What You Need To Know About Medicaid


Medicaid is the medical assistance that is offered in all of the fifty states and the District of Columbia. Paid for by a grant from the federal government, it pays for necessary medical services for the people who receive it. Because it only pays for the necessary medical procedures and medications, it may not cover everything you would like to have.

The most common examples of items that may not be included are:

  • Name brand medications, when there is a generic equivalent that serves the same purpose
  • Elective procedures, such as plastic or weight loss surgery
  • Cosmetic procedures, such as tooth whitening
  • Dental care for people over the age of 18 or 21 (depending on the state)

How Does Medicaid Work?

Medicaid is similar to socialized medicine, in that the government both provides this service and ultimately has the final say in what procedures they will pay for. However, if the physician who prescribed the medicine or procedure believes that you or your family member truly needs it ( for the quality of your life, not just to enhance it, like cosmetic procedures ), he or she might be able to get an authorization for it. This is frequently done for medications that are not typically approved, and rarely done for actual procedures.

Medicaid is a medical assistance program, and as such, is usually income-based. It will pay, in entirety, for your medical bill, and in some cases will also pay for up to ninety days before the date of application. If you have applied for Medicaid, and believe that your finances and circumstances will make you eligible, you should try not to pay any medical bills while you’re waiting to be approved. This is because while the state will pay medical bills, they will not reimburse you, personally, for money you have spent.

The most common recipients of Medicaid are children, pregnant women, and the elderly or disabled.

Some adults, who are lower income, single parents, or both, may also be eligible. Although at least half of the funding for Medicaid comes from the federal government, each state has different qualification guidelines. Each state also decides what procedures and medications they will cover, above those required by the federal government.

History Of Medicaid

States are not required to participate in Medicaid; however they have all done so, since 1982. It may go by different names in different states, like “Medi-Cal” in California and “TennCare” in Tennessee.Poverty alone does not qualify a person for Medicaid, and anyone qualifying for it has to be either a U.S. Citizen or a permanent resident. A child can qualify is he or she meets one of those qualifications, even if the parent or guardian is not a legal resident or citizen.

Applying For Medicaid

If you receive Social Security, you may be able to apply for it at your local office. However, if you do not currently receive those benefits, you will need to apply for it at your closest Human Services Office. This office could also be known as the Food Stamp Office or the Department of Health and Human Services. Some areas allow you to apply online. You have the right to an application when you ask for it, and you may be able to turn it in in person, through mail, or even by fax. The sooner you apply, the sooner you will find out if you’re eligible.

You will need to provide certain items during, or soon after, the interview process. Although you may be asked for additional documentation, you should expect to provide:

  • A valid picture ID, provided by the government
  • Social Security cards for each member of your household
  • Pay stubs or proof of income for everyone in your household
  • Proof of residency
  • Utility bills and bank statements

Medicaid is an inexpensive way to provide for medical care and prescriptions for members of your family. If your income is too high for Medicaid, and you have children in the home, you might want to see if your state offers low cost insurance for kids. It is similar to Medicaid, but requires small co-pays and monthly or annual fees for families with higher incomes.