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Health Care Reform:

Health Insurance & Affordable Care Act

New to Medicaid? How It Works

Medicaid helps people with lower incomes get health care. Nearly 20% of Americans use it. Medicaid can help if you:

  • Don't make much money or are on a limited budget
  • Can't work because of a disability
  • Are already enrolled in Medicare but can’t afford the payments
  • Are already enrolled in Medicare and qualify for a long-term care service that Medicare doesn't cover
  • Are pregnant and don't make much money

The federal government requires that Medicaid cover certain groups of people -- like people with low incomes. The government sets the minimum benefits, too.

Your state also has a lot of say in the specifics of who gets covered. Generally, children, pregnant women, and people who are disabled get the most generous coverage. 

What Types of Health Care Does Medicaid Cover?

There are 56 different Medicaid programs -- one for each state, the District of Columbia, and the U.S. territories. Each Medicaid program may help pay for different types of health care. What you pay varies too. Any type of care it helps pay for is considered "covered."

You can use Medicaid for many types of health care. Medicaid covers screening and diagnostic tests, including X-rays. It helps pay for hospital stays and doctor visits. Prescription drugs are covered and so is family planning.  It also covers nursing home and long-term care services for people with lower incomes.

If you have a child who qualifies, Medicaid covers even more. You'll get financial help if your child needs to see an eye doctor or needs glasses. Mental health services are covered. So is long-term care in your home if your child needs it.  

You can get financial help if your spouse needs to be in a nursing home. Long-term care is costly. Medicaid can help make sure you have enough money to stay in your home while your spouse gets care elsewhere.

Who Is Eligible for Medicaid?

The rules about who can use Medicaid depend on the state you live in. Federal law requires that states cover certain population groups. States then have the option of expanding coverage to other groups or making the coverage more generous. 

For instance, in some states, if you're disabled, you can use Medicaid no matter how much money you make. In other states, if you’re disabled, you may not be eligible for Medicaid coverage if your income is above a certain level.

Your income is important when applying for Medicaid. States usually have a cut-off based on your income and assets. If you're below a certain level, you qualify.

You might be eligible even if you earn more. Even if your income and assets are above the cut-off level, you might still get Medicaid if your medical bills are high. You may be able to subtract those expenses from your income. This is called the spend-down process. After you subtract costs like hospital care and doctor visits, your income will be lower and may make you eligible for Medicaid.

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