Medicaid

Medicaid is for low income individuals and families in the United States.  People who can’t afford to pay for healthcare, no matter what age, are able to get the government insurance that is known as Medicaid.  Many people think that Medicaid is the largest source of medical insurance for low income families in the world but it is only in the United States.  Although Medicaid is managed by the states, it is funded by both the federal government and the state governments.  All the states in the United States have a choice if they want to participate in Medicaid, and so far they all do.  In order to qualify for the state’s Medicaid program a person must either be a legal resident of the United States or be a legal citizen.  So many people are asking the question what is Medicaid?  There are also people who qualify who are on disability for several reasons including mental health. 

Medicaid changed on January 1, 2014 by expanding the funding for eligible recipients of Medicaid.  If the state one is living in participates in the new funding a person who is an adult, with or without children can make over the poverty line amount of money and still receive Medicaid.  This is part of the Affordable Care Act that President Barack Obama signed into order during his second term in the White House. The US Supreme court found that don’t have to agree to the new Medicaid benefits and can keep the levels of funding that they have been receiving if they choose to. 

States have been utilizing waivers from the fed under what they call Medicaid managed care. People are under private medical insurance plans that receive payments from the state where the Medicaid recipient resides.  It is kind of like a Medicare HMO advantage plan.  The medical insurance carrier is taking care of the Medicaid person and making sure they are getting the healthcare they need, and also paying the premiums and copays for them.  Many people on Medicaid today are using Medicaid managed care because most of the states in the United States utilize this tool.  Most of the underprivileged children and parents take advantage of the managed care while the disabled and poor over 65 are sometimes in the original Medicaid program. 

Each state in the United States has different requirements when an individual is applying for Medicaid.  Medicaid is supposed to be for low income, but the criteria are a little bit larger than just being poor.  If you are a small child from a significantly poor family that could be a reason, along with pregnant women, parents of Medicaid kids who meet the low income status, and presently low income senior citizens of the USA. Since this is a state run program, you must look at the requirements from the state you reside in to absolutely be sure if you are eligible.  Many people with disabilities, whether it is physical or mental are enrolled in SSI and Medicaid to give them access to free health care.  Anyone with a disability can apply for SSI, although they might not be accepted, if they are able to work and provide a living for themselves.  Many companies require some kind of disability insurance to work for them because of illness or injury. 

Dental services are included in the Medicaid program as many states have it.  If a person is below the age of 21 this service is required, and if they are above 21, the dental insurance is optional.  Dental insurance is a huge topic and Medicaid with dental is due to oral health becoming so important.  Dental health maintenance, some pain relief, and the majority of dental restoration are covered for individuals on Medicaid.  Children that are on Medicaid must receive the minimum dental service required to get early detection and diagnostic treatment with the focus on dental protection and prevention and the treatment of oral medical conditions.  Once a dentist sees a dental condition that needs to be treated the state is required to pay for that treatment.  It doesn’t matter if the condition isn’t normally covered by Medicaid the state has to pay for the treatment. Get yourself a Medicaid application and apply if you meet the criteria for the Medicaid program.  If you want to know the answer to the ultimate question, what is Medicaid, you must contact the local state department for an explanation,   

Many people have not heard of the HIPP program which is an acronym for the Health Insurance Premium payment program.  The popular HIPP is where the private medical insurance is paid by the Medicaid program in that person’s state.  HIPP wasn’t a huge hit in the late 2000’s but they always had this type of Medicare advantage approach for Medicaid in the back burner. 

As part of Social Security Amendments that happened in 1965, Medicaid was formed as a way to give medical care to the lower income families of America.  If a person met the income requirements and other things matched up they could get on Medicaid.  If a person is part of a lower income population, they could possibly on Medicaid.  The CMS program (Center for Medicare and Medicaid Services) is in control of the eligibility, funding, services, quality control and other things that Medicaid does. Medicaid and CMS are the monitors of the state run program. 

Medicaid also deals with the prescription drugs of the lower income families in the US.  The Medicaid Drug Rebate program was formed because of the outpatient drug costs that the Medicaid program was paying.  There were all sorts of amendments made in the early 1990’s to ensure the integrity of the Medicaid program.  Medicaid also implemented a Medicaid state recovery program that made lawsuits against the estates for people who had improper medical bills and costs that were already paid for by the Medicaid system.  

When a child is on Medicaid there are a lot of rules that schools must also follow.  The US Supreme court ruled that a school child that is on Medicaid must get a proper education for free.  This is for special education children that have special needs for their education as well as underprivileged children in the US. If you want to know what is Medicaid and what is CHIP answers please go to the local government office for an explanation. 

Medicaid also has a program for lower income children in the US called CHIP.  This Children’s Health Insurance Program of the United States is a program that gives coverage to a number of children in need. There are many states that have expanded the coverage for children and for lower income families to enable them to receive CHIP and Medicaid.  The Federal Government of the USA passed their mandatory eligibility group that by law must be covered and the states can get some leeway for the optional eligibility groups.  The Federal Government sets the standards for CHIP and Medicaid and the states and the states set the individual eligibility laws for the people.  CMS controls most of the CHIP and Medicaid procedures and changes by them are made frequently. 

A family of four can make up to approximately $30,000 to be in the criteria to meet the Medicaid minimum as signed into order by President Barack Obama in 2010’s Affordable Care Act.  This is also known as Obama Care for many people in the United States of America.  The Affordable Care Act was enacted to help the United States citizens get affordable coverage.  Some have said that the funding has taken away from Medicare and the Medicaid program.  The Affordable Care Act starts in 2014 for the majority of citizens in the USA.  Look for a Medicaid application to see if you can get approved. 

In order to get Medicaid in the USA people must show legal documents of citizenship in the USA, immigration green cards that are legal, poverty level income docs, pregnancy or some other documentation. 

There are currently many waivers that the state can apply for to service the people outside of the normal criteria for Medicaid.  These waivers help people in need that might not qualify for Medicaid but still need the medical coverage.  The CMS can take an application with a waiver to accept these people into the program.

There are certain benefits for Medicaid that fall into mandatory and others that are optional for people that receive the benefits of Medicaid.  Some of the more common benefits include Hospital visits and services and physician visits.  They are covered for all Hospital inpatient and outpatient services and all doctors and medical center visits.  Home health care as of today is also a service that is part of Medicaid and lab and X-ray tests.  Medicaid also gives screening and tests to ensure early detection along with family planning and transportation to and from medical care.  Pregnant women receive medical care with their pregnancy and also with smoking cessation classes if they are smoking while pregnant. 

The optional services that are given by Medicaid are prescription drug plans, and the other therapies such as physical and occupational therapy.  Other things that are optional with Medicaid are Vision, hearing and dental coverage.  One of the biggest services that are optional for Medicaid is hospice care. 

If you would like to apply for Medicaid you must get a Medicaid application and fill it out correctly.  Premiums for out of pocket costs to Medicaid people vary when dealing with Medicaid.  With Medicaid, some states are doing cost sharing for Medicaid enrolled citizens and they have the right to have certain requirements for the copayments.  The charges can be either low deductibles, standard coinsurance or copayments.  There is a limit to the cost of the out of pockets copays and if you are higher income then the states can charge more than for the lower income people.  Some of the groups on Medicaid are protected from higher copays such as the children on CHIP and pregnant women who are vulnerable in nature. 

Prescription drugs that are paid for by the Medicaid program can charge deductibles and other out of pocket charges like copays.  Just like Medicare for instance, the prescription Medicaid plan encourages the use of cheaper generic drugs instead of brands to give to Medicaid people.  They call them non preferred drugs and the cost share can be a lot more expensive than the lower costing generic.  Sometimes Medicaid establishes copayments for mail order instead of the people getting it from the local pharmacy. 

When a citizen on Medicaid goes to the emergency room for a service like a headache or a non-emergency situation, the state can make them pay higher copayments.  Emergency situations are one thing but when someone uses the system for something that is not approved the person must pay a coinsurance or copayment to even the payment for the state.  The hospital has to determine that the person who came into the ER was not in need of emergency care.  Also, if there is a non-emergency doctor in the house per say, they can establish that there was no cause for the Medicaid recipient to use the hospital and ER.  Another thing the hospital needs to do to a Medicaid recipient is provide them with a paper that states there copayment requirement if they use the ER or other emergency care that is not needed. 

Medicaid does cover and can be used for (LTC) Long Term Care and other care for people who need this type of regular assistance.  Home health care and other comprehensive support system like community based care are covered with Medicaid under certain circumstances. 

The CHIP program is different than Medicaid but similar in some ways.  CHIP is a program that is for children who have families that make above the amount allowed to be serviced by Medicaid but do not have the funds to get private insurance.  There are and always will be a few different state programs that a child can be on, depending on which way the state wants to service them.  For now Medicaid which would be the same program, another is CHIP and the third is a hybrid between the two programs.  This enables coverage for all the families in the US to be covered.  

 

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