Medicaid Coverage Questions

Medicaid, the federal program designed to offer health care to low-income and otherwise needy individuals, helps pay all or part of the cost of medical care and treatment. Eligible individuals include those with a demonstrated need, those over the age of 65 and those suffering from disability or illness. Though each state determines specific guidelines, such as those concerning co-payments, some basic tenets established by federal guidelines apply to Medicaid programs across the country.

Who Qualifies for Medicaid?

• The categorically needy, medically needy and those suffering from special circumstances can qualify for Medicaid. Categorically needy individuals have an income at or below the federal poverty guideline. As of 2009, the federal poverty guideline for a family of four was $22,050, according to the U.S. Department of Health & Human Services. Calculations to determine if your income falls below the poverty line also include assets, such as checking and savings accounts, property and certain investments. Those eligible under the medically needy provisions include those over the age of 65, blind persons, disabled persons and children under 21 attending school full-time. Eligibility under the special circumstances provision allows for Medicaid coverage for tuberculosis patients and for women battling breast or cervical cancer.

What Type of Coverage Is Best?

• Medicaid provides coverage for doctor's visits, routine exams, emergency room visits and surgical procedures for eligible participants. Health services for pregnant women are also covered, including the costs of doctor visits during pregnancy and after delivery. Medicaid pays hospitals and doctors directly for the care they provide. Each state determines how much, if any, co-payment a covered individual must pay for services treated. The program allows for retroactive eligibility periods, so that qualified individuals can receive help from Medicaid for services rendered up to three months prior to actual enrollment. In addition, Medicaid also covers medical care and treatment related to home health care services, dental care and eye care for eligible individuals.

What Else Should I Know?

• Contact your state's Medicaid office or Job and Family Services office for information related to eligibility, coverage and special circumstances. Your individual state Medicaid program will make the final determination on acceptance. Other individuals who may qualify for Medicaid coverage include those suffering from a terminal illness in need of hospice care, teenagers living on their own and children of parents who do not meet qualification requirements. The Medicaid program also helps pay for Medicare premiums for qualified individuals. To qualify, individuals must have an income at or below the federal poverty guideline and meet the Social Security Administration's restrictions related to resources.