Medicaid is a government funded program that helps low income families with medical costs. Individuals who are disabled, pregnant, and dependent children are the most commonly eligible. Depending on the circumstances, people who are not eligible for any other benefit may still be eligible to receive Medicaid.

Where the State Comes into Play

Each state has their own program and eligibility guidelines. Though they all follow the same basic principles, the formulas are not exactly the same. Due to the cost of living variances across many states, qualifying income levels and total asset allowance may change. However, every state participating in the programs is required to follow certain federal guidelines when setting their limitations on qualification. States are not required to set forth the same amount of funding for the Medicaid program, as one state may have more poverty stricken residents than another.

Medicaid Funding

Each state sets aside a certain amount of funds to cover the services provided through Medicaid. As medical costs continue to rise, the Medicaid portion of state budgets continues to become a problem. In some states, as much as 25% of the entire budget goes toward Medicaid. As such, states have the right to limit the coverage they offer. Information on coverage limitations is provided by the state at the time of acceptance into the program.

Services Covered by Medicaid

Services typically covered by Medicaid include: doctor's office visits, medications, vaccinations, prenatal care (states usually require a special form of Medicaid meant to cover these services only, with higher income and asset limits), lab tests, x rays, and even hospital stays. Some states even cover vision and dental, but these programs are often very limited in services and providers.

Payment

For recipients of Medicaid, there may be co-payments required for doctor's office visits and prescriptions. These co-payments however will be the only out of pocket expense for the medical care, and they will be much lower than traditional health insurance programs co-payments. There are several scenarios where a co-payment is waived or not required. The state will inform recipients of these co-payments.

Any doctors or medical facilities that accept Medicaid as a form of payment must take whatever funds the state is willing to pay for those services rendered.

Medicaid Application Process

Medicaid is typically handled through the county Department of Social Services. Applications can usually be picked up there or found online. Complete the application with information on all the people in the family who need coverage. Provide identification for everyone on the application, and provide proof of income and assets. Mail the application or return to the office and wait. Application approval or disapproval may take weeks or months depending on locality. Application decisions can usually be appealed. It is the recipients responsibility to report any changes in circumstance that would otherwise prohibit eligibility during the coverage period.

 

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