What are the Different Medicaid Programs?

Tricia Christensen
Tricia Christensen
Medicaid helps families from lower income brackets receive medical care.
Medicaid helps families from lower income brackets receive medical care.

Medicaid is a US joint federal/state program to help provide qualifying individuals with the means to pay for some of their medical care. There are actually 56 programs because each state and territory runs their own program in conjunction with the federal government. This is a little confusing, and people generally need to apply in the state or territory in which they reside.

Children are often covered by Medicaid.
Children are often covered by Medicaid.

Each state runs several different Medicaid programs that may be applicable to certain people who fall into various categories. These categories may vary from state to state and it’s important to check local programs for qualification requirements. In general, Medicaid programs may serve impoverished or low income families, recipients of supplemental security income (SSI), seniors who qualify for Medicare but who cannot afford supplemental insurance, people with permanent disabilities, foster children or wards of the state, and some individuals in poverty or slightly above the poverty level who cannot obtain insurance. On this last group, it’s variable whether people without children will always qualify for Medicaid and this is a matter of state discretion.

Not all individuals and families with low incomes qualify to receive Medicaid assistance.
Not all individuals and families with low incomes qualify to receive Medicaid assistance.

One program administered by Medicaid is the State Children’s Health Insurance Program (SCHIP). This may help provide very low cost insurance for kids when their parents do not have insurance and exceed income requirements for standard Medicaid. Unlike many other forms of government insurance, parents pay a small monthly fee to obtain insurance from private insurers, who then cover the cost of most healthcare services. Those who can’t currently insure kids but have low incomes may very well qualify for this program and it is definitely worth investigation.

Medicaid programs may help seniors who qualify for Medicare but who cannot afford supplemental insurance.
Medicaid programs may help seniors who qualify for Medicare but who cannot afford supplemental insurance.

The various Medicaid programs can get confusing because not all people will apply in the same place or to the same agency. Those who receive SSI, even in very small payments, may automatically receive federal insurance even if they have other health insurance. This could be useful for meeting costs of copayments if certain providers are used. Others will apply for programs when they apply for Medicare or through organizations that provide welfare. Some people make applications from hospitals if they have no insurance and need help meeting hospital bills.

Individuals with severe mental and developmental disabilities may qualify for SSI as well as Medicaid.
Individuals with severe mental and developmental disabilities may qualify for SSI as well as Medicaid.

It’s important to note that Medicaid programs are income tested, but not all people with low incomes meet requirements to get it. People usually have to be eligible by belonging to one of the above-mentioned groups, in addition to qualifying by low income. On the other hand, those who wouldn’t ordinarily qualify may do so if they have sudden huge hospital expenses they can’t meet. This is why the issue is so confusing; people may not know whether they qualify unless they fit into one of these groups.

Many physicians who work with Medicaid patients are internists, family physicians, or pediatricians.
Many physicians who work with Medicaid patients are internists, family physicians, or pediatricians.

It’s equally vital to understand that certain qualifications may require a fight to prove. Many people who are fully disabled do not automatically get Medicare or are eligible for Medicaid programs and must participate in hearings to prove their disability. It has been noted by people outside of the system that there appears to be significant numbers of applicants who initially are refused SSI and government health care, but who eventually obtain it.

Tricia Christensen
Tricia Christensen

Tricia has a Literature degree from Sonoma State University and has been a frequent TheHealthBoard contributor for many years. She is especially passionate about reading and writing, although her other interests include medicine, art, film, history, politics, ethics, and religion. Tricia lives in Northern California and is currently working on her first novel.

Tricia Christensen
Tricia Christensen

Tricia has a Literature degree from Sonoma State University and has been a frequent TheHealthBoard contributor for many years. She is especially passionate about reading and writing, although her other interests include medicine, art, film, history, politics, ethics, and religion. Tricia lives in Northern California and is currently working on her first novel.

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