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What is Medicaid?

  • While sometimes confused with Medicare, Medicaid is a separate government health insurance program for individuals and families with low-income
  • Medicaid can cover disabled adults and children in households that are below certain income levels
  • Medicaid offers first-payer or supplemental coverage for many medically necessary services.
  • People already receiving Supplemental Security Income (SSI) can also qualify for Medicaid
  • Medicaid is jointly funded by state and federal governments, so benefits may vary by state

How is Medicaid Funded?

The state and the federal governments jointly fund Medicaid, but the states organize it.

Correspondingly, Medicaid operates at the state level, meaning each state has its own Medicaid program. Therefore, the program’s scope and management can vary significantly from state to state.

Federal and state legislators as well as administrators of Medicaid determine funding requirements. Crucially, they decide which services will be available and how much providers will pay for them. That can mean critical programs regularly become subjected to funding changes.

According to the Centers for Medicare and Medicaid Services, the federal government covers about 80 percent of the cost of people insured by Medicaid, depending on the state.

Dual-eligible beneficiaries are those who qualify for both Medicare and Medicaid. These individuals may also qualify for specific Medicare Advantage plans that are pre-coordinated with their Medicaid benefits.

Children get coverage through the Children’s Health Insurance Program (CHIP).

Defined by state, it provides coverage for children under 18 in households with income up to 400% of the Federal Poverty Level (FPL). CHIP also provides coverage to children with pre-existing conditions such as cancer.

Medicaid

Is Medicaid part of Medicare?

Medicaid and Medicare are two separate health care programs.

The federal government exclusively handles Medicare. Medicaid comes through joint efforts of the federal government with state governments.

While Medicare benefits start at age 65, or earlier for disabled individuals, no age restriction exists for Medicaid benefits.

Often, we regard Medicare as care for seniors, whereas Medicaid gives aid to those who need it.

They are separate programs, but some people qualify for both Medicare and Medicaid.

Medicaid

Understanding Medicaid Eligibility

Medicaid along with the Children’s Health Insurance Program (CHIP) provide health care coverage to approximately 72.5 million Americans. Of these, 9.6 million are children covered under CHIP.

Overall, those covered can include children, pregnant women, parents, seniors, and individuals with disabilities.

While Medicare may be more identifiable, Medicaid is the single largest health coverage source in the United States, according to Medicaid.

Medicaid

Who is covered by Medicaid?

There are three categories of individuals who have to be provided Medicaid coverage by the states. They include:

The various states can provide additional coverage, such as:

  • Individuals receiving home and community-based services
  • Children in foster care
  • Nursing home assistance
  • Inpatient hospital services, such as room and board, drugs, lab tests, and other benefits when staying in a hospital
Medicaid - Affordable Care Act

Medicaid Expansion

Through the availability of Medicaid expansion offered at the state level by the federal government and the Affordable Care Act, the states can provide health services to more people.

At present, 38 of the states and the Washington, D.C. area have adopted the Expanded Medicaid programs.

  • Medicaid and Medicare are separate programs.
  • Learn more about Medicaid by visiting our listed references.
  • If you have questions about Medicare coverage, feel free to call our hotline.
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