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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    A , 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.