The Basics of Medicaid


What Is Medicaid?

Medicaid is a government insurance program that provides health coverage to almost 60 million Americans.

Who Can Get Medicaid?

Medicaid eligibility differs in some ways from state to state, but there are some low-income groups of people who are always able to get coverage, including:

 – Children

 – Parents

 – Pregnant women

 – People with disabilities

 – People over age 65

There are different income requirements for each group listed above. For example:

 – Generally kids whose families make under 133% of the Federal Poverty Level qualify

 – Pregnant women with a family income up to 133% of the Federal Poverty Level qualify

As of 2014, 133% of the Federal Poverty Level is $15,856. Each year, the government comes out with new guidelines for what the official poverty level is. To see what the most recent guidelines are, go here and click on the link for the current year under the headline “Poverty Guidelines.”

2014 Changes in Medicaid

Beginning in January of 2014, some states will be expanding their coverage of Medicaid. If you are already enrolled in Medicaid, nothing will change. But if you have applied in the past and were denied because your income was too high, you may now be eligible if your state is expanding Medicaid. With Medicaid expansion, new groups will now be eligible, including:

 – Low-income adults under the age of 65 without children

 – Low-income adults who are disabled, but not eligible for SSI (Social Security Income) or SSDI (Social Security Disability Insurance).

You can find out more each state’s Medicaid coverage here.

What Does Medicaid Pay For?

If you are an adult, states are required to cover certain services. These are known as mandatory services, and include:

 – Hospital services (inpatient and outpatient)

 – Home health care

 – Physician, midwife, and nurse practitioner services

 – Rural health clinic services

 – Family planning services

 – Birth center services

 – Transportation to medical care

Other services for adults are considered optional, and coverage varies state by state. These optional services include:

 – Dental care

 – Eye care

 – Prescriptions

You can go here to see the long list of both mandatory and optional services for Medicaid.

Can I Get Medicaid for My Kids?

All children ages 6–19 coming from low-income families are eligible for Medicaid in all states. There are some children, however, whose family incomes are too high to qualify for Medicaid, yet they still cannot afford private insurance. For those children, CHIP (Children’s Health Insurance Plan) is an option. Around 8 million children in the U.S. use CHIP.

Many services that are considered “optional” for adults, are required for children under the age of 19, or for young adults living on their own under age 21. Medicaid’s child health program is known as EPSDT and stands for Early and Periodic Screening, Diagnostic, and Treatment. You can read more about what services for children are covered by Medicaid here.

How Do I Find Out if I Qualify for Medicaid?

It’s easy. You can do one of two things:

  1. Visit your state’s Medicaid website by going here and choosing your state from the menu at the bottom of the page.

  2. Apply for health care on the government’s Health Insurance Marketplace website. After you fill out the application, you will be told if you qualify for Medicaid or CHIP.

How Do I Apply for Medicaid?

 – You can fill out an online application here.

 – You can also get contact information to apply by phone here.

 – To find out if your child is eligible for Medicaid or CHIP, call 1-877 KIDS NOW (1-877-543-7669), where you’ll be connected with an operator from your state who will guide you through the application process.

Keep in mind that you will need to have important documents on hand such as proof of citizenship, tax returns, etc.

What is the Difference Between Medicaid and Medicare?

Medicaid and Medicare are both government programs funded by taxpayers, and are often confused. Medicaid is for low-income individuals only whereas Medicare is for anyone over the age of 65, and people with certain disabilities, regardless of income.

How Long Will My Medicaid Benefits Last?

As long as you remain eligible. If you get a new job with higher pay, you need to notify the state, usually within 10 days.

Can I Get Dental Care on Medicaid?

While most states provide emergency dental care to adults covered by Medicaid, only some states provide regular dental care. But for children using Medicaid or CHIP, federal law requires that states provide them with dental services that are “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.”

Medicaid or CHIP must provide children with coverage for dental services that do the following:

 – Relieve pain and treat infections

 – Restore teeth

 – Maintain oral health

 – Prevent dental problems through regular exams

Where Can I Find a Medicaid Dentist?

In many states there is a shortage of dentists who accept Medicaid, so it can be challenging to find a Medicaid dentist. All Kool Smiles dental offices in the U.S. do accept Medicaid. You can find out if there is an office near you by visiting or calling toll free, 855-653-1223. Kool Smiles is committed to providing access to dental care for dental patients on Medicaid.

If there aren’t any Kool Smiles locations near you, you can do one of the following:

 – search online for Medicaid dentists in your area

 – contact your Medicaid eligibility worker at your local Office of Public Assistance

 – Call the Medicaid Help Line at 1-800-362-8312

 – Visit a community health center, as they often have information on Medicaid dentists in your area.


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