Medicaid Is The Nations Public Health Insurance Program For People With Low Income
Medicaid is the nations public health insurance program for people with low income. The Medicaid program covers 1 in 5 Americans, including many with complex and costly needs for care. The program is the principal source of long-term care coverage for Americans. The vast majority of Medicaid enrollees lack access to other affordable health insurance. Medicaid covers a broad array of health services and limits enrollee out-of-pocket costs. Medicaid finances nearly a fifth of all personal health care spending in the U.S., providing significant financing for hospitals, community health centers, physicians, nursing homes, and jobs in the health care sector. Title XIX of the Social Security Act and a large body of federal regulations govern the program, defining federal Medicaid requirements and state options and authorities. The Centers for Medicare and Medicaid Services within the Department of Health and Human Services is responsible for implementing Medicaid .
Figure 1: Medicaid plays a central role in our health care system.
Can I Get Medicaid
States have different rules to decide who’s eligible for Medicaid. You may be eligible if:
You’re disabled. Your state may let you use Medicaid no matter how much money you make in a year. In other states, a disabled person may only qualify for Medicaid when their income falls below a cutoff level.
You already get Supplemental Security Income . In the majority of states, SSI eligibility automatically qualifies you for Medicaid unless your state uses more strict criteria. Those states are commonly called 209 states.
You don’t make much money during a year. The rules are different in each state.
Check with your state’s Medicaid office to get the exact income requirements. You can also find out if you qualify by going online at www.healthcare.gov.
Some states have expanded their Medicaid program to allow more people to qualify. In those states, the income rules have loosened for adults without children. Other states have chosen not to expand Medicaid.
If your state has expanded Medicaid under the Affordable Care Act:
You’re eligible if:
- You’re single, don’t have children, and make less than $17,609 a year.
- You have a family of three and make less than $29,974 a year.
If your state has NOT expanded Medicaid:
In Alaska and Hawaii, youâre able to make a slightly higher income than in other states and still qualify. Your state Medicaid office can help you with the specific income limits based on how many people are in your family.
What Does Medicaid Cover
In each state, Medicaid must cover:
- Birth control medicine and devices
- Care at rural and federally qualified health clinics
- Care at many childbirth centers
- Care from a pediatrician or family nurse practitioner
- Early Periodic Screening, Diagnostic, and Treatment Services , which includes an array of services for children and adolescents
- Doctor’s fees
- Nurse midwife care during pregnancy and childbirth
- Preventive care and immunizations for children under age 21
- Quit-smoking programs
- Transportation to medical care
Many states offer more care, such as checkups and cancer screening tests for adults, physical therapy, and occupational therapy.
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What If I Lose My Card How Can I Get A New One
You can order a new card by phone or by visiting YourTexasBenefits.com‘s Medicaid Client Portal.
Frequently Asked Questions For Current Medicaid Beneficiaries
What is a Community Spouse?
A community spouse is someone whose husband/wife is currently institutionalized or living in a nursing home. The community spouse is not currently living in a nursing home and usually resides at the couple´s home.
I am a community spouse. Will I be allowed to keep any income or resources?
If your spouse is institutionalized or living in a nursing home, you will be permitted to keep some income known as a minimum monthly maintenance needs allowance . If you are currently receiving income in excess of the minimum monthly maintenance needs allowance, you may be asked to contribute twenty-five percent of the excess income to the cost of care for the institution
How do I find my local Medicaid office?
The Medicaid office is located in your local department of social services. A listing of offices can be located here:
If you live in the five boroughs of New York City, your offices are run by the Human Resources Administration . A listing of offices can be found here:
How do I order a new benefit card?
If your Medicaid is with your LDSS, to order a new Medicaid Benefit Identification Card, please call or visit your
If your Medicaid is with the and you need to order a new benefit card please call the call center at 1-855-355-5777.
Members residing in the five boroughs of NYC can call the HRA Infoline at 1 557-1399 or the HRA Medicaid Helpline at 1 692-6116.
How often do I have to renew?
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Medicaid Facilitates Access To Care
A large body of research shows that Medicaid beneficiaries have far better access to care than the uninsured and are less likely to postpone or go without needed care due to cost. Moreover, rates of access to care and satisfaction with care among Medicaid enrollees are comparable to rates for people with private insurance . Medicaid coverage of low-income pregnant women and children has contributed to dramatic in the U.S. A growing body of research indicates that Medicaid eligibility during childhood is associated with reduced teen mortality, improved long-run educational attainment, reduced disability, and lower rates of hospitalization and emergency department visits in later life. Benefits also include second-order fiscal effects such as increased tax collections due to higher earnings in adulthood. Research findings show that state Medicaid expansions to adults are associated with increased access to care, improved self-reported health, and reduced mortality among adults.
Figure 7: Nationally, Medicaid is comparable to private insurance for access to care the uninsured fare far less well.
Do I Qualify For Medicaid
Medicaid provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels. Medicaid qualifications depend partly on whether your state has expanded its program.
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What Do I Do With Medical Bills
Pay attention to the mail you get for medical care. If the bill says that you owe money, you should:
You may have to pay your own medical bills for Medicaid covered services if:
- You see a provider who is not part of your health plan
- You receive services without showing your Medicaid Member Card to the provider
You will have to pay the bill for services you get:
- When you were not eligible for Medicaid
- During an appeal, grievance or hearing if the action is denied
- If the services you receive are not covered by Medicaid
If you get services that Medicaid does not cover, you have to pay for the services yourself. You should sign a form that says:
If you receive about a bill from a medical provider, you talk to the provider about the bill, and you still have a question, call Medicaid Information at 801-538-6155 or toll-free at 1-800-662-9651.
Cannon Health Building
What If I Don’t Want My Medicaid Doctors And Providers To See My Health Information Through This Website
You can “opt out” of sharing. “Opt-out” means that you choose not to share your health information. To opt out, go to and then:
You can also opt out by calling 800-252-8263. If you opt out, we won’t share your health information with Medicaid doctors or other providers.
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Meeting The Individual Mandate
The Affordable Care Act changed the health insurance industry. No longer can companies deny coverage to those that wish to buy it. The trade-off was that everyone must buy insurance and stay covered.
Those with certain forms of Medicare do not need to do anything else. They have qualified health insurance and do not need to pay the penalty. Part B Medical Insurance is the outpatient services part of Medicare. Standing alone, it does not satisfy the requirement for minimum essential coverage.
Need more coverage than Original Medicare provides? Call our hotline at for assistance in finding a more comprehensive plan near you, or compare plans yourself online.
How Can I Find A Provider Who Accepts Medicaid
Regardless of the state you live in, you can easily find doctors who accept Medicaid. Once you successfully enroll in this program, you can begin your research online. In fact, you can use the federal Physician Care search feature to begin looking. This tool is managed by the Center for Medicare and Medicaid Services. You can use this Medicaid find a provider database to locate professionals no matter where you live. However, if you reside near the border of another state, make sure you only use your benefits in the state where they were issued. Even though Medicaid is partially funded by the federal government, these benefits are also managed on the state level. This means that the benefits are not transferable across state lines.
If you do not have access to a reliable internet connection, you may wonder how to find Medicaid doctors in your city. Fortunately, your local program representatives may be able to help you. Usually your Medicaid office will offer a list of providers and clinics near you that accept benefits. Contact your office by phone or in person to learn more about doctors near you.
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Cms Learning Lab: Improving Oral Health Through Access
The Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services is hosting a series of webinars to support States and their collaborative partners to improve access to dental services for children enrolled in Medicaid and CHIP. The webinar materials are available below. For more information about the CMS Oral Health Initiative and the CMS Learning Lab webinars, see the .
Reducing Early Childhood Tooth Decay: Approaches in Medicaid May 27, 2015
Email Mail And Fax Inquiries
Send your inquiry by email, fax or postal mail. Include your full name, mailing address, phone number, email address, date of birth and Social Security number. If sending your inquiry by email or fax, you may wish to only include the last four digits of your Social Security number as these communication methods tend to be less secure than others. Some state agencies, such as Indiana and Connecticut, also accept inquiries through their website.
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How Do I Replace My Medicaid Id Card
Call Medicaid Customer Service at 1-888-342-6207 to request a new card or visit the online Medicaid Self-Service Portal. You can create an online account at any time. Until you receive your new card you should call your health care provider before your appointment to make sure they can verify your coverage.
If you need a new Healthy Louisiana plan ID card, call the member services department for a replacement card.
How Do I Contact My Local Medicaid Office
Agency Details Website: Centers for Medicare and Medicaid Services Contact: Contact the Centers for Medicare and Medicaid Services Local Offices: Contact State Medicaid Offices. Toll Free: 1-800-633-4227. TTY: 1-877-486-2048. Forms: Centers for Medicare and Medicaid Services Forms.
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Can I Get Medicaid And Medicare At The Same Time
You may in some situations. Medicare is a health insurance program for:
- People ages 65 and older
- People younger than age 65 who are disabled
- People with end-stage kidney disease
With Medicare, you have to pay monthly premiums and other costs, such as copays and deductibles, when you go for medical care. If you are on Medicare and have a limited income, you may qualify for help from Medicaid to pay the costs of Medicare. If you have both Medicaid and Medicare, you may hear people refer to you as being dually eligible.
Medicaid Spending Is Concentrated On The Elderly And People With Disabilities
Seniors and people with disabilities make up 1 in 4 beneficiaries but account for almost two-thirds of Medicaid spending, reflecting high per enrollee costs for both acute and long-term care . Medicaid is the primary payer for institutional and community-based long-term services and support as there is limited coverage under Medicare and few affordable options in the private insurance market. Over half of Medicaid spending is attributable to the highest-cost five percent of enrollees. However, on a per-enrollee basis, Medicaid is low-cost compared to private insurance, largely due to lower Medicaid payment rates for providers. Analysis shows that if adult Medicaid enrollees had job-based coverage instead, their average health care costs would be more than 25% higher. Medicaid spending per enrollee has also been growing more slowly than private insurance premiums and other health spending benchmarks.
Figure 9: Medicaid per enrollee spending is significantly greater for the elderly and individuals with disabilities compared to children and adults.
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The Florida Access System
The Florida Department of Children and Families is a state agency that helps families with public assistance programs like Medicaid. Customers can create online MyACCESS accounts and then get information 24 hours a day, seven days a week. They can also check eligibility and apply for Medicaid through this website. People who are denied Medicaid coverage and wish to file complaints can call the Medicaid Helpline at 1-877-254-1055 .
The Family-Related Medicaid Fact Sheet is another good source of information that has links to many additional resources. It also has information about other state and local programs, like the Children’s Health Insurance Program and the Children’s Medical Services Network . The Federally Facilitated Marketplace is also described in the fact sheet this is an online marketplace that helps people understand and apply for qualified health insurance plans. FEM and Advance Premium Tax Credits may be available for people whose incomes are higher than the maximum limits for Medicaid.
How To Find A Provider For Medicaid Services
The Medicaid find a doctor process can be overwhelming. This is especially true if you have never enrolled in this program before and are looking for a new medical provider. One of the first questions on your mind may be, How do I find a Medicaid doctor? It is important that you understand how to locate in-network professionals near you. Just as with other insurance plans, if you do not find a provider who accepts Medicaid as a form of payment, you will likely need to pay extra to receive the same services.
You may also be wondering, How can I find clinics that accept Medicaid near me? This question is especially common if you are an individual who is looking for general care. No matter the type of doctor you are seeking, you can connect with professionals by searching online. Using the internet is one of the most convenient ways you can find a provider with Medicaid coverage. However, you need to make sure you understand how to conduct your search so you know you are finding doctors who accept your insurance.
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How Do I Find A Doctor Who Takes Medicaid
You can usually look up doctors on your state’s Medicaid web site. Or call the number on the site to talk with someone about finding a provider. Usually, Medicaid is administered by a private insurance company. In this case, call your insurer or look on its web site to find a participating provider.
Medicare Offers Easy Enrollment
The best way to find out if one has Medicare is to apply. The main websites for Medicare and Social Security have short and simple online application pages. One can apply and get an official answer very quickly. The sites state the qualifications needed, and they process moves quickly for most applicants.
The Medicare system requires choices. One must choose the all-in-one plans of Medicare Advantage or the Original Medicare with Prescription drug and Medigap benefits added.
Comparison shopping is the ideal tool for making selections of private health, prescription drug, and gap insurance plans.
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