What Is Medicaid
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.
What is the difference between Medicare and Medicaid?
Medicaid is an assistance program. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines.
Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.
What are the Mandatory Benefits
- Services provided by a hospital for patients who are not in the hospital
- Hospital services for patients who are in the hospital
- Services provided by the EPSDT Freestanding Birth Center The state recognizes (licensed or otherwise)
- In-home medical care
- Services for Nursing Homes
- Nurse practitioner services for children and families
- Services are provided via rural health clinics
- Providers of medical care
- Getting to and from the hospital
- X-ray and laboratory services
- Services that are available to patients at federally approved health centers
- Providing pregnant women with advice on quitting smoking
- Services provided by a Nurse Midwife
- Planned Parenthood
Should I Get Medicaid Legal Advice?
Paying for long-term care services becomes more difficult as life expectancies and expenditures grow. Nursing home costs $10,000 per month or more, and those who can afford it for a time may lose their whole life savings in only a few months, not years.
As a result, the Medicaid program is here to assist. Medicaid has become the middle-long-term class's care insurance in our generation. However, in order to get Medicaid assistance, you must meet specific income and asset requirements. Medicaid planning has a straightforward rationale. First and foremost, you must ensure that you have amassed sufficient financial resources to cover the needs of your loved ones. A further consideration is whether or not you want to leave anything behind for your children. The third problem is that the regulations are incredibly convoluted and difficult to follow. As a result, many individuals overspend and imperil their family's security because they lack forethought and assistance.
There are several particular legal difficulties faced by the elderly and their families. In light of our examination of the Medicaid program, it's clear that the legal, financial, and care-planning challenges confronting potential nursing home patients and their families may be exceptionally difficult. If you or a loved one requires nursing home care, it's obvious that you'll benefit much from the assistance of an experienced attorney. What resources are available to you in order to get assistance in this matter? Consumers may have a tough time locating attorneys with the knowledge and experience necessary to provide sound advice when they most need it.