Medicaid: General Information

There has been much debate about health care in the United States. As it stands, there are tens of millions of uninsured individuals that have limited access to the services they need. But for some who cannot get insurance through an employer or an individual policy, Medicaid is an option.

Established by Congress in 1965, the Medicaid program was designed to provide health care for impoverished individuals. It covers a variety of services, from doctor visits to nursing home care. But there are strict requirements regarding who is eligible for coverage.

Who Can Get It?

Although Medicaid is a federal government program, it is run by each individual state. Because of this, eligibility rules vary from state to state. There are, however, some requirements that each state must meet in order to receive matching funds from the federal government.

All states must cover the following individuals:

- Pregnant women and children under 6 years of age with a family income under 133% of the poverty level
- Children age 6 to 18 with a family income under 100% of the poverty level
- Parents and 18 year olds with a family income below welfare standards
- The elderly and disabled who are eligible for SSI

Adults without dependent children are only eligible under these guidelines if they are pregnant, elderly or disabled. In addition to these requirements, there are also certain asset limits that may not be exceeded.

Some states provide coverage to individuals who do not meet these guidelines. These groups often include the working disabled and those with very high medical bills compared to their income (known as the medically needy). The states may also set higher income limits than the federal minimum.

What Does It Cover?

As with eligibility requirements, coverage differs from state to state. But some basic services must be covered by every state. These include:

* Most basic medical services, including doctor visits, hospital stays, lab work, x-rays, family planning and certain screenings for children
* Home-based care
* Care provided in nursing homes

Most states cover more than these basic services. Many cover dental care, but it is subject to certain exclusions. Prescription drugs are also covered by most states, but many require a small copay. Vision care is included in Medicaid coverage in some states. When offering these optional services, states must provide them to everyone in the applicable eligibility categories.

Medicaid does not guarantee health care coverage for everyone in the United States. But it does provide care for many of those who could not otherwise afford it. For details about how Medicaid works in your state, visit your local Medicaid office. There you can learn more about the program and apply for benefits.