How do medicaid work

Medicaid covers certain mandatory medical services similar to those offered by Original Medicare Parts A and B. These include the following:. States have the option to offer additional benefits, such as dental and vision.

Other optional benefits include:. Additionally, Medicaid will not pay for:. Medicaid is a federal entitlement program that offers guaranteed coverage to all qualifying residents. Certain individuals, including low-income families, pregnant women and adults who are blind or disabled, are included in mandatory eligibility groups. States may also offer optional coverage to individuals who are categorically needy. This includes seniors who receive home- and community-based services, are on hospice, live in a nursing home or are in poor health.

Because each state operates its own Medicaid program within the federal framework, income limits and medical eligibility requirements vary by state. At least 42 states have adopted the optional Special Income Level standard for Institutional Medicaid. Other states, such as California, Hawaii and Kansas, require seniors to use all or nearly all of their income for institutional long-term care before Medicaid kicks in. Fortunately, there are other ways for individuals who have substantial medical needs to qualify for Medicaid.

Since Medicaid is never simple, there are also a number of exemptions. The American Council on Aging provides a state-by-state eligibility guide.

You can visit MedicaidPlanningAssistance. Institutional Medicaid only pays for skilled nursing if individuals need this level of care. Most states require seniors to complete a functional needs assessment as part of the application process. This assessment typically takes 45 minutes to an hour to complete. These answers are then scored and used to determine an overall rating. To qualify for Institutional Medicaid or Long-Term Services and Supports that are covered by Medicaid waivers, applicants typically must require assistance with at least two activities of daily living.

If you think you may qualify for Medicaid, you must apply for coverage in your primary state of residence. Benefits are available to U. Out-of-state coverage is limited unless you experience a life-threatening emergency or are unable to access necessary services in your home state. The only way to see if you qualify for Medicaid is by completing an application.

However, before you do, consider working with a Certified Medicaid Planner CMP to ensure the best chances for success. They must meet strict standards for education and work experience before they can sit for this exam. CMPs include attorneys, accountants, social workers, financial advisors and geriatric care managers. Some CMPs charge for their services, while other organizations offer free assistance, thanks to private donations and community block grants.

You can find a professional in your community by calling or contacting your local senior center, legal aid society or Area Agency on Aging. The American Council on Aging also offers a free service that can check your eligibility and match you with a qualified advisor before you need long-term care. There are a few ways that Medicaid can help with the cost of long-term care:. To receive long-term care benefits, you must require a nursing home level of care as determined by a functional needs assessment that gauges your ability to perform activities of daily living, such as cooking, bathing, dressing and toileting.

Fortunately, many states offer spend-down programs that allow medically needy adults to qualify for Medicaid if they use excess income to pay for qualifying medical bills. Federally qualified health center services. Podiatry foot care services. Laboratory and X-ray services. Optometry vision services.

Family planning services. Dental services. Nurse midwife services. Certified pediatric and family nurse practitioner services. Prosthetics to replace missing or damaged body parts. Freestanding birth center services when licensed or otherwise recognized by the state. Transportation to medical care. Chiropractic services. Tobacco cessation counseling for pregnant women. Other practitioner services. Private duty nursing services.

Personal care. Case management. Services for individuals age 65 or older in an institution for mental disease IMD. Services in an intermediate care facility for Individuals with intellectual disability. Self-directed personal assistance services. Community first choice option. TB related services. Inpatient psychiatric services for individuals under age Other services approved by the Secretary of Health and Human Services.

Health homes for enrollees with chronic conditions. Medicaid home health care and residential senior care coverage. Examples of the types of home health care and residential senior care services provided as part of HBCS programs include: Personal care like showering Transportation services Skilled nursing care Occupational, speech and physical therapy Managing diet and nutrition healthy eating Home-delivered meals Home chores and housekeeping Some HCBS services like skilled nursing care and occupational, physical or speech therapy are delivered by qualified and, in some cases, licensed professionals.

How to apply for Medicaid. See UnitedHealthcare plans in your area. What is behavioral health? Help to pay for hearing aids is a valuable benefit with many dual-eligible health plans How a dual-eligible health plan D-SNP can help people with diabetes What is Medicaid and what does it cover? Caregiver The ups and downs of caregiving How to help someone eat healthier; Tips for caregivers. Medicaid vs Medicare: You can have both. Enrollment Why choose UnitedHealthcare for your dual-eligible health plan?

What are the 4 parts of Medicare? Medicare Special Needs Plans: What are they and how do they work? How to find the right doctor when you have Medicaid and Medicare. When can you enroll in a dual health plan if you have Medicaid and Medicare? Still Have Questions? Close Still Have Questions? First Name. Last Name. Email Address example email. Your request was successfully submitted. Thanks, your Guide is on its way. Higher-income individuals may find that Medicaid pays their Medicare Part B premiums.

Lower-income individuals may continue to receive full benefits. Medicaid benefits vary by state, but the Federal government mandates coverage for a variety of services, including:. Each state also has the option of including additional benefits, such as prescription drug coverage, optometrist services, eyeglasses, medical transportation, physical therapy, prosthetic devices, and dental services.

Medicaid is also often used to fund long-term care , which is not covered by Medicare or by most private health insurance policies. In fact, Medicaid is the nation's largest single source of long-term care funding, which often covers the cost of nursing facilities for those who deplete their savings to pay for healthcare and have no other means to pay for nursing care.

Medicare is available to individuals based on age or disability. If your eligibility depends on age, you'll have access to the program once you turn Medicaid is designed for individuals in low-income situations, or other special circumstances.

Not everyone qualifies for Medicaid. If your income falls below the poverty level, determined by your state, you might qualify. There are also a number of mandatory eligibility groups, including some pregnant women and children and individuals receiving Supplemental Security Income.

It increases healthcare flexibility, like covering more telehealth services. Get ready! Accessed Nov. Supreme Court. Sebelius, U.

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We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Your Money. Personal Finance. Your Practice. Popular Courses. Medicare vs. Medicaid: What's the Difference? Medicaid: An Overview Key Takeaways Medicare is the primary medical coverage provider for seniors and those with a disability.

Medicaid is designed for people with limited income. Medicare has four parts that each cover different things—hospitalization, medically necessary services, supplemental coverage, and prescription drugs. Part A: Hospitalization Coverage.