What is Medicaid Health Insurance Program?

The Medicaid Health Insurance Program is considered the largest healthcare insurance in the nation, with coverage provided to almost 60 million low income individuals and families. The program is funded by both federal and state governments with varying enrollment requirements. Whether or not an individual or family qualifies for Medicaid depends on their financial and medical necessities, as well as other criteria.

Only United States citizens and legal residents may apply for Medicaid. Additionally, most qualifying people must meet one or more of the following factors in order to be deemed eligible:

  • You are a disabled individual.
  • You are a pregnant woman.
  • You are an elderly individual over the age of 65.
  • You are a blind individual.
  • You are the parent of a dependent child or children in your home.
  • You are the legal caretaker of a dependent child or children in your home.
  • You have very low income (must be up to 133 percent of the poverty line).

Several states have their own Medicaid programs, by which they administer healthcare services and care to local residents. Since 1982, every single state has participated in Medicaid, and the federal government has, on average, covered 57 percent of related costs.

Some examples of state programs include the ones listed below:

  • Wisconsin – BadgerCare
  • Massachusetts – MassHealth
  • California – Medi-Cal
  • Oregon – Oregon Health Plan
  • Kentucky – Kynect
  • Maine – MaineCare

Eligible children under the age of 19 may apply for Medicaid Children’s Health Insurance Program (CHIP). Generally speaking, children in families who earn too much may qualify for CHIP. Pregnant women and parents may also apply.

Mandatory Healthcare Services

The Children’s Health Insurance Program  provides coverage that includes the following:  immunization shots, check-up visits, doctor visits, prescription medication, dental services, vision services, inpatient hospital care, outpatient hospital care, laboratory tests, X-ray exams, emergency services and so much more. Both dental and doctor visits are usually provided at no cost to the eligible individual.

The regular Medicaid program offers a wide range of mandatory benefits, as well as optional benefits to facilitate access to health care. States are required to provide coverage that entails the following: doctor visits, home health services, outpatient hospital services, lab exams, X-ray exams, nursing facility care, pediatric services, transportation to health centers and others.

Medicaid Expansion

In 2014, a provision under the Affordable Care Act made it possible for 28 states to expand their Medicaid coverage, thus allowing millions of previously uninsured individuals to obtain access to healthcare. The federal government is currently providing funding for this Medicaid expansion; however, by 2020 they will only be responsible for 90 percent of the costs. Each state will then be required to chip in and cover the remaining portion.

States that have implemented Medicaid expansion and thus provided further coverage to their residents include the following: West Virginia, Washington, Minnesota, North Dakota, California, California, Oregon, Maryland, Washington, Arkansas, Arizona, New Hampshire, Hawaii, Illinois, Vermont, Ohio, Delaware and others.  Other states that are open to expansion are Indiana, Wyoming, Utah and Tennessee, though no decisions have been finalized as of March 2015.

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