A state and federal partnership, Medicaid provides coverage for people with lower incomes, older people, people with disabilities, and some families and children. Learn more about the program in this section.
- What is Medicaid?
- How can I get Medicaid?
- What does Medicaid cost?
- What does Medicaid cover?
- What special coverage is available to women?
- How can I get Medicaid coverage for my children?
Each state operates a Medicaid program that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities.
The eligibility rules for Medicaid are different for each state, but most states offer coverage for adults with children at some income level. In addition, beginning in 2014, most adults under age 65 with individual incomes up to about $15,000 per year will qualify for Medicaid in every state.
You may be eligible for benefits through Medicaid. Medicaid programs vary by state, so you will need to check with your state Medicaid office for more information.
- Eligibility: People with disabilities are eligible in every state. In some states, people with disabilities qualify automatically if they get Supplemental Security Income (SSI) benefits. In other states you may qualify depending on your income and resources (financial assets).
- “Buy-Ins”: Some states also have “buy-in” programs that allow people with disabilities with incomes above regular Medicaid limits to enroll in the Medicaid program. Children with disabilities can qualify for Medicaid either under these disability-related rules, or based on family income.
- Expansion in 2014. Starting in 2014, the Affordable Care Act will expand the Medicaid program to cover people under age 65, including people with disabilities, with income of about $15,000 for a single individual (higher incomes for couples and families with children).
- Help for disabled people: This expansion helps low-income adults who have disabilities but don’t meet the disability requirements of the SSI program. The expansion also helps those whose income is above their state’s current eligibility levels.
Medicaid coverage is designed to be affordable for everyone who is eligible. Cost sharing for Medicaid varies by state but is extremely limited for most participants.
The benefits covered for adults through Medicaid are different in each state, but certain benefits are covered in every Medicaid program.
Doctor’s services that are covered by Medicaid include:
- Laboratory and X-ray services
- Inpatient hospital services
- Outpatient hospital services
- Health screenings for children and treatment if medical problems are identified
- Comprehensive dental and vision services for children
- Family planning services and supplies
- Long-term care services and supports
- Medical and surgical dental services for adults
- Pediatric and family nurse practitioner services
- Services provided in health clinics
- Nurse-midwife services
- Nursing facility services for adults
- Home health care services for certain people
- Prescription drugs
Other benefits your state must cover for children and may cover for adults:
- Physical, occupational, or speech therapy
- Eye doctor visits, eyeglasses
- Audiology, hearing aids
- Prosthetic devices
- Mental health services
- Respite and other in-home long-term care
- Case management
- Personal care services
- Hospice services
The Affordable Care Act will expand options for community-based care. There will be more opportunities for people of all ages who have a disability to get help with daily activities while remaining in their homes. The Medicaid program continues to move toward providing more community-based care options as an alternative to nursing homes.
Cancer Prevention and Treatment
Breast and Cervical Cancer Prevention and Treatment (BCCPT) Medicaid programs are available to eligible women who are diagnosed with either breast and/or cervical cancer through the state screening program. You may be eligible even if you have a higher income. States have flexibility to define what it means to have been diagnosed or screened under the program.
Medicaid Options for Pregnant Women
Pregnant women may have special eligibility for Medicaid coverage for themselves and their infants at little or no cost if they have limited income.
Medicaid eligibility for pregnant women varies by state, but all states must cover pregnant women with incomes up to about $20,000 as an individual. Most states cover pregnant women under Medicaid with higher incomes, and some states cover pregnant women under the Children’s Health Insurance Program (CHIP).
If you’re enrolled in Medicaid when your baby is born, your child is automatically eligible for Medicaid until your child’s first birthday. This means you don’t have to file a separate application for your new baby. He or she should be automatically enrolled after birth.
All states provide coverage for children through Medicaid and the Children’s Health Insurance Program (CHIP). In fact, your children are likely to be eligible for coverage if your income is up to about $45,000 per year (for a family of four).