In the United States, Medicaid is a health program designed to help low income families. The program is funded through both federal and state governments, but it is managed by each individual state. To qualify, individuals must been strict guidelines that are based on income, family size, or disability. Medicaid is currently the largest provider of funding for low income families in need of medical services.
Medicaid services are available in all 50 states even though participation is entirely voluntary. Because each state manages its own program, the name may vary. Some states use the Medicaid name while others use different names such as TennCare in Tennessee or MassHealth in Massachusetts. The programs may also be combined and managed by the same organizations that manage other programs like the Children's Health Insurance Program. Medicaid services are subcontracted to private health insurance providers in some areas while other states pay Medicaid benefits directly. While operations vary slightly among states, the federal Center for Medicare and Medicaid Services is responsible for monitoring each program. They also establish the criteria for eligibility, delivery of service, and funding for state-run Medicaid programs.
Medicaid Eligibility
Eligibility for Medicaid is primarily based on income. The program may provide coverage to low-income individuals such as pregnant women, children, parents of children who are eligible, individuals with permanent or temporary disabilities, and elderly people who are in need of nursing home care. The coverage is intended to help low-income people with little or no health insurance or to provide funding for nursing home costs. Although income is one factor in determining whether or not one is eligible for Medicaid coverage, it is not the only qualifier. Recipients must fall into certain defined categories in order to receive benefits.
What does Medicaid Cover
Medicaid insurance can be used to pay for routine health care, emergency services, and preventative tests and treatments. It also covers many prescription medications. In some states, eligible recipients may also qualify for vision and dental coverage through Medicaid. Any services funded by Medicaid must be deemed medically necessary. As a result, elective procedures and prescriptions are not covered.
Studies have shown that Medicaid programs have a positive impact on public health. In studies of low-income households, those who are on Medicaid are more likely to seek preventative care and undergo diagnostic testing. Medicaid recipients are also more likely to seek medical treatment when necessary and report their health as being “good” or better.