Medicaid 101

Define: Medicaid

What is Medicaid?

Medicaid is a program that pays for medical assistance for certain individuals and families with low incomes and resources. Medicaid is the largest source of funding for medical and health-related services for people with limited income. Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services.

Who is Eligible for Medicaid?

Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state’s rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services.

Medicaid eligibility is limited to individuals who fall into specified categories. The federal statute identifies over 25 different eligibility categories for which federal funds are available. These categories can be classified in to five broad coverage groups:

• Pregnant Women
• Children and Teenagers
• Person who is Aged, Blind, and/or Disabled
• Some Other Situations

Apply if you are leaving welfare and need health coverage. Apply if you are a family with children under 18 and have very low income and few resources. (You do not need to be receiving a welfare check.) Apply if you have very high medical bills, which you cannot pay (and you are pregnant, under 18 or over 65, blind, or disabled).

Question: Who is covered by Medicaid?

Answer: Medicaid is the nation’s public health insurance program for low-income Americans, and is jointly financed by the Federal and State governments. The program finances health and long-term care services for children and adults in low-income working families and for the elderly and disabled. Individuals must meet both financial and categorical criteria to qualify and be either a U.S. citizen or have five years of legal residency. Federal law mandates eligibility for certain groups, and states have authority to expand eligibility beyond federal minimums through waivers or amendments to their State Medicaid Plans. According to Medicaid: A Primer, Kaiser Family Foundation (2007), states cannot receive federal matching funds to extend Medicaid to adults under age 65 without children, unless they are pregnant or disabled. As a result, over 40% of low-income adults without children are uninsured.