Medicaid Tips for US Citizens

Medicaid is an "entitlement" program,  which suggests that anyone who meets eligibility rules has a right to enrol in Medicaid coverage. It also means states have guaranteed federal financial support for part of the cost of their Medicaid programs.

To receive federal funding, states must cover certain "mandatory" populations:

  • Children up to the age of 18 living in families earning less than 138 percent of the federal poverty line ($29,974 for a family of three in 2020);
  • Pregnant women with incomes less than 138 percent of the poverty line;
  • Certain parents or caretakers with a very low income; and
  • Most seniors and other people with disabilities who receive cash assistance through the Supplemental Security Income (SSI) program are

States can also receive federal Medicaid funds to cover "optional" populations. These include people within the groups listed above whose income exceeds the limits for "mandatory" coverage;

seniors and people with disabilities not receiving SSI and with an income below the poverty line; "medically needy" people (those whose income exceeds the state’s regular Medicaid eligibility limit but who have high medical expenses, like for nursing home care, that reduce their income below the eligibility limit);

and other people with higher income who need long-term services and supports; and—thanks to the Affordable Care Act (ACA) —non-disabled adults with an income below 138 percent of the poverty line, including those without children.

The ACA was intended to increase coverage for all such adults, but a 2012 Supreme Court decision gave states the choice of whether to expand their programs.

Not all people with low incomes are eligible for Medicaid. They will read further to learn Medicaid tips for US citizens. Within the 15 states that have not implemented the ACA Medicaid expansion (as of April 2020),

adults over 21 are generally ineligible for Medicaid regardless of how low their incomes are unless they are pregnant, caring for young children, the elderly, or have a disability. Even parents are ineligible in the typical non-expansion state if their income exceeds 42 per cent of the poverty level ($9,122 for a family of three).

In addition, many of us who are not U.S. citizens are ineligible for Medicaid despite having a lawful immigration status. This group includes people with temporary protected status whom the federal government has allowed to live in the country for humanitarian reasons and people granted temporary permission to come to the United States for educational purposes, travel, or add a variety of fields, among others.

Also, lawful permanent residents (often mentioned as green card holders) cannot enrol in Medicaid for the first five years, whether or not they meet all eligibility requirements. (States have the choice to extend eligibility to all lawfully present children and pregnant women without a five-year wait.)

Medicaid Tips for US Citizens

Because of the Affordable Care Act, Medicaid tips for US citizens have become even more important in insuring low-income Americans. As previously stated, the ACA expands Medicaid eligibility to 138 percent of the federal poverty line, providing coverage for low-income adults.

As of April 2020, 35 states and the District of Columbia had expanded Medicaid to serve poor and low-income adults. According to the CBO, by 2029, 14 million more low-income adults will have enrolled in Medicaid and gained access to affordable comprehensive health coverage as a result of the ACA.

What Kinds of Services Does Medicaid Provide?

Federal law requires that state Medicaid programs cover certain "mandatory" services, such as B. Hospital and physician care; laboratory and X-ray services; home health services; and adult care facility services. States are also required to provide children under the age of 21 with a more comprehensive package of benefits known as the EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) benefit.

States can, and they all cover certain services. All states cover prescription drugs, and most cover other general optional services, including dental care, vision services, hearing aids, and personal care services for frail seniors and people with disabilities.

While these services are considered "optional" because states are not required to provide them, they are essential to meeting the health care needs of Medicaid recipients. About three-fourths of all Medicaid service expenditures are paid for acute care services, such as hospital care, physician services, and prescription drugs;

the rest is paid for nursing homes and other long-term care services and supports. Medicaid Advice for US Citizens: Medicaid covers more than 60% of all nursing home residents and roughly 50% of the cost of long-term care services and support.

The vast majority of Medicaid beneficiaries are covered by privately managed care plans. For others, state Medicaid programs pay hospitals, physicians, nursing homes, and other healthcare providers for covered services they provide to eligible patients. (Healthcare providers are not required to participate in Medicaid, and not all do.)

How Much Does Medicaid Cost? How is It Financed?

In the fiscal year 2018, states and the federal government spent approximately $630 billion on Medicaid services. State policies have a significant impact on the amount of money the federal government spends on Medicaid, not only because states are guaranteed federal Medicaid matching funds for the cost of covered services provided to eligible individuals,

but also because states, as previously discussed, have broad discretion over who is eligible, what services they will cover, and how much they will pay for covered services.

How Effective is Medicaid?

Medicaid is very effective in providing health coverage to the most vulnerable. Since the ACA's major coverage extensions went into effect in 2014, Medicaid has helped reduce the number of uninsured from 45 million to 29 million. If Medicaid didn't exist, most of the tens of millions of Medicaid members would be uninsured.

This is because private health insurance is generally not an option for Medicaid recipients; many low-income workers do not have access to health insurance for themselves and their families through their jobs and cannot afford to get health insurance on the open market.

The creation of Medicaid, the subsequent expansion of Medicaid coverage for children and pregnant women in the 1980s and 90s, and the recent expansion of Medicaid coverage for low-income adults under the ACA have resulted in a significant decrease in the proportion of Americans without health insurance coverage.

Medicaid is also effective in improving access to care, supporting the financial stability of low-income families, and improving health outcomes. Some of the clearest evidence comes from the ACA's expansion of Medicaid coverage for low-income adults, which offers a recent "natural experiment" that allows researchers to compare outcomes in states that have and haven't introduced the expansion. 

Studies show that after the expansion took effect, the proportion of low-income adults having a personal physician, checkups and other preventative health care, and regular chronic disease care increased in expansion states compared to non-expansion states.

According to another study, medical debt fell by $1,140 among those receiving Medicaid coverage under the ACA expansion, and low-income adults in expansion states gained better access to credit (including low-interest mortgages and auto loans) and were less likely to be evicted from their homes.

Meanwhile, several studies collectively show that Medicaid coverage leads to improvements in self-reported general health, reduces the proportion of low-income adults testing positive for depression, improves control of diabetes and hypertension, and reduces mortality per year in patients diagnosed with end-stage renal failure disease. Perhaps most surprisingly, multiple rigorous studies have found that expanding Medicaid saves lives.

One study estimates that expansion among seniors alone has saved more than 19,000 lives, while state decisions not to expand have cost more than 15,000 lives. Other research also points to the large benefits of Medicaid coverage in Celebration.

In particular, a landmark study conducted by the Oregon Medicaid program discovered that people on Medicaid were more likely than similar people without health insurance to seek preventive care, have a regular practice or clinic where they can receive primary care, and receive diagnosis and treatment for depression. and diabetes.

Health insurance also has long-term benefits for children. Research shows that children on Medicaid do better in school and miss fewer days of school due to illness or injury. They are also more likely to graduate from high school, attend college, and graduate college; they earn more as adults; and they experience fewer emergency room visits and hospital stays.

By Samara Miller | Sep 12 2022

Get Social

Recent Posts
  • Does Medicare Cover Respite Care?
  • Medicare Advantage enrollments
  • What you pay in a Medicare Advantage Plan
  • Why Medicare Matters to All Americans
  • Are you eligible for medicare ?

DISCLOSURES - This is an advertising referral and comparison service that matches consumers with prospective agents and companies depending upon your information. The operator of this website is not an insurance company, an agent, a provider, a broker, a representative, a bank, or a financial or lending institution. We do not represent any specific provider and do not provide insurance or financial quotes, or policies. Quotes are provided by independent participating companies that participate in network. Lowest advertised rates may vary and are not necessarily available from all participating service providers. We do not endorse or charge you for any product or service. Any compensation received is paid by participating providers and only for advertising services provided. This service is void where prohibited. We are not connected with or endorsed by the U.S. government or any federal programs. This service and these disclosures are provided to you for information purposes only and should not be used as a substitute for informed professional advice.