877 518 4295
Knowledge Center

Medicaid Health Insurance Program

 Medicaid was created on July 30, 1965. It is the United States health program for eligible individuals and families with low incomes and resources. The program ensures health coverage including nursing home coverage to people who can not afford medical treatment or other expensive health insurance. In normal cases Medicaid includes children, pregnant women, parents of eligible children, people with disabilities and elderly needing nursing home care.

Having limited assets is one of the primary requirements for Medicaid eligibility, but poverty alone does not qualify a person to receive the benefits of the program unless they also fall into one of the defined eligibility categories. Within each category there are requirements other than income that must be met. Of course, at first the income should not exceed the eligibility levels and then a person must fall into the respective category.

The eligibility for the Medicaid program may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for calculating the limited income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.

Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state operates its own Medicaid system, but this system must conform to federal guidelines in order for the state to receive matching funds and grants. The matching rate provided to states is determined using a federal matching formula (called Federal Medical Assistance Percentages), which generates payment rates that vary from state to state, depending on each state's respective per capita income.

Medicaid does not pay benefits to individuals directly; the program sends benefit payments to health care providers. In some states the program beneficiaries are required to pay a small fee (co-payment) for medical services. However, the system is vulnerable to various types of frauds. A cottage industry has developed with attorneys providing "Medicaid Planning" for those in a nursing home or likely to be admitted. The attorneys develop plans to convert countable assets to exempt assets, thereby making an elder with excess assets eligible.

The program Medicaid is considered to be one of the best health care efforts in the world. Political willingness and fair participation from the individuals opting to enroll for the program can definitely make it world´s envy and US pride.
