Medicaid is a state-federal health insurance program for those in need. Find out if you qualify for it, and if so, how you can apply to get the medical benefits you need.
Medicaid is a health insurance program that helps protect over 66 million U.S. citizens from illness and injury and ensures women get the prenatal care they need while pregnant.
The program offers coverage to eligible citizens who meet the income and asset limits set by federal and state governments for individuals in need. Medicaid coverage varies somewhat between states, as do co-payment and other requirements, though all programs have similar minimum levels of care available. You can apply for Medicaid in several ways, though the process can be somewhat complex depending on which state you’re applying in.
Medicaid Is a Joint State-Federal Program
Medicaid is a joint entitlement program funded by both state and federal governments. With some exceptions, the federal government provides half of Medicaid’s budget through the Department of Health and Human Services, while a state agency picks up the rest of the cost and administers the program.
The federal government sets minimum standards for coverage and care, as well as basic guidelines for beneficiary eligibility. States are generally free to exceed these minimums, though many adhere strictly to the federal guidelines. Applications for Medicaid coverage get handled on the state level, with federal program authorities referring all inquiries to the relevant state where the person is applying from.
What Does Medicaid Cover?
Coverage varies from one state program to another, but nearly all Medicaid beneficiaries can count on preventive care, emergency care and several types of routine medical services, such as immunizations and cancer screenings. Most states provide extra coverage for children and pregnant mothers, seniors and at-risk recipients, such as HIV-positive beneficiaries and people with terminal illnesses. Various prescription drugs are also included in Medicaid coverage.
Federal Medicaid Eligibility Guidelines
The federal government sets standards for Medicaid eligibility. In order to qualify for Medicaid in every state, you must be:
- A citizen or permanent legal resident of the United States
- Resident in the state where you are applying for benefits
- Of limited means, including income and asset totals that do not exceed your state’s limits
Within the federal eligibility guidelines, states are free to expand coverage limits and acceptance criteria. States are free, for instance, to set higher income limits than the federal guidelines. This helps compensate for the higher-than-average cost of living in states such as California and Massachusetts. States also commonly adopt “medically needy” programs, which offer limited Medicaid assistance for applicants whose incomes would otherwise be too high to qualify for Medicaid, but who have a medical need for care they cannot afford. Ask your local intake worker about your state’s exceptions to Medicaid eligibility.
How to Apply for Medicaid in Your State
There are several ways people can apply for Medicaid, some of which vary according to the state you’re in. In most states, eligible beneficiaries can submit an application in person or by mail with a county human services department. Applications can also be submitted through a Social Security office or online at your state’s health marketplace.
Many first-time Medicaid applicants find local coverage through the federal Healthcare.gov website. Many hospitals and long-term care facilities also have a benefits coordinator who can assist with applications for new patients. Look over a typical Medicaid application form PDF and figure out what information might be needed to apply.
Things to Remember When Applying for Coverage
Medicaid is an entitlement program, which means all qualified individuals are accepted for coverage without waiting lists or enrolment limits. That does not mean you are automatically accepted for coverage, however. Most states require applicants for Medicaid to submit proof of income and other documents, such as proof of residency, along with their applications before coverage is approved. Other quirks of the Medicaid application process can actually make it easier to get the coverage you need.
Many means-tested programs confer automatic eligibility for Medicaid. For example, a person who has already been approved for some types of income-restricted aid can either apply for Medicaid at the same time, or their state might automatically extend Medicaid coverage. Such programs include:
- SNAP, also known as food stamps
- Cash aid, often known as welfare
- Low-income housing vouchers, formerly known as Section 8
If you already get state or federal assistance from any of these programs, let your Medicaid worker know during the application process. It could streamline your approval.
In some states, applications for Medicaid can be made retroactively. Individuals in these states, such as California, who arrive at a hospital or medical office in need of care have a limited time, usually up to 6 months, to apply for and get Medicaid coverage. After approval, if the approval would have been granted at the time of care, the program can issue payment for all covered services rendered. In some facilities, a member of the billing staff can assist with a Medicaid application prior to discharge.
Certain protected groups can get Medicaid benefits without meeting the traditional eligibility criteria. Medicaid for children, for example, allows families to earn up to 133% of the usual federal benefit limit without penalties. Pregnant women and some high-risk individuals may also be eligible for fast-tracked application status in your state. Some states also offer Medicaid as a gap option for seniors who are eligible for Medicare, which helps simplify health insurance paperwork and reduce costs at the point of care.