How Does Medicaid Work

As Established by Centers Medicare Medicaid Services

How does Medicaid work? Medicaid definition and Medicaid income eligibility requirements discussed as administered by the Centers for Medicare Medicaid Services.

So how does Medicaid work?
Medicaid is the federal long term health care program for low income individuals and families created July 30, 1965 by the Social Security Act. Being poor do not necessarily qualify people for Medicaid. Approximately 60 percent of impoverished Americans are not eligible for Medicaid.

Those served by Medicaid are low income adults, their children, eligible resident aliens, and those with certain disabilities. There are also special rules for nursing home residents and disabled children living at home.

Varies By State
The Medicaid eligibility requirements vary significantly by program and state and from my experience can be difficult to determine. Each state program may name its Medicare program such as Medi-Cal for California or Tenn-Care for Tennessee. Some states manage other programs within the same organization.

There are several groups of people covered by Medicaid. There are also certain requirements that have to be met within these groups to be eligible for Medicaid. These include a person’s age, pregnancy or disability status, and if they are blind.

There are also Medicaid income eligibility requirements and availability of assets (such as bank accounts, property, or items of cash value). These requirements vary from state to state and from group to group. Do a Google search for your specific state Medicaid program to find the specific requirements for income and asset limitations.

How does Medicaid work with regard to funding? It is jointly funded by the federal and state government, but is managed by the states. The program must meet minimum federal guidelines in order to receive federal matching funds.

Dental Services
Dental services are also covered under Medicaid. These services are optional for adults over 21 but required below age 21. The services as a minimum include dental maintenance and prevention, restoration, and pain relief. Wealthier states receive a federal match of 50 percent while poorer states receive more.

Asset Transfers
The Deficit Reduction Act of 2005 affecting how asset transfers and homes are considered with regard to nursing home patients. The legislation created a “look-back period” which applied to the assets of Medicaid applicants for the previous 5 years. Any asset transfers made during the 5 years prior to application are penalized dollar for dollar. Due to this requirement, older citizens who transfer assets can have no money and yet not be eligible for Medicaid.

2010 Health Care Vote
The 2010 health care reform act will impact the Medicaid federal long term health care program significantly. Primary care doctors will receive higher payments for procedures performed making them comparable to Medicare. Medicare versus Medicaid payments are about 20 percent higher.

This will increase the number of doctors who will accept Medicaid patients for the anticipated several million more Americans will be eligible for coverage under the health care bill. However the higher payments only apply to primary care physicians – not for specialists.

Beginning in 2014, those with incomes below 133 of the poverty level will be eligible for Medicaid coverage. States cannot cut people from Medicaid until the health care exchanges established by the health care reform bill are available in 2014 – 2019 for children.