Medicaid is administered by individual states and is supported by state and federal tax dollars. It provides healthcare to who cannot afford the costly services of clinics, hospitals, and doctors, and have no other insurance.
In order to qualify for Medicaid, you must meet certain requirements. States set eligibility requirements that are within federal guidelines. These may include whether you are pregnant, have a disability, are blind, or are elderly. In most cases, you also need to be a US citizen or a legal immigrant. The state and federal government also takes into consideration your income, which must be low in order to quality for Medicaid, and resources, such as property that you own. Children can be covered by Medicaid, as well, but they also have to meet requirements.
The Affordable Care Act, which went into effect in early 2014, expands and streamlines coverage for Medicaid and Children's Health Insurance Program (CHIP). When you choose a plan from the Health Insurance Marketplace and find you need Medicaid or CHIP coverage, the Marketplace will share your information with the appropriate agencies for follow-up. You find out if your state has expanded Medicaid and CHIP coverage by visiting the Marketplace or contacting your local social services department.
The only way to know what your state offers is to contact your local department of social services. Because the states vary so widely in their plans and whom they cover, it is a good idea to ask specifically about your situation. All states must offer certain mandatory benefits, such as inpatient and outpatient hospital services and family planning services. Optional benefits a state may provide include prescription drug coverage, dental services, and chiropractic care.
These are some of the basic needs usually covered by Medicaid to eligible persons:
- Most necessary hospital stays
- Outpatient services provided by certain facilities
- Laboratory and x-ray fees
- Nursing home services
- Family planning
- Doctors' services
- Medical and surgical dental treatment
- Some home healthcare services
- Some home medical supplies and appliances
- Pregnancy, delivery, and postpartum care from various sources, including nurse-midwife services and freestanding birth centers
- Some physical, speech, hearing, and occupational therapy
- Approved prescription drugs
- Screening and preventive services
- Some mental health services
- Hospice care
- Transportation to medical appointments
Some states also supply training and employment services to people with disabilities. And some provide wider services, including respite for caregivers who need some time for themselves, and various support systems that permit disabled persons to live in the community or in housing that meets specific needs. The particular services you can get through Medicaid will depend on what your state offers and what you are eligible for.
To apply for Medicaid, contact your state's social services department, Medicaid, or Health Insurance Marketplace for more information. In most cases, you can find what you need and apply for services online.
Virtually all states will require an interview and will ask you for various kinds of proof of eligibility, such as:
- A birth certificate or other proof of age
- Citizenship papers or other proof of legal alien status (Benefits may extend to all children regardless of their parents' citizenship status, as well as to pregnant women and anyone needing emergency care.)
- Pay stubs and paperwork from other sources of income, such as retirement, or veteran or Social Security benefits
- A rent receipt or other proof of where you live (People who are homeless are also covered.)
- Other documents including bank books and insurance policies
Medicaid & CHIP program information. Medicaid.gov website. Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/Medicaid-and-CHIP-Program-Information.html. Accessed August 13, 2014.
HFS 591 healthcare and family services medical programs. Illinois Department of Healthcare and Family Services website. Available at:
http://www2.illinois.gov/hfs/MedicalPrograms/Brochures/Pages/HFS591.aspx. Accessed August 13, 2014.
Medicaid in New York State. New York State Department of Health website. Available at:
http://www.health.ny.gov/health_care/medicaid. Updated July 2014. Accessed August 13, 2014.
Last reviewed August 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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