Health Care

Medicaid FAQ's

What is Medicaid?

Medicaid is a government program that assists low-income individuals and families in paying for medical treatment and preventative care. Medicaid is partially funded by the federal government, but administrated by the state governments. So in reality Medicaid is not a single program so much as it is fifty separate programs. This means that eligibility, application requirements, and coverage vary depending on where you live.

What does Medicaid cover?

There are services that every state is required to cover with Medicaid funds, including:

  • Inpatient and Outpatient hospital care
  • Doctor’s Office Visits
  • Pediatric Visits
  • X-ray and lab services
  • Prenatal care
  • Family planning services (including abortion)
  • Children’s vaccinations
  • Home health care services
  • Nursing home services

While the federal government does not mandate prescription drugs, dental care, and emergency hospital care coverage, many states do cover these expenses as well. Check with your state Medicaid program to find out if these expenses are covered.

Am I eligible for Medicaid?

The federal government requires states to cover people in certain circumstances, which you may or may not qualify for, depending on how long your unemployment has lasted. The mandatory coverage groups include:

  • Limited income families with children
  • Supplemental Security Income (SSI) recipients
  • Recipients of adoption assistance and foster care
  • Some Medicare recipients

Again, states are required by the federal government to cover these individuals, but they may cover individuals in other circumstances. Check with your state Medicaid program to find out if you qualify.

What do I have to pay?

Because Medicaid is intended to assist low-income families, you do not have to pay monthly premiums as you would with other insurance plans. Some services require co pays from the patient, but these are often lower than other insurance co pays.

How does Medicaid pay claims?

Doctors who treat Medicaid patients bill the state, which pays them directly.

How do I apply for Medicaid coverage?

Apply with your local state health and social services department.

What if I am denied coverage?

If your Medicaid application is denied, you do have right to an appeal, and an eligibility hearing. You can also bring a lawyer along to help you prepare and argue your case, but the state will not likely appoint a free one for you.

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