What Is The Medicaid Program

Medicaid is a medical service program that helps individuals and families with low incomes. The federal government is the primary oversight of the medicaid program each state is responsible for the following:

  • » Sets the rate of payment for services
  • » Determines the duration, type, scope, and amount of services
  • » Administers its own Medicaid program
  • » Establishes its own eligibility standards

States set their own Medicaid eligibility guidelines. The program is aimed for people with low income, but eligibility also depends on meeting additional requirements based on things such as pregnancy status, age, disability status, citizenship and assets.

It is required that states provide Medicaid services for people who fall under specific categories of need in order for the state to receive matching funds from the federal government. Groups that the federal government considers "categorically needy" for Medicaid include:

  • » Special protected groups such as individuals who lose cash assistance due to earnings from work or from increased Social Security benefits
  • » Individuals who meet the requirements for the Aid to Families with Dependent Children (AFDC) program that were in effect in their state on July 16, 1996
  • » Pregnant women with family income below 133% of the FPL
  • » Supplemental Security Income (SSI) recipients
  • » Recipients of adoption or foster care assistance under Title IV of the Social Security Act
  • » Children born after September 30, 1983 who are under age 19 and in families with incomes at or below the FPL
  • » Children under age 6 whose family income is at or below 133% of the Federal poverty level (FPL)
  • » Certain Medicare beneficiaries

It is also possible that states may provide Medicaid to other groups that have similiarities but that are more broadly defined. These include:

  • » Low-income institutionalized individuals
  • » Infants up to age 1 and pregnant women whose family income is not more than a state-determined percentage of the FPL
  • » Certain uninsured or low-income women who are screened for breast or cervical cancer
  • » Certain low-income and low-resource children under the age of 21
  • » Certain aged, blind, or disabled adults with incomes below the FPL
  • » Certain "medically needy" persons, which allow States to extend Medicaid eligibility to persons who would be eligible for Medicaid under one of the mandatory or optional groups
  • » Certain working-and-disabled persons with family income less than 250 percent of the FPL
  • » Some individuals infected with tuberculosis

Medicaid does not provide medical assistance for all poor persons. In fact, it is estimated that about 60% of America's poor are not covered by the program.