Medicaid: Everything You Wanted to (and Should) Know

By on October 9, 2017
Medicaid: Everything You Wanted to (and Should) Know

Medicaid is an all-important medical care program helping tens of millions of Americans. However, it’s a system which is sometimes difficult to understand and navigate.

Read on to understand everything you’d want to (and should) know about Medicaid.

How and when did Medicaid start?

Medicaid began alongside Medicare through the introduction of the Social Security Amendments legislation. This legislation started in 1965 and defined guidelines and standards imposed by the federal government but ultimately dictated by the individual states & territories.

Who is covered by Medicaid?

Medicaid plays the important role of covering health services typically found in the low-income bracket including children, families, seniors, and those with disabilities. It’s a support system designed to improve the quality of life and care for those impacted by socioeconomic disparity. A way for these individuals to receive services not covered under existing insurance plans.

About 67+ million U.S. citizens are covered by the Medicaid program.

What is covered under Medicaid?

Medicaid is not to be confused with Medicare as these are separate entities though do have a common goal of aiding toward health services for eligible individuals.

What does Medicaid cover?

The services covered are broken into two types:

·  Mandated

·  Optional

Medicaid eligibility is based on requirements (detailed above) and set by the state. If eligible, the state will determine qualification for long-term and personal care services. Most of these are related to nursing, home, and community-based services within the area of the applicant.

Mandated coverages

The federal government has mandated state requirements included with the basic coverage provided by Medicaid. This includes sexual health coverage such as providing family planning to childcare such as access to birth centers and pediatricians.

Other mandated coverages include:

·  Physician services

·  Nurse-midwife services

·  Outpatient hospital services

·  Inpatient hospital services

·  Tobacco cessation (for pregnant women)

Transpiration to centers and other health services done so through qualified, federal centers are included within this mandated coverage.

Optional coverages

States may choose to cover optional items for a range of beneficial health care services – including:

·  Personal or hospice care

·  Dental & vision

·  Mental health & psychiatric

·  Prescription drug & clinical services

These optional services aren’t commonly covered by the state. It’s worth visiting the state website or talking with a healthcare provider to understand if/which optional services may be covered, though.

A note about prescription drugs

Prescription drugs are an optional coverage despite nearly 70% of Americans taking at least one at any given time.

Select eligible individuals covered by Medicaid may receive payment toward premiums for their prescription drugs under Medicare Part D. This plan will contribute toward the first $2,510 of your drug costs throughout the year if you cover the deductible.

Those falling between this $2,510 and $4,050 will receive 100% coverage. With a 5% cost whenever one goes over this amount.

How to apply for Medicaid

The website for your state is the best place to begin.

A full list of these state Medicaid requirements and links to their respective websites can be found at the following link: https://www.benefits.gov/benefits/browse-by-category/category/21

Within these listings you will find:

·  Program descriptions

·  Requirements

·  Contact information

A Medicaid agency typically responds within 45-90 days from the day of your application.

The application can be done on your own or with the assistance of a designated individual whom you trust (such as a family member). This process will open the books to your financial information. The state will examine your taxes, mortgage, and appraisals to determine eligibility.

·  If accepted, you will receive a notification.

You will pay toward your care and the plan will begin.

·  If denied, you will receive a notification explaining the reasoning.

You may try again if/when you are meet requirements.

67 million+ and counting

Tax overhauls are possibly going into effect which will reshape Medicaid and Medicare. An aging population is placing more and more into retirement. Begin the application process when the time is right to have it aligned for when you’re ready for long-term care.

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Medicaid: Everything You Wanted to (and Should) Know