Medicaid is a social welfare program designed to provide access to medical care to those who would otherwise be unable to get the medical help they need to stay healthy or to care for themselves in time of injury or illness. The Social Security Act of 1965 established the Medicaid program, which has evolved over the years to cover millions of families within the United States and provide them with a form of health insurance that allows them to get care. In many states, Medicaid actually contracts out much of the coverage to HMOs such as Blue Cross and Independent Health, which manage the insurance for Medicaid recipients. Although Medicaid is designed as a social welfare program to help the public, it is not available for everyone. Only people who meet certain qualifications can obtain medical coverage under the Medicaid program.
Criteria
The principal criterion for Medicaid eligibility is limited income. The health program principally serves those with low income and limited financial resources. However, poverty does not automatically qualify a person for Medicaid. He must also fall into one of the eligibility categories.
Furthermore, even when an individual falls into one of these eligibility groups, he still has to meet certain requirements that may take into account factors such as income, resources, age, blindness, disability, pregnancy and status as a U.S. citizen or a legal immigrant. The rules regulating income and resources vary significantly from state to state and from group to group. In short, determining one's eligibility for Medicaid is not a cut-and-dry matter, and it may be advisable to speak with a representative in your state who can guide you through the process.
General Qualifications
Certain groups are generally considered to be eligible for Medicaid if they meet maximum income restrictions in their states and if they fall into one of several general categories. For example, pregnant women and the resulting child are covered by Medicaid as long as their family income is below the state maximum levels for Medicaid. It does not matter whether the woman is married or single. Children under 18 are qualified if their families have limited family income. Teens living on their own (emancipated minors) can qualify for Medicaid as well, and in some states are considered to be qualified until their 21st birthday.
Finally, people over 65, who are blind or who are disabled are considered to be generally qualified if their incomes are under state maximums. Persons who are aged, blind or disabled, and are terminally ill and want to get hospice services are also qualified. So are those who live in a nursing home and have limited income and resources, as well as those who need nursing home care but are able to stay at home if given special community care services. Those who are eligible for Medicare and have limited income and resources should also apply for Medicaid.
Other Ways to Qualify
Parents who have a child who is injured or disabled who would require nursing home care are covered if they stay home with the child instead of sending the child to a nursing home (this is a special qualification).
Other eligible people include people or families who are leaving welfare and need health coverage, and people with very high medical bills that they cannot afford to pay (for example, patients diagnosed with cancer or other very expensive illnesses).
Mandatory Eligiblity
Medicaid is jointly funded by states and the federal government but is managed by the states. To qualify for funds from the federal government, states are obliged to provide Medicaid coverage to the majority of people who receive assisted income payments from the federal government as well as to other related groups. These groups include low-income families with dependent children who qualify in their state's Aid to Families with Dependent Children (AFDC) program, recipients of Supplemental Security Income (SSI), and those who receive Social Security or veterans (VA) benefits. States must also cover infants born to pregnant women who are Medicaid-eligible, children below the age of 6 and pregnant women whose family income is 133% (or below) of the poverty level defined by the federal government. Finally, states must cover individuals who receive adoption assistance and foster care under the Social Security Act and certain people who are on Medicare. Finally, specific protected entities are allowed Medicaid coverage for a period of time (such as people who lose SSI payments on account of income from work or augmented Social Security benefits.)
Why You Must Meet Eligiblity Criteria
In the United States as of 2009, health insurance is not provided by the state as a general matter. Health insurance is purchased by individuals or employers and is run as a private enterprise. Most health insurers operate for-profit and health insurance is very expensive. Because the US uses a free market system for health care, the government does not provide health coverage to all citizens. As a result not every citizen can be on Medicaid. However, because of high health care costs, low-income individuals and families are often unable to pay for health insurance on their own. To avoid the social problems that arise when a class of people is denied access to medical care, the government has established the Medicaid program to provide aid. It would be expensive and outside the scope of the program to provide this type of insurance coverage to all citizens, so the eligibility requirements are in place to ensure that the program serves its purpose of providing health care to the poor.
