Medicaid

Medicaid

For individuals with low income and low resources, for children, the disabled, pregnant women, the blind and the elderly, medical assistance may be able to pay for both preventative care and standard services. Created by Title XIX, United States Code, Medicaid is the government's heath care of last resort for those who qualify. While different groups may have different eligibility requirements, all are means tested. Medicaid does not cover all poor people. You must be in one of the covered groups. Many states however do have some type of coverage that will help even those not eligible for Medicaid. Medicaid may take into account not only income and resources, but the levels of medical expenses.

Recently Answered

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    AJoane Goodroe, Nursing, answered
    The new law has changed the requirements for Medicaid and depending on your income, you might be eligible. Anyone with an income at or lower than 138 percent of the federal poverty level, (about $16,000 for an individual or $32,500 for a family of four based on current guidelines) would be eligible for Medicaid. However, the Supreme Court ruled in June 2012 that states cannot be forced to make that change. As of December 2012, 25 states and the District of Columbia have chosen to expand Medicaid.
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    Generally, people with diabetes should apply for Medicaid if their income is low and they are one of the following:
    • pregnant
    • 65 years old or older and eligible for Medicare, but have extremely low incomes and limited resources
    • blind
    • disabled
    If a person with diabetes is not sure whether he/she qualifies for Medicaid, he/she should apply for Medicaid and have a qualified caseworker in his/her state evaluate the situation.
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    Early and periodic screening, diagnosis and treatment (EPSDT) Medicaid services are required for the categorically qualified under age 21, but optional for medically needy (those who qualify as a result of high medical expenses that reduce income below a state's Aid to Families with Dependent Children (AFDC) limit).


    Required EPSDT dental services: 

    • Screening: Screening services provided at intervals meeting reasonable dental standards, and at such other intervals to determine illness and which shall, at a minimum, include dental services that are provided at intervals meeting reasonable dental standards and at other intervals as medically necessary to determine the existence of illness, and which shall, at a minimum, include relief of pain and infections; restoration of teeth; and maintenance of dental health. Although an oral screening may be a part of a physical examination, it does not substitute for examination through direct referral to a dentist. A direct oral referral is required for every child in accordance with a state's periodicity schedule and at other intervals as medically necessary.
    • General care: Dental care, at as early an age as necessary, needed for relief of pain, infections, restoration of teeth, and maintenance of dental health.
    • Emergency services: Services necessary to control bleeding, relieve pain, eliminate acute infection; operative procedures which are required to prevent pulpal death and the imminent loss of teeth; treatment of injuries to the teeth or supporting structures; palliative therapy for pericoronitis associated with impacted teeth.
    • Preventive Services: Instruction in self-care oral hygiene procedures; cleanings; sealants when appropriate to prevent pit and fissure caries.
    • Therapeutic Services: Pulp therapy for permanent and primary teeth; restoration of carious permanent and primary teeth with silver amalgam, silicate cement, plastic materials and stainless steel crowns; scalings and curettage; maintenance of space for posterior primary teeth lost permanently; and provision of removable prosthesis when masticatory function is impaired or when existing prosthesis is unserviceable; and orthodontic treatment when medically necessary to correct handicapping malocclusion.
    • Nursing Facilities: Nursing facilities must provide routine dental services (to the extent they are covered under the state plan) and emergency dental services to meet the needs of each resident.
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    Medicaid covers a broad range of services to meet the complex needs of the populations it serves, particularly the elderly and people with disabilities. Because Medicaid beneficiaries have limited financial resources, cost-sharing is limited and not permitted for children and pregnant women.
    State Medicaid programs must cover the following:

    • Inpatient and outpatient hospital services
    • Physician, midwife & certified nurse practitioner services
    • Laboratory and x-ray fees
    • Nursing home and home health care
    • Early and periodic screening, diagnosis, and treatment (EPSDT) for children under 21
    • Family planning
    • Rural health clinics/federally qualified health centers

    States have the authority to cover additional, optional services and receive federal matching funds.

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    AUnitedHealthcare answered

    Generally speaking, Medicaid will cover either a portion or all of the cost of medical devices, drugs and actual clinical trials if they approved by the Food and Drug Administration (FDA). In order to be reimbursed, the drug or device must meet certain classifications set by the FDA based on intended use and risk to the patient and user.

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    AUnitedHealthcare answered
    Seniors over the age of 65 can find discounts on their prescriptions at certain pharmacies.
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    AUnitedHealthcare answered

    Generally, Medicaid pays to distribute and dispense the drugs to covered individuals. They must cover the distributor and pharmacy cost of acquiring the drug from the manufacturer and the cost of distributing and dispensing it. These costs include generic drugs. If you have Medicare, you may also have coverage through your Medicare drug plan. Check with your state’s Medicaid program to find out more about prescription drug coverage.

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    AUnitedHealthcare answered

    Medicaid covers certain low-income families including the elderly and disabled, but parents of children who are covered cannot use Medicaid. Also, illegal immigrants are not allowed to use Medicaid. Some states may offer Medicaid coverage to adults without children and other special populations. Check with your state's Medicaid program about specific requirements.

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    AUnitedHealthcare answered

    You will need to show your Medicaid card at the doctor's office. If you have Medicare, you will also need to show your Medicare card.

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    AUnitedHealthcare answered

    To apply for Medicaid, visit the website of the Medicaid office for your state to find out how to complete an  application. Some states may offer an online application on their website, or you can schedule an appointment with your local Medicaid office to complete the application in person. Generally, the application will ask you to provide the names and Social Security numbers of everyone in your household, along with income information. A Medicaid representative will schedule an interview (phone or in person) to gather additional information about your finances, bills and medical expenses. Be prepared to provide last year's tax returns, bank statement and check stubs plus a utility bill to verify your address and your driver's license. Once the interview has been completed, you should receive a notice of your eligibility within 30 days.