Understanding Medicaid

There are a lot of people who make use of Medicaid and Medicare, but there are also many who may not fully understand eligibility, the benefits, or what’s covered. For the sake of this article, we’ll be looking at Medicaid.

What is Medicaid?

Medicaid is a joint federal and state program that was signed into law in 1965. It was designed to give health insurance to both low-income families and individuals. Although it started out as a way to give health coverage to the recipients of government welfare, Medicaid has since expanded beyond low-income individuals, and it now includes certain sections of the elderly and disabled populations. Today, there are approximately 60 million people getting benefits from Medicaid and CHIP (or Children’s Health Insurance Program), at a cost of over $400 billion annually; it is the largest health insurance program in the nation.

Who is Eligible for Medicaid?

Eligibility for Medicaid is determined at state level and is contingent on income, so each person and family needs to check the Medicaid site to find the policy in their state. Those childless adults between 18 and 65 are eligible for coverage in the Affordable Care Act (ACA) Medicaid expansion, but other states may not cover those people.

Almost all people living in states that are implementing the expansion will qualify if they earn up to 138% of the federal poverty level. Also, a lot of children, pregnant women, parents, seniors and those people with disabilities qualify for Medicaid so long as they meet residency and immigration requirements and are documented United States citizens.

Now, let’s look at some of the benefits available for Medicaid recipients.


All enrollees are entitled to receive the following mandatory benefits:

  • Inpatient hospital services
  • Outpatient hospital services
  • EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
  • Nursing Facility Services
  • Home health services
  • Physician services
  • Rural health clinic services
  • Federally qualified health center services
  • Laboratory and X-ray services
  • Family planning services
  • Nurse Midwife services
  • Certified Pediatric and Family Nurse Practitioner services
  • Freestanding Birth Center services (when licensed or otherwise recognized by the state)
  • Transportation to medical care
  • Tobacco cessation counseling for pregnant women

Some states also provide the following optional benefits as well:

  • Prescription drugs
  • Clinic services
  • Physical therapy
  • Occupational therapy
  • Speech, hearing and language disorder services
  • Respiratory care services
  • Other diagnostic, screening, preventative and rehabilitative services
  • Podiatry services
  • Optometry services
  • Dental services
  • Dentures
  • Prosthetics
  • Eyeglasses
  • Chiropractic services
  • Other practitioner services
  • Private duty nursing services
  • Personal care
  • Hospice 
  • Case management 
  • Services in an intermediate care facility for the mentally retarded
  • Self-directed personal assistance services
  • TB Related Services
  • Inpatient psychiatric services for those under 21
  • Other services approved by the Secretary

In conclusion, Medicaid is a state program, so it’s best to work with the state when trying to determine eligibility and applying for the program. With increasing benefits coming to half the states as a result of the Affordable Care Act, a lot more people and families will be able to receive health coverage.