Medicaid

Medicaid is a health insurance coverage option for many in the United States. Having health care is important for every American, but applying for health insurance can be a difficult task to navigate. Health insurance coverage can sometimes be too expensive for families to afford. That is why the government provides insurance coverage options for low-income families through the Medicaid program. Today, more people are eligible for Medicaid than ever before due to the Affordable Care Act, which covers more than 72 million Americans.

Eligibility for coverage under the Medicaid program varies by state. Those who are not sure if they qualify for Medicaid benefits are encouraged to apply in order to not miss out on assistance, as decisions on Medicaid applications are made on a case-by-case basis. Continue reading to find out more about Medicaid, how it can benefit you and how you can enroll in the program.

What is Medicaid?

Medicaid is a federal program originally created to offer health care to those who are unable to work, including senior citizens, disabled persons and single-parent households. Although Medicaid is federally established, individual states manage and regulate their own programs. Many states have expanded their Medicaid programs to cover children, pregnant women and families living below the federal poverty line. Residents who are eligible for Medicare may also be eligible for Medicaid. Both Medicare and Medicaid can be used together for health coverage. However, not everyone is eligible for Medicaid assistance benefits, so it is important to know what your state’s Medicaid eligibility requirements are.

Income Eligibility for Medicaid

As Medicaid is a cooperative program ultimately controlled by state governments, eligibility requirements vary from state to state. Federal law sets basic mandatory requirements that states must follow to participate in the Medicaid program, such as providing coverage for those with disabilities, pregnant women and children. However, states have the option to extend eligibility to other groups outside of the mandatory eligibility groups, like low-income adults.

Under the Affordable Care Act, Medicaid eligibility is determined using an applying household’s Modified Adjusted Gross Income, or MAGI. MAGI is also used to determine eligibility for other programs and benefits, such as the Children’s Health Insurance Program, income tax credits and educational benefits, making it easier for individuals to apply for the program that is best suited to them.

For certain groups, it is not necessary to calculate Medicaid eligibility based on MAGI. Any individual receiving Supplemental Security Income (SSI) is automatically eligible for Medicaid benefits. Children who are part of an adoption assistance program or adults who are former foster care recipients are also eligible for Medicaid regardless of income level.

Other Medicaid Eligibility Requirements

Most eligible Medicaid recipients meet both financial and non-financial eligibility requirements. Aside from income level, residency is also a factor in an applicant’s eligibility. An applicant must be a legal resident of the state in which he or she is applying for Medicaid. Applicants must also be a citizen of the United States or an eligible non-citizen resident. Certain eligibility groups are also restricted to certain age limits, or whether an individual is pregnant or a parent.

Medicaid Benefits

Just as with eligibility requirements, federal law establishes guidelines for benefits that states are required to offer in their Medicaid programs, as well as optional benefits they may offer eligible residents. Medicaid benefits offered vary by state, as states can choose to offer any of the optional benefits. State Medicaid programs can change at any time, so benefits that are not currently offered in a state may be added at any point.

Below is a list of some of the mandatory benefits state Medicare programs must provide:

  • Inpatient and outpatient hospital visits
  • Physician services
  • Rural health clinic services
  • Family planning services
  • Nursing facility services

How to Apply for Medicaid

Since Medicaid is a joint program between federal and state governments, applications differ slightly by state. As each state has its own eligibility requirements, applications will involve varying amounts of necessary information.

There are two main ways to apply for Medicaid coverage: applying through your state’s application method and applying through the Health Insurance Marketplace. When applying through the Health Insurance Marketplace, applicants who are eligible for Medicaid are forwarded to state Medicare programs for enrollment. Though this method is not as direct as applying through the state, it allows applicants that are ineligible for Medicare to review other health care options they may be eligible for.

To apply for Medicaid, certain documents need to be submitted to verify eligibility. Some of the required documents for applying are:

  • Proof of citizenship and residency – Applicants must submit documents that prove their citizenship or legal permanent resident status. Some accepted proofs are a U.S. passport, certificate of naturalization and permanent resident card.
  • Proof of identity – Acceptable proof of identity documents include a U.S. passport, state-issued driver’s license, school ID card and U.S. military card.
  • Proof of income – Those applying for Medicaid must submit financial documents proving low-income status. Some acceptable proofs of income are a recent pay stub, a Social Security awards letter and an unemployment check stub.

Medicaid Enrollment Strategies

With the implementation of the Affordable Care Act came several changes to the way the Medicaid program is run by states. One of those changes concerned the methods by which states accept applications and enroll eligible applicants for Medicaid coverage. These strategies, suggested by the federal government for states to choose and use at their discretion, make the Medicaid enrollment process much more efficient. The five strategies that states could choose from are as follows:

  • Early adoption of MAGI rules – This allowed for states to implement the use of Modified Adjusted Gross Income to help streamline the process of determining eligibility.
  • Extending renewal periods – This option would permit states to extend renewal periods for certain Medicaid recipients.
  • Enrollment through assistance program data – Applications from individuals who were already eligible for other assistance programs, such as the Supplemental Nutrition Assistance Program, would be processed and enrolled automatically.
  • Enrollment of parents through child eligibility – Parents of children who were already eligible for Medicaid or CHIP would be considered eligible for Medicaid.
  • Use of 12-month eligibility periods – Use of this method would allow states to guarantee adult Medicaid recipients a full year of coverage despite any changes in the recipients’ circumstances.