Medicaid Insurance Information

Medicaid is a federally subsidized, state-run health and welfare program that provides medical care for the poor and indigent. It covers the disabled, low-income adults and their dependents, and provides nursing home services for seniors who have exhausted their own financial resources.

History

• Medicaid was signed into law in 1965, with President Lyndon Johnson's signature on the Social Security Act of 1965. Medicaid, together with Medicare, was part of Johnson's "Great Society" program. Congress amended the program with the Medicaid Drug Rebate Program in 1990; it required pharmaceutical companies to enter special pricing agreements with Medicaid officials, subsidizing prescription drug coverage for Medicaid recipients.

Services

• Specific programs vary by state, but generally Medicaid provides emergency and catastrophic medical care, health maintenance services, mental health care, nursing home services to selected seniors, including home care, physical therapy, occupational therapy and adult day care services.

Eligibility

• States set their own specific eligibility requirements. Medicaid is primarily a means-tested program, though poverty is only one criteria. To be eligible for Medicaid, beneficiaries must also demonstrate they are members of one of a number of specified "eligibility groups." These groups include children under age 6 and pregnant women whose family income is 133 percent of the federal poverty line or less, SSI-recipients, recipients of adoption assistance and foster care, and certain Medicare recipients. Some states also extend coverage to low-income, uninsured women identified under the Centers For Disease Control's Breast and Cervical Cancer Early Detection Program and provide expanded coverage for children of low-income families. To qualify, you must be a U.S. citizen or legal resident. Children of illegal immigrants are covered if the children are citizens or legal residents, even if their parents are not covered.

Medicaid Fraud

• Many families attempt to transfer assets out of elderly individuals' names to qualify them for Medicaid. However, the law allows states to "look back" up to 60 months and disallow any transfers or gifts made in that period of time. Certain assets are considered "non-countable" for Medicaid eligibility purposes. For example, states may allow the family to keep a certain amount of home equity, life insurance or a car, or enough to provide for a spouse not receiving Medicaid.

Asset Recovery

• States will sue the estates of deceased Medicaid recipients to recover any Medicaid funds paid on their behalf, and it frequently places liens on family homes to recover assets for the taxpayer. Common measures include placing liens on family homes and other property to prevent passage of assets through probate to heirs before the debt to Medicaid is clear. Some states, however, have established "long-term care partnership programs," which exempt a portion of assets from Medicaid recovery if the recipient also owned a long-term care insurance policy.