Changes to the U.S. health-care system under the Affordable Care Act increased the number of Americans who are eligible for Medicaid coverage. The legislation also made improvements to the Medicaid program, according to the federal government's website Medicaid.gov. To understand the program and eligibility, it helps to know what Medicaid is, whom it covers and what benefits are available.
What It Is
Medicaid is a government-funded health-care program designed to help pay medical expenses for those who otherwise cannot afford comprehensive coverage. The Medicaid program is financed by both federal and state governments, though each state runs its own program and sets its own eligibility rules. Although the guidelines and application process may differ somewhat from one state to another, certain standards apply across the board.
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Whom It Covers
The Medicaid program provides health insurance coverage to a diverse population across the United States. This includes millions of low-income seniors, people with disabilities, low-income families with children and pregnant women, among others. For low-income seniors, Medicaid fills in the gaps left by Medicare, as most seniors who receive Medicaid benefits also receive Medicare. For example, Medicaid covers nursing home care, some personal care services and some prescription drugs not typically covered by Medicare policies, according to Medicare.gov.
Eligibility requirements are based on need. In some states, all adult residents who meet income level requirements are eligible for Medicaid coverage, according to Healthcare.gov.
What It Covers
What the federal government calls "mandatory benefits" are medical costs covered through Medicaid regardless of the beneficiary's state of residence. These standard benefits include inpatient and outpatient hospital care, physician care, laboratory tests, X-rays and home health services. Family planning and midwife services are additional mandatory benefits. Medicaid also covers skilled nursing care, long-term nursing home care and rehabilitation services provided by state-certified Medicaid nursing facilities.
Optional Medicaid coverage benefits vary from state to state. Examples of optional services some state Medicaid programs provide include help with the costs of prescription drugs, optometry services and eyeglasses, dental services and dentures, prosthetics, physical and occupation therapy services and respiratory care.
If you are interested in checking your eligibility for the program and do not know how to begin in your state of residence, the federal government has a website portal that can help. Enter your ZIP code and answer a simple question, and the online software will direct you to the proper agency in your state.