+ What is Medicaid?
+ Who qualifies for Medicaid?
+ What benefits are covered by Medicaid?
+ Can someone qualify for both Medicare and Medicaid?
+ Who pays for Medicaid?
+ Is Medicaid the same thing as the Children’s Health Insurance Program (“CHIP”)?
+ What is the Medicaid Expansion?
Swearing in of Seema Verma, Administrator for the Centers for Medicare and Medicaid Services (CMS)
What is Medicaid?
Medicaid is a health insurance program jointly funded by the federal government and the states. Although states are not required to adopt Medicaid, all states plus the District of Columbia have had some form of Medicaid program for many years.
If interested in California’s Medicaid program (“called Medi-Cal”) specifically, visit the Medi-Cal FAQ page. You can also find detailed information about Medicaid and its importance in American healthcare at the Center on Budget and Policy Priorities website or on the Kaiser Family Foundation website.
Who qualifies for Medicaid?
In all states, Medicaid provides health coverage for certain low-income populations, families and children, pregnant women, the elderly, and people with disabilities. In states that have accepted the Medicaid expansion, the program covers all low-income adults with incomes at or below 138% of the Federal Poverty Level (“FPL”). California’s Medicaid program is called Medi-Cal.
What benefits are covered by Medicaid?
The federal government requires that states offering Medicaid cover certain mandatory health benefits. These mandatory benefits include inpatient and outpatient hospital services, Early and Periodic Screening, Diagnostic, and Treatment Services (“EPSDT”) for children , nursing facility services, home health facility services, physician services, rural health clinic services, federally qualified health center services, laboratory and x-ray services, family planning services, nurse midwife services, certified pediatric and family nurse practitioner services, free-standing birth center services, transportation to medical care, and tobacco cessation services.
States are free to include additional Medicaid benefits beyond those that are federally required.
Can someone qualify for both Medicare and Medicaid?
Yes. Medicare is generally available to all eligible persons age 65 and older. It is also available to individuals under age 65 who receive Social Security Disability Insurance (“SSDI”) payments, and to individuals with end stage renal disease. A person can be “dual-eligible” if they meet the eligibility requirements for both Medicaid and Medicare. These individuals are often referred to as “Medi-Medis” or “duals.”
Who pays for Medicaid?
The federal government and the states share the cost of Medicaid equally. Under current law, the federal government must match whatever the state spends on covered benefits for qualifying individuals and does not limit or cap states’ Medicaid spending.
Is Medicaid the same thing as the Children’s Health Insurance Program (“CHIP”)?
The Children’s Health Insurance Program (“CHIP”) provides health coverage to eligible children whose families earn too much money to qualify for Medicaid. Each state operates its own CHIP and has its own eligibility requirements. CHIP, like Medicaid, is jointly funded by the federal government and the states.
What is the Medicaid Expansion?
Under the Affordable Care Act (“ACA”), states were authorized to expand Medicaid coverage to adults with incomes up to 138% of FPL. Prior to this expansion, adults in most states were only eligible if their income was well below FPL.
Not all states expanded Medicaid. You can view Kaiser Family Foundation’s discussion of states who have not expanded here. Kaiser Family Foundation also has a list where you can see whether your state has expanded its Medicaid program.