Welcome to Our Medicaid Page

Medicaid provides health coverage to more than 4.6 million low-income seniors, nearly all of whom are also enrolled in Medicare.

Medicaid also provides coverage to 3.7 million people with disabilities who are enrolled in Medicare.

 

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Pregnancy

Medicaid and Pregnancy

More information is available on the Medicaid Pregnant Women page.

Medicaid Waivers

States can apply to the Centers for Medicare & Medicaid Services for waivers to provide Medicaid to populations beyond what traditionally can be covered under the state plan.

See more information about waivers.

Medicaid Information and Links for Seniors

How Medicaid Works for Low Income Seniors

Medicaaid Medicaid Gov Medicaid provides health coverage to more than 4.6 million low-income seniors, nearly all of whom are also enrolled in Medicare.

Medicaid also provides coverage to 3.7 million people with disabilities who are enrolled in Medicare.

In total, 8.3 million people are "dually eligible" and enrolled in both Medicaid and Medicare, composing more than 17% of all Medicaid enrollees.

Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.


What Medicaid Covers for Medicare Enrollees

Medicare has four basic forms of coverage:

  • Part A: Pays for hospitalization costs
  • Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
  • Part C: Medicare Advantage Plan (like an HMO or PPO) offered by private companies approved by Medicare
  • Part D: Assists with the cost of prescription drugs

Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs).

Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids.

Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state's payment limit.

 

Click Here for a Listing of More Medicaid Benefits

 

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Medicaid Eligibility

Find out if you are eligible for Medicaid Help

 

Medicaid and CHIP provide health coverage to nearly 60 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities.

In order to participate in Medicaid, federal law requires states to cover certain population groups (mandatory eligibility groups) and gives them the flexibility to cover other population groups (optional eligibility groups).

States set individual eligibility criteria within federal minimum standards. States can apply to CMS for a waiver of federal law to expand health coverage beyond these groups.

Many states have expanded coverage, particularly for children, above the federal minimums. For many eligibility groups, income is calculated in relation to a percentage of the Federal Poverty Level (FPL).

For example, 100% of the FPL for a family of four is $23,550 in 2013. The Federal Poverty Level is updated annually.

For other groups, income standards are based on income or other non-financial criteria standards for other programs, such as the Supplemental Security Income (SSI) program.

In accordance with CHIPRA section 213, CMS published a notice in Federal Register on December 18, 2009, (Vol. 74, No. 242) soliciting comments to assist in the development of a model process.

CMS invites feedback from stakeholders regarding the viability of the proposal on interstate coordination.

 

Click Here for Medicaid Income Levels Needed to Qualify for Medicaid Assistance

 

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Other Eligibility Criteria

There are other non-financial eligibility criteria that are used in determining Medicaid eligibility.

In order to be eligible for Medicaid, individuals need to satisfy federal and state requirements regarding residency, immigration status, and documentation of U.S. citizenship.

 

Click Here for Medicaid Income Levels Needed to Qualify for Medicaid Assistance

 

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Retroactive Eligibility

Medicaid coverage may start retroactively for up to 3 months prior to the month of application,

if the individual would have been eligible during the retroactive period had he or she applied then.

Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

 

Click Here for Medicaid Income Levels Needed to Qualify for Medicaid Assistance

 

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Income Resource Guidelines

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Waivers

States can apply to the Centers for Medicare & Medicaid Services for waivers to provide Medicaid to populations beyond what traditionally can be covered under the state plan.

See more information about waivers.

Some states have additional state only programs to provide medical assistance for certain low-income people who do not qualify for Medicaid.

No federal funds are provided for state only programs

Click Here for Medicaid Income Levels Needed to Qualify for Medicaid Assistance

 

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Non-Disabled Adults

Medicaid provides health coverage to 11 million non-elderly low-income parents, other caretaker relatives, pregnant women, and other non-disabled adults.

States provide coverage to parents/caretaker relatives who are in mandatory eligibility groups and optional eligibility groups.

More information is available on the Non-Disabled Adults page.

 

Click Here for Medicaid Income Levels Needed to Qualify for Medicaid Assistance

 

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Pregnant Women

Medicaid plays a key role in child and maternal health, financing 40% of all births in the United States.

Medicaid coverage for pregnant women includes prenatal care through the pregnancy, labor, and delivery, and for 60 days postpartum as well as other pregnancy-related care.

More information is available on the Pregnant Women page.

 

Click Here for Medicaid Income Levels Needed to Qualify for Medicaid Assistance

 

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Individuals with Disabilities

Medicaid provides health coverage to over 8.8 million non-elderly individuals with disabilities, including people who are working or who want to work.

Federal statute provides for both mandatory and optional coverage for people with disabilities.

More information is available on the Individuals with Disabilities page.

Click Here for Medicaid Income Levels Needed to Qualify for Medicaid Assistance

 

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