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Health Care Reform:

Health Insurance & Affordable Care Act

10 Questions About Medicaid Answered

1. What Is Medicaid?

Medicaid is a partnership between the state and federal government.  This program provides low-cost or free health care to:

  • Low-income adults
  • Low-income families and children
  • People with disabilities
  • Certain older adults who use Medicare

The federal government sets basic guidelines for the types of care you can get with Medicaid and how much you pay for them, if anything. States can offer extra services, so Medicaid differs from one state to another.

Some states have other special programs to help low-income people who don't qualify for Medicaid.

2. Can I Get Medicaid?

States have different rules to decide who's eligible for Medicaid. You may be eligible if:

You're disabled and younger than 65. Your state may let you use Medicaid no matter how much money you make a year. In other states, a disabled person may only qualify for Medicaid when their income falls below a cutoff level.

You already get Social Security income (SSI). SSI eligibility automatically qualifies you for Medicaid unless your state uses more strict criteria. Those states are commonly called 209(b) states.

You're younger than 65 and don't make much money during a year. The rules are different in each state and they're changing in 2014.  In many states, Medicaid has not covered adults without children, or the income cutoffs have been very low. For example, in Georgia for 2013, a single person who makes $235 a month or more ($2,820 per year or more) makes too much to qualify for Medicaid.

Check with your state's Medicaid office to get the exact requirements for 2013.

For 2014

Some states are expanding Medicaid so people who make a bit more than the typical Medicaid limit can qualify. In those states, the income rules are also loosening for adults without children. Other states aren't expanding Medicaid. 

If your state is expanding Medicaid in 2014

You're eligible if:

  • You're single, don't have children, and make less than about $15,856 a year.
  • You have a family of four and make less than $32,499 a year.

If your state is NOT expanding Medicaid in 2014

  • Check with your state's Medicaid office for the rules and income limits.

In Alaska and Hawaii, you may be able to make more than the general income cut-off and still qualify. Your state Medicaid office can help you with the specific income limits based on how many people are in your family.

3. What Does Medicaid Cover?

In each state, Medicaid must cover:

  • Birth control medicine and devices
  • Care at a rural health clinic
  • Care at many childbirth centers
  • Care from a pediatrician or family nurse practitioner
  • Doctor's fees
  • Home health services
  • Inpatient and outpatient hospital services
  • Lab tests and X-rays
  • Nurse midwife care during pregnancy and childbirth
  • Prescription drugs (This depends on your state. Not all states offer this coverage through Medicaid.)
  • Preventive care and immunizations for children under age 21
  • Quit-smoking programs
  • Transportation to medical care

Many states offer more care, such as checkups and cancer screening tests for adults, physical therapy, and occupational therapy.

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