HealthCare Center – Medicaid


Most States provide Medicaid services to “categorically needy” individuals – people who receive benefits from federal assistance programs.

Those entitled to receive benefits include:
The aged, blind and disabled receiving cash assistance from the federal Supplemental Security Income (SSI) program. Chemical supplements that you can find here Many states also choose to provide Medicaid services to other groups of persons, including ” medically needy” individuals. Medically needy individuals are those people whose income after medical expenses is below a certain level set by the state, although they do not qualify for a cash benefit.

The federal government shares the cost of Medicaid services with the state. Federal funds contribute 50 percent to 78 percent of the health care costs for legible needy and low-income individuals. Individual states pay the remaining costs for Medicaid programs with help from local governments.

What Services are covered ?
Each state designs and runs its own Medicaid program. For this reason, covered services and eligibility requirements vary from state to state. Basic Medicaid health services that all states cover ( at least partially) include:

Inpatient hospital services
Outpatient hospital services
Laboratory and X-ray services
Nursing facility services at a Medicaid-certified facility
Physician services
Medical and surgical services furnished by a dentist
Certified pediatric and certified family nurse practitioners’ services ( others are optional)
Transportation services
Hospice services

Optional Services

In many states, Medicaid may help pay for additional services. Some of the most frequently covered optional services include clinic services, intermediate care facility services for individuals with mental retardation, optometrist services and eyeglasses, prescribed drugs, case management services, prosthetic devices and dental services.

Medicaid Eligibility

Each state sets it’s own eligibility requirements. If an individual does not receive aid from Federal assistance program, Medicaid determines eligibility based on income and resources. (The amount of income and resources can vary according to what levels federal law allows for certain groups, such as the aged, pregnant women or children.) The financial eligibility standards that govern Medicaid eligibility allow individuals, a couple or a family to keep small amount of income and resources.

To establish income levels for Medicaid eligibility for a medically need person,  the state sets an amount that it considers to be the minimum cost of the basic necessities of living (adjusting for family size). If the family income is beneath Medicaid standards, members of the family may be eligible for Medicaid benefits.  (Income of medically needy persons is reduced by their medical expenses before being compared with the Medicaid standard to determine eligibility.)  Usually, resources such as a house, a car and limited amounts of other property are not counted in determining resource levels.

To receive Medicaid coverage for hospital or nursing home services, states require that the applicant meet basic medical criteria.  Staff at the hospital or nursing home can assist with completing necessary forms and providing proof of medical need or financial eligibility.

Medicaid Qualifying Trusts

The Omnibus Budget Reconciliation Act of 1993 made policy on Medicaid-qualifying trusts obsolete for all trusts established on or after August 11,1993. The law is very complex and specifically covers several types of trusts. Before setting up a trust or transferring funds, individuals should seek advice from an attorney.

Medicare Premiums

Medicaid pays the Medicare premiums, deductibles and coinsurance for certain low-income elderly and people with disabilities in the Medicare Part A Hospital Insurance program and the Medicare Part B Medical Insurance program. The provision applies to individuals with income under 100 percent of federal poverty line.  Medicaid also  pays premiums for people whose incomes are between 100 percent and 120 percent of the federal poverty line.

In addition, Medicaid pays premiums for Medicare Part A coverage for certain working people with disabilities. These are people who have income below 200 percent of the federal poverty line and limited resources, but whose income and resources render them ineligible for Medicaid.

Paying for Services

States pay providers directly for Medicaid health care services. State generally require individuals to apply any monthly income (i.e., Social Security) they receive to cost of services, except for a specified amount for personal needs. Providers such as hospitals, nursing homes and physicians must the accept Medicaid rate as payment in full. States also have the option of imposing nominal coinsurance or deductibles for certain services.

Applying for Medicaid 

Anyone may apply for Medicaid by completing an application provided by the state( information is confidential). Individuals who especially should apply:

Are pregnant and have a low income.
Have dependant children and a low income.
Have high medical costs in relation to income.
Are elderly, blind or disabled with little or no income.

In most states, individuals may apply for Medicaid at the local state welfare, public health or social service agencies.  Call the local welfare office for an appointment and more detail on Medicaid application process. Your local Social Security district office can refer you to the local welfare office. A representative will help complete the application and will advise of additional, necessary documents. Also, a recent federal law requires states to take applications at certain additional locations including federally qualified health centers and hospitals serving large numbers of low income patients. 

Items generally needed when applying for Medicaid are:

Proof of income (proof of wages or earnings, Social Security or veterans benefits, private pension benefits, royalty or rental payments, railroad retirement benefits, civil service annuities, state or local retirement benefits, gifts or contributions, state or local retirement benefits, gifts or contributions, wages or earnings of relatives living in the same household etc.).
Proof of resources( proof of bank accounts and certificates of deposit, real property, life insurance policies, burial plots and funds, stocks and bonds, oil/gas/mineral rights, jewelry and antiques, cars/vehicles).
Proof of residency, unless homeless (utility bill, property tax receipt, photo identification with current address, etc.).
Proof of U.S. citizenship or alien with approved status (birth certificate, voter’s registration card, Social Security card, passport or legalized or permanent resident alien card.)
Proof of disability, if any (bring any medical records). The state must decide eligibility within 45 days (for individuals with disabilities the same time frame is longer). If applying through the Supplement Security Income program , there is no time limit. Applicants have the right to appeal the state’s decision.

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