Medicaid Overview

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Medicaid Overview

What is Medicaid?

Every state runs a Medicaid program although it may be called something else. For example, California has Medi-Cal; Maine has MaineCare. This program provides health insurance for those who can least afford it.  The coverage is very comprehensive - including doctors visits, hospital care, dental care, prescriptions and mental health care.

How to I apply? 

Contact your local Health and Human Services or Social Services office

Who qualifies?

Each state has its own income and asset guidelines. Some states include more categories of people (for example, non-disabled adults with no children) and people with somewhat higher incomes. Most states also have related programs, to provide some help to those who do not qualify for full Medicaid benefits. For example, most states provide help with prescription drugs for adults with higher incomes. 

Also, many more children now qualify due to federal CHIP [formerly SCHIP] funding.  Again, each state runs its own program and sets many of the rules.  Most states provide CHIP coverage for children in families at or above 200% of the federal poverty level [FLP].  But some states cover children in families up to as high as 350% FLP. See chart below. 

All of the states' Medicaid programs use a complex system of eligibility rules, with different income and asset tests for each category of people served. Ask your local Social Services office for details, or see if their website posts the rules.

What can I do if I am denied?

You have the right to appeal a denial. Most low-income legal services offices can advise you or help you with an appeal.
 
Medicaid may require you to go to specific doctors or may require you to try certain drugs or therapies before going to a specialist or taking a more expensive drug. If you are denied a particular service or treatment, contact your local legal services office to see if they can help you in getting the treatment you want.
 
Medicaid has requirements for reporting income and assets. Make sure you understand your reporting responsibilities. If you get a notice terminating you from Medicaid or denying you treatment, contact your local legal services office for advice.