Medicaid

Medicaid

Medicaid
Medicaid is a U.S. government program that helps pay for medical costs and health care for certain individuals, including those with low income and low resources, children, the disabled, pregnant women, the blind and the elderly. Medicaid insurance is jointly funded by the federal and state governments. Each state administers its own Medicaid program, so Medicaid eligibility requirements vary. Learn more about how to qualify for Medicaid and healthcare resources available with expert advice from Sharecare.

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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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    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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    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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    A , Nursing, answered
    Medicaid is a benefit program which is primarily funded by federal dollars and whose monies are administered separately by each state; therefore, the rules vary from state to state. For specific rules, consult an attorney that specializes in elder law. Consulting an attorney specializing in this form of law is definitely worth the investment because they are so many rules and the planning must be put into affect at least 5 years before a patient has need of long term care. Medicaid is probably the payment form that is utilized the most. In order to be eligible for Medicaid, there must be proof of medical necessity. Medicaid does provide coverage for Alzheimer's, Parkinson's and other dementias and there must be financial eligibility. When determining qualification for Medicaid, exempt and non-exempt (or countable) assets will be examined. Exempt assets are those which Medicaid does not take into account when determining eligibility. These include a primary home which is the principal residence, personal belongings and household goods, one car or truck (even if married), burial spaces and items related to burial for both applicant and spouse (there is a maximum amount that can be designated, so again, check with your own state's rules), irrevocable prepaid funeral contract (it must be irrevocable or it does not qualify), a life insurance policy with a limited face value (again, check with your own state for the maximum allowable face value), and a monthly income of $2022 if single or $4044 if married. Special needs trusts for survivors (for instance, if a child with cerebral palsy or other handicap needs to continue to be provided for ) are also exempt. Additionally, in some states, a home may be placed in trust for a disabled child to continue to live in after their parent dies.
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    To apply for Medicaid in your state, contact your local Medicaid office. Some states let you apply on the Internet, by telephone, or at locations in the community, such as community health centers. By contacting Medicaid directly, you can get state information.
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    A , Internal Medicine, answered
    Some people with ADHD may qualify to get Supplemental Security Income (SSI) benefits. First, you or your child must be classified as disabled by ADHD based on the federal definition. Next, you must meet the financial requirements based on family income. These rules get as technical as an official review of a play in football, so to find out if you qualify for SSI, check with your local Social Security office.
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    If you are interested in getting Medicaid, go to:
    Centers for Medicare and Medicaid Services
    Web site: www.cms.hhs.gov/MedicaidGenInfo
    Medicaid is a federally funded, state-run program that helps people and families who have very limited incomes and resources. It pays for health care costs, including doctor visits, hospital visits, and prescription drugs. Income cut-offs, asset limits, and benefits vary from state to state. In some states, it may have different names (TennCare, Medi-Cal, etc.) Contact your State Health Department by phone for more information. (It is listed in the blue pages of your local phone book.) You can find your local office by visiting.
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    To qualify for Medicaid, an individual must meet financial criteria or may be a member of a group that is "categorically eligible" for the program, such as low-income children, pregnant women, the elderly, people with disabilities and parents. Federal law mandates coverage of some groups below specified minimum income levels, but also gives states broad optional authority to extend Medicaid eligibility beyond these minimum standards. The flexibility that states have to establish their own eligibility rules has produced wide state-to-state variation in who and how many are covered by Medicaid.
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    A , Nursing, answered

    The following are guidelines published by Medicaid services on home care.

    Federal Coverage and Eligibility Requirements for Medicaid Home Health Services

    The mandatory home health services are: (a) nursing services provided on a part-time or intermittent basis by a home health agency that meets requirements for participation in Medicare; (b) home health aide services provided by a home health agency that meets requirements for participation in Medicare; and (c) medical supplies, equipment, and appliances suitable for use in the home. The optional home health services are physical therapy, occupational therapy, and speech pathology and audiology services.

    • All services offered under the home health benefit are mandatory for all Medicaid beneficiaries entitled to nursing facility services under a state plan. This includes (a) categorically eligible persons age 21 and over, (b) persons under age 21 if the state plan provides nursing facility services for them, and (c) medically needy persons if the state plan provides nursing facility services for them.
    • Services must be ordered by a physician as part of a written plan of care that the physician reviews every 60 days.5
    • Services must be provided at the recipient’s place of residence, which does not include a hospital, nursing facility, or ICF/MR.
    • Eligibility of beneficiaries to receive home health services does not depend on their need for, or discharge from, institutional care.
    • States may place coverage limits on home health services if the limits are based on considerations related to medical necessity or utilization control.

    For more information, call your local state Medicaid office. 

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    Currently, not one state in the U.S. ensures that their Medicaid population is properly screened for gestational diabetes, or diabetes during pregnancy. Gestational diabetes affects both mom and baby. Half of women diagnosed with gestational diabetes will be diagnosed with type 2 diabetes within a decade of pregnancy. About 12% get type 2 diabetes within a month of pregnancy. Her child also has an increased risk of type 2 diabetes. The Gestation Diabetes Act (or GEDI Act. S.84) is proposed legistion asking for these important screenings to take place in addition to seeking and expanding public health research on gestational diabetes as a whole. However, it has no major organization backing it as a legislative priority.