Medicaid is essentially a public healthcare insurance program funded by the federal and state governments in America. The two tiers of government pull resources together to provide healthcare insurance coverage to individuals of all ages with limited resources or income, who cannot sufficiently afford to access healthcare. Medicaid goes further than Medicare, providing additional services such as personal healthcare services and nursing home services.
Medicaid is considered as the biggest source of finance that provides free healthcare insurance to millions of Americans for health and medical-related services. It is solely managed by states, which have the authority to determine the eligibility of its people. All the states within the countries are not under any legal obligation to operate Medicare.
However, since its inception in 1982, all states of the federation have actively participated. Although Medicaid is aimed at providing healthcare insurance to people with some degree of poverty, such people must satisfy some criteria before they are considered eligible.
Eligibility for Medicaid
Eligibility criteria may vary from one state to another. Signing up is usually not so straightforward as it can mean weeks or months before an eligible individual can begin to enjoy the benefits of Medicaid.
Some states’ requirements for a potential enrollee include undergoing a medical assessment and providing several financial documentation, which may contribute to the delay. Children and individuals that live in establishments are exempted from paying for medical services that are not insurable.
The first criterion for eligibility for access to Medicaid is that an individual must be an American citizen or a non-citizen that fulfills some residency conditions. Individuals that satisfy any of the criteria below are considered eligible for Medicaid.
- Individuals that are pregnant regardless of marital status are eligible for Medicaid as long as their income level is below the state’s limit. Also, the individual and their baby are provided coverage by this program.
- Parents or guardians that have a low income and a minor that requires skilled nursing services within a home are eligible for Medicaid. It also provides coverage to teenagers that are living without a guardian. Some states permit coverage for dependents that are up to 21 years of age.
- Individuals that are old, disabled, or blind are eligible. For individuals that qualify but cannot afford Medicare, they may opt for Medicaid as its premium payment is low. Individuals that are 65 years and above or disabled can make use of Medicaid if they consider Medicare to be too costly for them.
- Individuals that neither have disabilities nor are minors are also eligible. The ACA allows the state the liberty to provide healthcare insurance coverage to individuals that are less than 65 years or less than 18 years, respectively. However, this coverage depends on the policy of each state.
Income Threshold for Eligibility
A poverty line is an essential tool that is used to determine the income eligibility threshold for Medicaid. Each state has a specific set of rules for the eligibility of an individual. Individuals that may exceed the income threshold may still be eligible for Medicaid in a state if they require costly medical needs.
For an individual to qualify for Medicaid, they may be allowed to spend down their medical expenses below a threshold. Additionally, assets can help to determine eligibility. These assets may include funds in accounts, stocks, vehicles, and buildings. As such, individuals that have assets that do not exceed $2,000 are eligible for Medicaid. The value is $3,000 for married couples. However, valuable like a single-car, furniture, and a home is not considered as assets when applying for Medicaid.
Depending on the regulations within a state, individuals can be asked to consider spending down to allow then to qualify for Medicaid. The process of spending down may come in several forms. For example, an individual can spend down by paying off debts, renovating a home, or paying for funeral services in advance.
Coverage of Medicaid
The extent of cover an individual can get from Medicaid varies from state to state. Services that are covered by Medicaid include hospital services, lab tests, transportation, and therapy. Additionally, Medicaid offers other services, which are:
- Nursing Home services – provide basic lifelong nursing home facilities to people that require such service. The Medicaid program is instrumental in the operations of nursing homes. Individuals that qualify for nursing home services through Medicaid may pay some percentage of the cost, which is a function of their income and tax payments. However, the amount, if any, that an individual pays depends on the state’s guidelines.
- Supervisory care – assists individuals in their everyday activities. Such activities may include bathing, eating, dressing, and more. Supervisory (custodial) care is mostly used by people that require temporary or permanent care. It is also provided to individuals that may happen to go into care homes for a short period due to certain temporary medical conditions.
The current COVID19 pandemic had prompted the current administration to sign a new act that allows states to provide uninsured individuals with insurance coverage for COVID19 patients and services.