Medicaid is one of the most important public assistance programs in the United States.
Medicaid is often confused with Medicare. In reality, they are two completely different programs. While Medicare is primarily for older adults, Medicaid is a health insurance program for people with low income and certain other eligible groups.
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Medicaid is part of a series explaining how the health insurance system in the United States works. This article provides essential information about Medicaid so you can consider which health insurance option may be appropriate for you and your family.
What is Medicaid?
Medicaid is a public health insurance program for people who meet income requirements and other criteria set by federal and state rules. The goal of the program is to help eligible individuals access necessary medical care without facing an overwhelming financial burden.
The program is funded jointly by the federal government and state governments, and it is administered by each state. Because every state runs its own Medicaid program, benefits and eligibility rules can vary significantly from state to state.
In addition to income, eligibility may also depend on age, pregnancy status, disability status, family circumstances, and the rules of the state where you live.
Following the Affordable Care Act (ACA), many states expanded Medicaid to cover nearly all low-income adults under age 65, while some states still apply more restrictive eligibility rules.
Who may qualify for Medicaid?
Although eligibility depends on the state, the groups commonly prioritized include:
- Children.
- Pregnant women.
- People with disabilities.
- Older adults with low income.
- Low-income parents and families.
In many states, Medicaid has been expanded to support more low-income adults. Some states also have more flexible rules regarding income limits and immigration status of children when determining Medicaid eligibility. As a result, there are cases where parents or guardians may not have Medicaid, but their children or dependents may still qualify.
What does Medicaid cover?
Depending on each state’s rules, Medicaid may cover:
- Doctor visits.
- Hospital care.
- Prescription medications.
- Maternity care.
- Pediatric care.
- Mental health services.
- Long-term care services for eligible individuals.
Medicaid often has very low costs, and in many cases there is no monthly premium.
Can immigrants qualify for Medicaid?
Whether immigrants can qualify for Medicaid depends on their immigration status, how long they have lived in the United States, and the rules of the state where they reside.
If you are a lawful permanent resident, or green card holder, you may need to wait a certain period of time before becoming eligible for regular Medicaid. However, many states still provide certain forms of medical assistance for children or pregnant women even if they do not fully meet regular Medicaid requirements.
Medicaid and long-term care benefits
Medicaid is the largest payer of long-term care services in the United States, including services for older adults, people with disabilities, and children with special care needs.
For example, Medicaid may cover the following services:
- Nursing home care.
- Home care or personal care services.
- Caregiver assistance with activities of daily living (ADLs).
- Long-term rehabilitation services.
- Certain community-based care programs that help patients remain at home instead of moving into a nursing home, also known as Home and Community-Based Services (HCBS).
Age limits for beneficiaries
Some people enrolled in Medicaid do not necessarily have to switch entirely to Medicare when they turn 65, unless they no longer meet Medicaid eligibility requirements. This is fairly common among people with disabilities or older adults with low income. In these cases, Medicare typically pays first for services it covers, while Medicaid may help with additional costs and long-term services that Medicare does not cover.
Key Takeaways
- Medicaid is a public health insurance program for eligible low-income individuals and families.
- Eligibility rules vary by state.
- Many services, including hospital care, doctor visits, prescription drugs, and long-term care, may be covered.
- You can apply through your state’s Medicaid agency, health department, or the Health Insurance Marketplace, which will determine whether you qualify for Medicaid.
You can visit the official website of your state’s Medicaid agency or health department, or the equivalent agency in your state, to review the rules and benefits that apply where you live.
You may also visit HealthCare.gov, the official U.S. government website for health insurance, to learn more about Medicaid, CHIP, and other health insurance programs.