments to the health care providers for the services rendered. The states make these payments based on the fee-for-service arrangement and then receive compensation for a share of the expenditure from the feds. The states may impose minimal deductibles,coinsurance, orcopaymentsfor certain services.

Federal and State Governments

The feds control the crucial oversight of Medicaid, but each state:

  • Sets their eligibility standards,
  • Regulates the scope of services given: the type, amount, and duration,
  • Controls the amount of payment rendered,
  • Manages their program.

States have the final say on what their Medicaid program and benefits provide. But they must meet several requirements before receiving federal government funding:

  • Inpatient and Outpatient Hospital services
  • Physician services• Prenatal care
  • Vaccines for the young
  • Skilled nursing home services for individuals 21 or older
  • Family planning
  • Rural health clinic services
  • Home health care for individuals who qualify to receive skilled-nursing services
  • Laboratory and x-ray services
  • Pediatric services• Ambulatory services
  • Early and periodic screening, diagnostic, and treatment for children under age 21

The optional Medicaid services offered by states

  • Diagnostic and Clinic services
  • Intermediate care facilities for the mentally challenged
  • Prescribed drugs
  • Optometrist services
  • Nursing facility services for individuals under 21
  • Transportation
  • Rehabilitation and physical therapy
  • Home and community-based care to certain persons with chronic impairments

Contact Medicaid to learn the rules and benefits in your state at https://www.medicare.gov/Contacts/ and to see if you qualify.

Who is eligible for Medicaid?

Each state sets their eligibility requirements. But the program intends to serve people with the lowest incomes. Other factors include age, pregnancy status, disability status, other assets, and citizenship.

  • People who meet the Aid to Families with Dependent Children requirements
  • Pregnant women and children under six whose household income is at or below 133% of federal poverty
  • Supplemental Security Income recipients
  • Recipients of adoption or foster care assistance
  • Other Medicare beneficiaries

Medicaid spend-down

If your income exceeds the Medicaid income set by your state, you still are eligible under the "spend down" process. Check with your state. For example, if you are "medically needy," but have too much income, your state may approve your benefits. This process enables you to subtract the medical expenses from your income.

To qualify as "medically needy," your assets must meet the resource amount allowed in your state

Carol Marak helped her parents with long-term care concerns and were the creator of the Aging matters column. If you have a question, or need help, Carol invites you to visit SeniorCare.com and complete the contact form on the site. The address Contact Carol.

Part of the Aging Matters Weekly Syndicated Column

Aging Matters is a weekly column tackling everyday challenges that our growing elderly population and their loved ones face. It is also published in a variety of syndication partners including newspapers all over the country.

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