Medicaid: 10 Things To Know

Medicaid in the U.S is a joint federal-state program that provides health coverage to over 72.5 million Americans, including eligible low-income children, pregnant women, parents of eligible children, people with disabilities and elderly needing nursing home care. Eligibility and Medicaid Income Limits vary by state.

Here are 10 things to know about the Medicaid Program, including who is eligible for Medicaid, Obamacare expansion states, what Medicaid covers, what help is available to those who don’t meet the Medicaid income guidelines, and how to apply through your state provider during the enrollment period.

This Post Will Cover:

  • Who is Eligible for Medicaid?
  • What is the difference between Medicare and Medicaid?
  • Is Medicaid based on Income or Assets?
  • How much income do you need to qualify for Medicaid?
  • What if I Don’t Meet the Medicaid Income Limits?
  • Can you have Medicaid and Private Insurance at the same time?
  • Which States Have Accepted Medicaid Expansion?
  • What Does Medicaid Cover?
  • What Percentage of the Population Does Medicaid Cover?
  • How Do I Apply for Medicaid?

Who is Eligible for Medicaid?

In all states, Medicaid provides health coverage for some low-income adults, children, pregnant women, elderly adults and people with disabilities. In some states, the program covers all low-income adults below a certain income level.

In states that have expanded Medicaid under the Affordable Care Act, low-income adults may qualify for Medicaid based on income and family size.

How much income do you need to qualify for Medicaid?

Almost every state has multiple Medicaid programs and income limits vary by state. However, as a good rule of thumb, if you make between 100% to 200% of the federal poverty level (FPL) and are pregnant, elderly, disabled, a parent/caretaker or a child, you are likely to qualify for Medicaid in your state.

In addition, if you are an individual without a dependent, and you live in a state that expanded Medicaid under Obamacare, you are likely to qualify for Medicaid if you make less than 133% of the FPL.

In 2018, the FPLs (in all states except Alaska and Hawaii, which have higher guidelines) are:

"Medicaid Income Limit 2019 - Federal Poverty Level"

What if I Don’t Meet the Medicaid Income Limits?

Low-Income Individuals who do not qualify for Medicaid (and who do not live in a Medicaid Expansion State) may be eligible for CHIP or BHP depending on their state.

The Children’s Health Insurance Program (CHIP) provides federal matching funds to states to provide health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.

The Basic Health Program (BHP) allows states an option to provide affordable coverage and better continuity of care for people whose income fluctuates above and below Medicaid and CHIP eligibility levels.

Can you have Medicaid and Private Insurance at the same time?

No, you cannot have Medicaid along with any type of private insurance at the same time. However, you can have Medicaid and Medicare at the same time.

Which States Have Accepted Medicaid Expansion?

Since 2010, 33 states and the District of Columbia have accepted federal funding to expand Medicaid under the Affordable Care Act (ACA), and at least three more are expected to do so in 2019.

Here are the Medicaid Expansion States:

Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Dakota
Ohio
Oregon
Pennsylvania
Rhode Island
Utah
Vermont
Virginia
Washington
West Virginia

Here are the States that have Not Expanded Medicaid

Alabama
Florida
Georgia
Kansas
Mississippi
Missouri
North Carolina
Oklahoma
South Carolina
South Dakota
Tennessee
Texas
Wisconsin
Wyoming

How will low-income individuals benefit from Medicaid expansion?

States that expand Medicaid are making health coverage available to many people who would not otherwise have insurance. These individuals don’t qualify for regular Medicaid but cannot afford private health insurance.

Data from 11 states that have expanded Medicaid under the Affordable Care Act shows that the majority of residents who can benefit from expanded Medicaid are employed.

What States Have Medicaid work requirements?

Eight states have received federal approval requiring people to be working (or volunteering, in school, in job training, etc.) for at least a certain number of hours per week in order to receive Medicaid.

Most people who receive Medicaid benefits are either already working or would be exempt from work requirements (due to being disabled, taking care of a minor child, pregnant, etc.).

Here are the States that have received Federal Approval for Medicaid Work Requirement:

Arizona
Arkansas
Indiana
Kentucky
Michigan
New Hampshire
Ohio
Wisconsin

The following states are in the process of Implementing Work Requirements or have Pending Applications with the Federal Government for approval:

Alabama
Mississippi
Oklahoma
South Dakota
Tennessee
Utah
Virginia

What is the difference between Medicare and Medicaid?

Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients.

Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program and is the same across all states.

The program is run by the Centers for Medicare & Medicaid Services.

Medicaid is an assistance program. It serves eligible low-income people including children, pregnant women, parents of eligible children, people with disabilities and elderly needing nursing home care.

Patients usually pay no part of the costs for covered medical expenses. A small co-payment is sometimes required.

Medicaid is a federal-state program. Eligibility varies widely among the states. However, all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guidelines.

Is Medicaid based on Income or Assets?

Medicaid eligibility is based on income for some groups and on income and assets for other groups.

Income limits – Medicaid income limits and rules vary for different groups of individuals and household sizes. Income limits for children, parents and caretaker relatives, adults ages 19-64, and pregnant women are different than those for the aged, blind or disabled individuals and for those on Medicare.

Asset Limits – Asset limits only apply to certain groups including individuals who need long term care or are applying based on being aged, blind or disabled.

What Does Medicaid Cover?

Medicaid coverage falls under two categories. There are mandatory Medicaid benefits, which states are required to provide under federal law, and optional benefits that states may cover if they choose. Here are the details:

Mandatory Benefits 

Here is the Coverage You will Get in Your State if You are Approved for Medicaid:

    • Inpatient hospital services
    • Outpatient hospital services
    • EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
    • Nursing Facility Services
    • Home health services
    • Physician services
    • Rural health clinic services
    • Federally qualified health center services
    • Laboratory and X-ray services
    • Family planning services
    • Nurse Midwife services
    • Certified Pediatric and Family Nurse Practitioner services
    • Freestanding Birth Center services (when licensed or otherwise recognized by the state)
    • Transportation to medical care
    • Tobacco cessation counseling for pregnant women

Optional Benefits

These are the benefits that are not required under federal law and coverage vary by state. Contact your state’s Medicaid agency to see what optional benefits are covered.

  • Prescription Drugs
  • Clinic services
  • Physical therapy
  • Occupational therapy
  • Speech, hearing and language disorder services
  • Respiratory care services
  • Other diagnostic, screening, preventive and rehabilitative services
  • Podiatry services
  • Optometry services
  • Dental Services
  • Dentures
  • Prosthetics
  • Eyeglasses
  • Chiropractic services
  • Other practitioner services
  • Private duty nursing services
  • Personal Care
  • Hospice
  • Case management
  • Services for Individuals Age 65 or Older in an Institution for Mental Disease (IMD)
  • Services in an intermediate care facility for Individuals with Intellectual Disability
  • State Plan Home and Community Based Services- 1915(i)
  • Self-Directed Personal Assistance Services- 1915(j)
  • Community First Choice Option- 1915(k)
  • TB Related Services
  • Inpatient psychiatric services for individuals under age 21
  • Other services approved by the Secretary*
  • Health Homes for Enrollees with Chronic Conditions – Section 1945

What Percentage of the Population Does Medicaid Cover?

Medicaid covers roughly 19% of the American Population. Here is the full breakdown of healthcare coverage in the United States:

  • Medicaid – 21%
  • Medicare – 14%
  • Military and Veteran Healthcare – 1%
  • Employer-Sponsored Healthcare – 49%
  • Marketplace Exchange – 7%
  • Uninsured – 9%

Another way to look at Healthcare coverage is Public Insurance vs Private Insurance

Public Insurance 

  • Medicaid – 21%
  • Medicare – 14%
  • Military and Veteran Healthcare – 1%

Private Insurance 

  • Employer-Sponsored Healthcare – 49%
  • Marketplace Exchange – 7%

Uninsured – 9%

How Do I Apply for Medicaid?

There are two ways to apply for Medicaid:

  1. Contact your state Medicaid agency. You must be a resident of the state where you are applying for benefits.
  2. Fill out an application through the Health Insurance Marketplace.

If you have any questions about Medicaid, you can ask us in the comments section below.

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