Understanding Medicaid

Understanding Medicaid

Millions of Americans benefit from the Medicaid program, but understanding it better can help you determine if you may be eligible for the support and services as well.

What is Medicaid? Medicaid is the federal program helping low-income individuals and families have access to the health care they need. Although the federal government provides broad guidelines, eligibility rules, coverage, and costs may vary from state to state. States must offer federally mandated benefits, but individual states can establish the type, amount, duration, and scope of services provided, and may offer additional optional benefits.

What are the Mandatory Benefits provided by Medicaid? Mandatory benefits include, but are not limited to:

  • Inpatient and outpatient hospital services
  • Home health services
  • Laboratory and x-ray services
  • Physician services
  • Family planning services
  • Rural health clinic services
  • Certified Pediatric and Family Nurse Practitioner services
  • Transportation to medical care
  • Federally qualified health center services

What are the costs to have Medicaid coverage? Costs can vary from state to state. States have the option of charging premiums and requiring cost-sharing, which can include out-of-pocket costs for copayments, coinsurance, and/or deductibles. Some individuals may be exempt from these costs based on their circumstances, including children and pregnant women.

Are prescription drugs included in Medicaid coverage? Medicaid regulations allow states to use out-of-pocket charges for prescription drugs and encourage the use of lower cost drugs by establishing generic vs. brand name pricing tiers, preferred drug lists, and cost variations based on income.

What quality of care can I expect with Medicaid? Everyone enrolled in Medicaid deserves high-quality patient care in a safe environment, and the Centers for Medicare & Medicaid Services (CMS) partners with the states to ensure that efficient and equitable care is offered to all of its enrollees.

Are you eligible? You may qualify for low-cost or free health services and supplies based on your income, household size, and other factors, including age and disability.

How do you apply? If you think you may qualify, fill out the application directly with your state Medicaid agency or through the on-line Marketplace at any time throughout the year. There is no limited enrollment period for Medicaid, and if you are eligible, your coverage will begin immediately.