Q What Documents Will I Need To Provide When I Apply
A. You will need to provide verification of your income. You do not need to provide proof of your assets or resources or come into our offices to be interviewed unless you are applying for one of the Long Term Care Medicaid programs .
If you are pregnant, you will need to provide proof that you are pregnant. If you are not a U.S. citizen, you will need to provide proof of your alien status. For example, you can provide a copy of your green card.
If you apply online using ASSIST, a web page at the end of the application will tell you exactly what documents must be sent by mail to support the application you are submitting, and the appropriate mailing address.
The Human Toll Of The Medicaid Coverage Gap
Of course, theres more to Medicaid expansion than just money. Harold Pollack very clearly explains the human toll of the Medicaid coverage gap: Based on the 3,846,000 people who were expected to be in the coverage gap in January 2015, we can expect 4,633 of them to die in any given year because they dont have health insurance.
Medicaid Program Variations By State
States determine their own standards for how to run the program, as long as they follow federal regulations, including who is eligible for services, what services can be covered by Medicaid and how hospitals and doctors will receive payments from Medicaid recipients, among other rules and requirements.
Because states have their own rules they determine eligibility and income requirements. In most state programs, pregnant women, children, seniors and disabled persons are almost always eligible for services. And generally, to be eligible for Medicaid your household income must fall below 138 percent of the federal poverty level .
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Q If I Have Private Health Insurance Can I Be Eligible For Medicaid
A. It depends. If your income is low, and you have minor children, you and your children can have private health insurance and still be eligible for Medicaid. Certain Medicaid qualifying programs require that you not have any other health insurance in order for you to get Medicaid. If you have both private health insurance and Medicaid, you should show both your Medicaid card and your private health insurance card to your medical provider each time you receive services.
Youth Aged Out Of Foster Care
Who is Eligible? Youth between the ages of 18 and younger than 26 who aged out of foster care on their 18th birthday and received Title IV-E payments.
Description: Provides health care coverage for youth, who aged out of foster care on their 18th birthday, until age 26.
Alien Emergency Medical Assistance
Who is Eligible? Non-U.S. citizens who are not eligible for Medicaid.
Description: Provides coverage for the treatment of emergency medical conditions for certain individuals who do not meet Medicaid citizenship requirements
State Funded Medical Assistance for Non-Citizen Victims of Trafficking
Who is Eligible: Non-Citizen Individuals who are a victim of a severe form of human trafficking and are applying for, or preparing to apply for, a T Non-Immigration Status . Individuals must be an Ohio resident, have countable monthly income at or below 100% of the Federal Poverty Level , and not have eligibility under another category of assistance.
Description: Provides state-funded medical assistance to Non-Citizen Victims of Trafficking who have provided verification of the T-Visa application or evidence of human trafficking. Individuals must file a formal application for a T-Visa within one year of the medical assistance application date.
Refugee Medical Assistance
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Medicare Advantage Plans: Common Elements
- All plans have a contract with the Centers for Medicare and Medicaid Services .
- The plan must enroll anyone in the service area that has Part A and Part B, except for end-stage renal disease patients.
- Each plan must offer an annual enrollment period.
- You must pay your Medicare Part B premium.
- You pay any plan premium, deductibles, or copayments.
- All plans may provide additional benefits or services not covered by Medicare.
- There is usually less paperwork for you.
- The Centers for Medicare and Medicaid Services pays the plan a set amount for each month that a beneficiary is enrolled.
The Centers for Medicare and Medicaid Services monitors appeals and marketing plans. All plans, except for Private Fee-for-Service, must have a quality assurance program.
If you meet the following requirements, the Medicare Advantage plan must enroll you.
You may be under 65 and you cannot be denied coverage due to pre-existing conditions.
- You have Medicare Part A and Part B.
- You pay the Medicare Part B premium.
- You live in a county serviced by the plan.
- You pay the plans monthly premium.
- You are not receiving Medicare due to end-stage kidney disease.
Another type of Medicare Managed Health Maintenance Organization is a Cost Contract HMO. These plans have different requirements for enrollment.
Do All Medicare Supplement Insurance Plans Pay The Same
The cost of a Medicare Supplement Insurance plan can vary from one carrier or location to the next.
However, the standardized benefits that each type of Medigap plan covers stays the same, no matter where you live or who your plan carrier may be .
The 9 standardized benefits that may be offered by a Medicare Supplement Insurance plan include the following:
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States Still Say No To Medicaid Expansion
Unfortunately for millions of uninsured Americans, in 2012 the Supreme Court ruled that states could not be penalized for opting out of Medicaid expansion. And a dozen states have not yet expanded their programs.
Until late 2015, there were still 22 states that had not expanded Medicaid, but Montana began enrolling people in their newly expanded Medicaid program in November 2015, for coverage effective January 2016, Alaskas Medicaid expansion took effect in September 2015, Louisianas Medicaid expansion took effect in July 2016, and Virginia began enrolling people in expanded Medicaid as of November 2018, for coverage effective January 2019. Maine expanded Medicaid as soon as Governor Mills took office in early 2019. Utah and Idaho both implemented full Medicaid expansion as of 2020, and Nebraskas Medicaid expansion took effect in October 2020. Medicaid expansion took effect in Oklahoma in July 2021, and in Missouri in October 2021.
As a result of those 12 states refusal to accept federal funding to expand Medicaid, the Kaiser Family Foundation estimates there are 2.2 million people in the coverage gap across 11 of those states .
Being in the coverage gap means you have no realistic access to health insurance. These are people with incomes below the poverty level, so they are not eligible for subsidies in the exchange. But they are also not eligible for their states Medicaid program.
Get Important News & Updates
Sign up for email and/or text notices of Medicaid and other FSSA news, reminders, and other important information. When registering your email, check the category on the drop-down list to receive notices of Medicaid updates check other areas of interest on the drop-down list to receive notices for other types of FSSA updates.
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Traditional Medicare And Medicare Advantage: A Historic Divide
Beneficiaries weigh considerable trade-offs when deciding whether to enroll in Medicare Advantage plans or traditional Medicare. Unlike the latter, Medicare Advantage plans are required to place limits on enrollees out-of-pocket spending and to maintain provider networks.3 The plans also can provide benefits not covered by traditional Medicare, such as eyeglasses, fitness benefits, and hearing aids. Medicare Advantage plans are intended to manage and coordinate beneficiaries care. Some Medicare Advantage plans specialize in care for people with diabetes and other common chronic conditions, including Special Needs Plans SNPs also focus on people who are eligible for both Medicare and Medicaid and those who require an institutional level of care.
Traditional Medicare and Medicare Advantage enrollees have historically had different characteristics, with Medicare Advantage enrollees somewhat healthier.4 Black and Hispanic beneficiaries and those with lower incomes have tended to enroll in Medicare Advantage plans at higher rates than others.5 Traditional Medicare has historically performed better on beneficiary-reported metrics, such as provider access, ease of getting needed care, and overall care experience.6
Medicaid Is Structured As A Federal
Subject to federal standards, states administer Medicaid programs and have flexibility to determine covered populations, covered services, health care delivery models, and methods for paying physicians and hospitals. States can also obtain Section 1115 waivers to test and implement approaches that differ from what is required by federal statute but that the Secretary of HHS determines advance program objectives. Because of this flexibility, there is significant variation across state Medicaid programs.
The Medicaid entitlement is based on two guarantees: first, all Americans who meet Medicaid eligibility requirements are guaranteed coverage, and second, states are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees. The match rate for most Medicaid enrollees is determined by a formula in the law that provides a match of at least 50% and provides a higher federal match rate for poorer states .
Figure 2: The basic foundations of Medicaid are related to the entitlement and the federal-state partnership.
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Person Who Is Aged Blind And/or Disabled
Apply if you are aged , blind, or disabled and have limited income and resources. Apply if you are terminally ill and want to get hospice services. Apply if you are aged, blind, or disabled live in a nursing home and have limited income and resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have limited income and resources.
What Medicaid Helps Pay For
If you have Medicare and qualify for full Medicaid coverage:
- Your state will pay your Medicare Part B monthly premiums.
- Depending on the level of Medicaid you qualify for, your state might pay for:
- Your share of Medicare costs, like deductibles, coinsurance, and copayments.
- Part A premiums, if you have to pay a premium for that coverage.
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Medicaid Covers A Broad Range Of Health And Long
Medicaid covers a broad range of services to address the diverse needs of the populations it serves . In addition to covering the services required by federal Medicaid law, many states elect to cover optional services such as prescription drugs, physical therapy, eyeglasses, and dental care. Coverage for Medicaid expansion adults contains the ACAs ten essential health benefits which include preventive services and expanded mental health and substance use treatment services. Medicaid plays an important role in addressing the opioid epidemic and more broadly in connecting Medicaid beneficiaries to behavioral health services. Medicaid provides comprehensive benefits for children, known as Early Periodic Screening Diagnosis and Treatment services. EPSDT is especially important for children with disabilities because private insurance is often inadequate to meet their needs. Unlike commercial health insurance and Medicare, Medicaid also covers long-term care including both nursing home care and many home and community-based long-term services and supports. More than half of all Medicaid spending for long-term care is now for services provided in the home or community that enable seniors and people with disabilities to live independently rather than in institutions.
Figure 5: Medicaids benefits reflect the needs of the population it serves.
Eligibility Requirements For Medicaid
As mentioned before, eligibility requirements can vary by state. Eligibility requirements can include income level, age, disability, and other factors. However, if your state has expanded its Medicaid program, there is only one eligibility requirement income. States that have expanded their Medicaid program or plan on expanding as of 2019:
- West Virginia
- Washington D.C.
If you live in one of these states, are under 65, and have income that is equal to or below 133% of the federal poverty level , you can qualify for Medicaid. However, if you dont live in one of the states, you may have to meet additional requirements to qualify for Medicaid. The only accurate way to see if you qualify is to apply.
Benefits Covered By Medicaid
The federal government requires Medicaid programs in each state to cover certain medical services. There are several additional services each state can choose to include in their Medicaid programs. Services that are required to be covered by each Medicaid program are:
- Certified Pediatric and Family Nurse Practitioner services
- Early and Periodic Screening, Diagnostic, and Treatment Services
- Family planning services
- Tobacco cessation counseling for pregnant women
- Transportation to medical care
Other services that arent required but may be covered include prescription drugs, therapy, hospice, dental, vision, and more.
How Medicaid Covers Cancer
How Medicaid works with Medicare
Medicaid programs vary by state and person
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A Number Of Large Health Insurance Companies Have A Significant Stake In The Medicaid Managed Care Market
States contracted with a total of 282 Medicaid MCOs as of July 2019. MCOs represent a mix of private for-profit, private non-profit, and government plans. As of July 2019, a total of 16 firms operated Medicaid MCOs in two or more states ,6 and these firms accounted for 63% of enrollment in 2019 . Of the 16 parent firms, seven are publicly traded, for-profit firms while the remaining nine are non-profit companies. Six firms UnitedHealth Group, Centene, Anthem, Molina, Aetna/CVS, and WellCare each have MCOs in 12 or more states and accounted for 51% of all Medicaid MCO enrollment . All six are publicly traded companies ranked in the Fortune 500.7 KFF analysis of more recent MCO enrollment data, from the subset of states that make these data available, showed that five for-profit parent firms accounted for almost 60% of the pandemic-related increase in MCO enrollment from March 2020 to March 2021 in these states. Earnings reports from Q4 2021 for these five for-profit parent firms showed year-over-year growth in Medicaid membership ranging from 10 to 20% and for the three firms that provided Medicaid-specific revenue information growth in Medicaid revenues ranging from 13 to 43%.8
Additional Types Of Medicaid Programs
Each state governs its own Medicaid program and is responsible for establishing its own set of benefits, costs and eligibility rules . That means the types of available Medicaid programs will differ from one state to the next.
But some of the types of Medicaid programs that you might find in certain states may include coverage for:
- Individuals under the age of 21 who are on the autism spectrum
- Foster care, adoption assistance and benefits for juvenile justice members
- Those in need of long-term care
- Those transitioning from long-term care back to the community
- Those in need of transportation to medical appointments
- Uninsured and underinsured pregnant women
- Women with breast or cervical cancer
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More States Easing Into Expansion
New Hampshire, Michigan, Indiana, Pennsylvania, Alaska, Montana, and Louisiana all expanded their Medicaid programs between 2014 and 2016. Expansion took effect in Virginia and Maine in 2019, in Utah, Idaho, and Nebraska in 2020, and in Oklahoma and Missouri in 2021.
The 2018 election was pivotal for Medicaid, with three states passing ballot initiatives to expand Medicaid, and Kansas, Wisconsin, and Maine electing governors who are supportive of Medicaid expansion .
The first six states to implement Medicaid programs did so in 1966, although several states waited a full four years to do so. And Alaska and Arizona didnt enact Medicaid until 1972 and 1982, respectively. Eventually, Medicaid was available in every state, but it certainly didnt happen everywhere in the first year.
Theres big money involved in the Medicaid expansion decision for states. Under ACA rules, the federal government pays the vast majority of the cost of covering people who are newly eligible for Medicaid. Through the end of 2016, the federal government fully funded Medicaid expansion. The states started to pay a small fraction of the cost starting in 2017, eventually paying 10% by 2020. From there, the 90/10 split is permanent the federal government will always pay 90% of the cost of covering the newly eligible population, assuming the ACA remains in place.
Medicaid And The Covid Pandemic
As noted above in the section about work requirements, the Families First Coronavirus Response Act essentially prevents states from making their eligibility standards any more strict during the COVID emergency period than they were as of the start of 2020. The COVID emergency period was most recently extended in April 2022 extensions last for 90 days.
Section 6008 of the FFCRA provides states with a 6.2 percentage point increase in their federal Medicaid matching funding for the duration of the COVID public health emergency period, as long as the state Medicaid program:
- keeps its eligibility standards no more restrictive than they were at the start of 2020,
- does not raise premiums above the levels they were at in January 2020,
- provides no-cost coverage for COVID testing and treatment,
- does not terminate enrollees coverage for the duration of the COVID emergency period, unless they move out of the state or request that their coverage be terminated.
CMS previously interpreted this last point to mean that in order to receive the increased federal Medicaid funding, a state must keep beneficiaries enrolled in Medicaid, if they were enrolled on or after March 18, 2020, with the same amount, duration, and scope of benefits, and that states could not subject such beneficiaries to any increase in cost-sharing or beneficiary liability for institutional services or other long-term services and supports during this time period.