Medicaid is a health insurance program that provides free coverage for low-income individuals and families. Each state manages an individual Medicaid program and has some control over who qualifies and which services are covered, according to the U.S. Department of Health and Human Services. The state programs are overseen by the federal government to ensure compliance with U.S. laws.
Who Is Eligible?
Medicaid eligibility is determined by the household size and the income and resource levels set by the state department overseeing the program. A person who makes too much money to qualify for Medicaid in one state can be eligible in another state. Certain persons, as defined under federal law, must be allowed to receive Medicaid regardless of income levels, including children born to women who are eligible and persons receiving federal adoption or foster care assistance.
What Coverage Is Available?
Medicaid coverage for persons over 21 is a combination of federally required services and optional services the state elects to cover, if any. The mandated services include physical wellness exams and emergency services but not dental or eye care.
Persons under the age of 21 have a wider range of coverage set forth in federal law, as part of the Early and Periodic Screening, Diagnostic and Treatment benefit. States must provide dental and eye care for recipients under the age of 21.
What Is the Application Process?
A person who wants to receive Medicaid must apply to the county department responsible for managing enrollment, usually the local department of social services or family services. A variety of information is requested on the application, including household income and the identities of all members. The form must be submitted to the department with proof of identity, income, living circumstances and expenses for the entire household. An interview with a caseworker is typically required, and the applicant may be asked for additional information and clarification about the information she entered on the form.
What Is the Medically Needy Program?
Some states allow a person with expensive medical needs to receive Medicaid even if his income is too high to qualify. A person using the medically needy option pays a certain amount of his own medical expenses per month, until his income is below the state eligibility level, or "spent down." Medicaid then covers his remaining medical costs for that month.
