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Health Care Reform:

Health Insurance & Affordable Care Act

At-a-Glance: Medicaid & the Affordable Care Act

Medicaid helps people at low incomes get health care at a low cost or free.  It's a partnership between the federal and state governments. The federal government sets the basic Medicaid program, who qualifies, and what services are offered.  State governments can cover more people and more services. 

The Affordable Care Act adds more people and more services to the basic Medicaid plan, but only in states that choose to expand Medicaid.

If you already use Medicaid to help pay for doctor's visits, or think you can get it, here's what the Affordable Care Act means for you.

If You Get Medicaid Now, You May Still Qualify

People with low incomes who've been helped by Medicaid in the past should still qualify in 2014. This includes:

  • Children
  • People with disabilities
  • Pregnant women
  • Parents who are working at low pay or are not working
  • Some older adults

A New Group of Adults Qualifies in Some States

If you're between the ages of 19 to 64, don't have children, and don't make much money in a year, Medicaid may now be a possibility for you. In the past, adults with no children could not receive Medicaid, except in a few states.

If the state where you live is expanding Medicaid (26 are as of October 2013), you can apply.

If the state where you live is NOT expanding Medicaid, you can't get Medicaid. But you may be able to get help paying for health insurance by shopping at your state's Marketplace web site.

Find out the rules in your state and whether you qualify at Medicaid.gov.

New Types of Care in 2014

In all 50 states, Medicaid will now help pay for:

  • Quit-smoking programs
  • The same basic benefits as someone who buys insurance through their state's Marketplace. These are called essential benefits and include:
    • Addiction treatment
    • Care for children (including vision and dental care)
    • Care for newborn babies
    • Maternity care
    • Hospital care 
    • Doctor visits
    • Emergency care
    • Lab tests
    • Mental health care
    • Occupational therapy
    • Physical therapy
    • Certain prescription medicines
    • Preventive care, like cancer screenings and vaccines
    • Speech-language therapy
    • Treatment for long-term diseases, like diabetes and asthma

In addition, each state can decide whether to offer these new benefits:

  • Health Homes are new places that will coordinate the care for people using Medicaid who have more than one chronic condition. The conditions include asthma, diabetes, heart disease, mental health, being overweight, and substance abuse.
  • More support to help you stay out of a nursing home. You may hear people call one a long-term care institution. Support may include more care in the home or financial help to keep people at home.

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