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Medicaid 101: The Basics and How it Works

Medicaid 101: The Basics and How it Works | The Senior Life

Did you know that in January of 2020, 63,920,268 individuals were enrolled in a Medicaid program within their respective states?

https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html

Every year, people within their resident states enroll in the Medicaid program due to their need for appropriate health care coverage that they can’t afford on their own.

So what exactly is the Medicaid program?

Who does it benefit?

What do its’ benefits entail?

How is it funded?

What are the eligibility requirements for the Medicaid program?

Keep reading in order to find the answers to some of your basic questions you may have about Medicaid and how the Medicaid program works.

What is Medicaid?

There’s an old adage that those who work in Medicaid use when explaining the Medicaid program in general: “If you’ve seen one Medicaid program, you’ve seen one Medicaid program.”

That’s to say that each state has a different way of administering its own Medicaid program, has different funding levels for their Medicaid programs, and has different numbers of enrollees within their Medicaid program.

Medicaid is a program that’s jointly funded by the Federal Government and local states that provide health coverage to United States (U.S.) citizens; including low-income adults, pregnant women, children, people with disabilities, and the elderly 2 . Medicaid is administered by the states; according to federal regulations and requirements.

Medicaid

Since each state has been given the authority by the Federal Government to administer the Medicaid program as they see fit, as long as they adhere to federal rules and regulations, each State has a different way of administering the Medicaid program within their State as it varies on their own goals and needs.

The way the Medicaid program is administered in Ohio may not be the same way it’s administered in Florida.

As a note, the federal agency in charge of the Medicaid program is the Centers for Medicare & Medicaid Services (CMS). CMS works closely with the states in order to ensure that the Medicaid program is being administered to U.S. citizens appropriately and effectively and that their Medicaid funding is on target with their needs.

How Would You Enroll in the Medicaid Program?

In order to see if you’re eligible for Medicaid, the state you live in would determine your eligibility.

Medicaid & You: Frequently Asked Questions

Eligibility is based on your income and household size, as well as if you’re pregnant or have a family with children.

It’s also best to check out whether or not your state is expanding their Medicaid eligibility parameters before submitting an application.

Who is eligible for Medicaid?

When filling out an application, visit Healthcare.gov to see if you qualify for the Medicaid program. You simply click the local state you reside in from the drop-down menu, then click on the “Visit Your State Marketplace” option. From there, it’ll direct you to your state’s healthcare marketplace website.

Then, you’ll be able to generate an estimate to see if you would qualify for the Medicaid program, you’d be able to create an account on the health marketplace’s website, and you can compare different healthcare plans and what they offer to their members.

With the Coronavirus pandemic sweeping through the U.S., many states are offering Emergency Special Enrollment, which is outside of the usual Medicaid Open Enrollment Period; last year in 2019 it was held from November 1, 2019, to December 15, 2019.

Since that time frame is currently over, if you’re still in need of Medicaid coverage and need to apply, you still have an option to do so. Visit Healthcare.gov to see if you qualify for Medicaid’s Special Enrollment Period for 2020.

There are certain circumstances that would make you eligible to apply during the Special Enrollment Period, including:

  • Any new changes within your household​: A recent marriage or divorce, having a baby, a recent adoption of a baby, placing a foster care child, or someone on your healthcare plan (marketplace) dies.
  • Any new changes within your living arrangements​: Moving to a new home within a new county or ZIP code, moving to the U.S. from a U.S. territory or foreign country, or moving either to or from transitional housing or a shelter.
  • Any loss of health insurance within your household​: If you or anyone within your home has lost appropriate (qualifying) healthcare coverage in the last 60 days or expects to lose their coverage within the next 60 days.
  • Leaving prison (incarceration)​.​
  • You’ve just become a U.S. citizen​: thus becoming newly eligible to the healthcare marketplace.

Get Marketplace health coverage outside Open Enrollment only with a Special Enrollment Period

If you’re having trouble navigating the website or have additional questions regarding Medicaid enrollment, contact your local state government for application or renewal information. If you need to contact someone at CMS, the Federal Government level, then contact someone at one of the local CMS regional offices.

How Does Medicaid Work?

Each state administers its own Medicaid program based on their need and funding from the Federal Government (CMS).

Medicaid is jointly funded by the Federal Government and is also comprised of taxpayer’s dollars, such as:

  • Federal payroll taxes (money automatically deducted from your paycheck)
  • Basic (generic) tax revenues
  • Beneficiary premiums

Since the Medicaid program is administered by the states, it’s also subject to Federal minimum requirements for benefits.

Medicare and Medicaid Funding Challenges

Once you’ve been approved and deemed eligible for the Medicaid program, Medicaid will cover your doctor’s visits, any pregnancy care and follow-up visits, prescription drugs, hospital visits, emergency room visits, plus more, at no additional cost to you.

Medicaid Eligibility & Enrollment

What Are the Benefits of Medicaid?

Medicaid benefits that are mandatory include the following:

  • Inpatient and outpatient hospital services
  • Physician services
  • Lab and x-ray services
  • Home health services

Benefits

There are also some alternative benefits that include:

  • Prescription drug coverage
  • Case management
  • Physical therapy
  • Occupational therapy

Is Medicaid Right For You?

Medicaid is right for you – only if you qualify for it. If you meet the eligibility requirements, there’s no reason for you not to apply and use the Medicaid program for your healthcare coverage. It’s healthcare coverage that’ll cover your basic healthcare needs, your children’s needs, and any other healthcare emergency that may arise.

Have additional questions? Check out Medicaid.gov​ for more detailed information on Medicaid requirements, eligibility, and state administration.

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