An Overview of Medicaid

Understanding Medicaid can be overwhelming at times especially as the laws can change annually. It is important to stay on top of your coverage and know your rights. You may be missing out on certain benefits that you didn’t even know you were eligible for.

What is Medicaid?Medicaid

There is often a confusion between Medicaid and Medicare.  Medicaid is a federal and state welfare program of medical assistance for low-income individuals regardless of their age.  In order for a person to qualify for Medicaid, they must be within a certain income level that is often difficult to meet.

Medicare is a national health care program that provides medical coverage to U.S. residents over the age of 65. Those under the age of 65 with certain disabilities and individuals with end-stage renal (kidney) failure may also qualify for Medicare benefits.

Coverage under Medicaid varies from state to state, so it is important to check your state rules since each state creates its own eligibility requirements.

How does one qualify for Medicaid?

In order to qualify for Medicaid, you must fall into one of the following groups: categorically needy, medically needy, or in a special group. Below is a brief description of each of these groups, but details may vary from state to state so check your state Medicaid office to learn more.

  • Categorically Needy: covers families with children who meet eligibility requirements, such as living in poverty status. In addition, categorically needy applies to pregnant women and children under six whose income is below the poverty level; children up to age 19 (if family is meets poverty level requirements); and disabled people or people who live in medical institutions.
  • Medically Needy:  covers pregnant women, some children and newborns who have medical needs but since their income or family’s income is too high to categorically qualify, they fall into this group. Seniors ages 65 plus and disabled persons also may fall into this group, it mainly depends on income and how much savings you have.
  • Special Groups:  covers people who have certain diseases and eligibility varies from state to state.

Who pays for Medicaid?

Medicaid is funded by both federal and state governments (so really we all pay for it with taxes) and is designed to act as an additional insurance plan; meaning in theory, you should have some other kind of coverage.

If you are in the process of determining your eligibility and need help, visit the Department of Health and Human Services (HHS) or call 1-800-633-4227.

Written by gerontologist Melissa Schulz