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A Beginner’s Guide To Medicaid

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Medicare, be it surgeries, living in a nursing home or assisting living facility, and even prescription drugs, is one of the most expensive expenses. Such high costs can end up causing your family substantial financial struggles, especially today when healthcare expenses are quite steep. This is why state and federal governments, in a partnership, formed the Medicaid health program targeted to help the low-income and most vulnerable U.S. citizens with their medical needs. 

However, the subject of Medicaid is often quite confusing because this system combines state and federal laws. These laws are also continually changing because different Medicaid rules and procedures differ from state to state. And, if you’re considering getting this medical insurance for yourself or a loved one, read on. This guide will take a deeper look into everything you need to know about Medicaid, for instance, Medicaid covered incontinence supplies, to understand this subject better. 

What’s Medicaid? 

Medicaid is a state and federal program that’s essential in the U.S. healthcare system as it allows persons from low-income households to get affordable and reliable medical care. The people qualifying for Medicaid include low-income persons aged 65 years and above, pregnant women, persons with disabilities, and children. 

But, after 2014, states were permitted to expand the list of persons qualifying for Medicaid through the Affordable Care Act (ACA) to persons aged below 65 years. However, the income of these individuals should be up to 133% of the federal poverty level. The asset limit for a person to qualify for Medicaid is set at USD$2000 per application.

Some of the considered assets include:

  • Cash in bank accounts 
  • Investments 
  • Life insurance policies 
  • Second home or vehicles 
  • Certain annuities 
  • Revocable trusts 

With that said, certain assets aren’t factored in when determining a person’s eligibility for Medicaid, and these include:

  • Personal property 
  • Primary vehicle
  • Retirement accounts 
  • Household items 
  • Primary home 

Thanks to Medicaid, most crucial healthcare services, for instance, community health centers, nursing homes, and professionals, such as nurses and doctors, get the needed cash flow to run their operations. 

What’s Covered By Medicaid? 

There’s a broad range of healthcare services that Medicaid covers, but this depends on the state’s structure and specific program. With that said, priority is placed on the most basic medical needs.

 According to the Affordable Care Act, these are the minimum healthcare services covered under the Medicaid policy in all the states:

  • Hospital services, both outpatient and inpatient  
  • Nursing facility services 
  • X-ray and laboratory services 
  • Nurse midwife services 
  • Physician services 
  • Home health care services 
  • Rural health clinic services 
  • Federally qualified healthcare center services 
  • Freestanding birth center services, if licensed 
  • Family planning services 
  • Certified nurse practitioner and pediatric services 
  • Transportation to medical care 
  • Tobacco cessation counseling for expectant mothers
  • Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services

In addition to these basics covered by Medicaid, there can be other additional and optional services offered, including: 

  • Dental care services 
  • Clinic services 
  • Eyeglasses 
  • Prescription drugs 
  • Hospice services 
  • Prosthetics 
  • Case management 
  • Podiatry services 
  • Personal care 
  • Private duty nursing services
  • Physical therapy 
  • Speech, hearing, and language disorder services 
  • Optometry services  
  • Occupational therapy 
  • Chiropractic services 
  • Dentures 
  • Respiratory care services 
  • Tuberculosis-related services 
  • Home and Community-Based Services (HCBS)
  • Community First Choice
  • Self-directed personal assistance services
  • Inpatient psychiatric services for persons aged under 21 years 
  • Other practitioner services 
  • Other screen, rehabilitative, and diagnostic services 
  • Services for an intermediate care facility for persons suffering from intellectual disabilities

These different medical services come in various combinations, which normally depend on the specific program structure of the state. With that said, certain services don’t come covered under Medicaid, and these include:

  • Acupuncture 
  • Autopsy
  • Cosmetic surgery 
  • Custodial care 
  • Drugs or biologics deemed by the federal government as less effective
  • Events and activities not offered by the healthcare facility  
  • Procedures for embryo implanting
  • Missed or broken appointments   
  • Organ transplants that lack prior approval  
  • Undocumented health services in a recipient’s medical record 
  • Printers, computer hookups, or computers, unless used for assistive communication gadgets 
  • Private room, unless needed for medical reasons 
  • Personal items, such as grooming items, cosmetics, and clothing 
  • Phones, radios, reading materials, and TVs
  • Home remedies, nutritional items, food supplements, alcoholic drinks, over-the-counter drugs, or vitamins besides those prescribed by a qualified medical doctor 
  • Drugs, procedures, or services deemed as experimental by the U.S. Department of Health and Human Services or a different federal agency

How Can You Apply for Medicaid? 

You can apply for Medicaid in different ways, including going to www.healthcare.gov, www.medicaid.gov, or your state’s Medicaid agency website. Alternatively, you can apply for Medicaid over the phone or head to the local offices in your state if you don’t have Internet access and manually file the application. 

Going to www.healthcare.gov first is especially advised because here, you’ll be taken through a quick screening questionnaire that helps determine your chances of qualifying for Medicaid. After that, you’ll be directed to your state’s program, where you can start your application. During the application process, you must issue certain documents required by the state and federal government for you to qualify for Medicaid, including:

  • Proof of citizenship 
  • Birth certificate or driver’s license to verify your age
  • Documentation of your income and assets 
  • Medical records showing proof of your disability 
  • Copies of your rent payment receipts, lease, utility bills, mortgage, or any other relevant document to show proof of your residence 
  • Details about any additional health insurance cover you have

The best thing about a Medicaid application is you can do it any time of the year. If your Medicaid request doesn’t go through, you’ll be sent a formal denial notice detailing why your application hasn’t been a success. You can issue additional documentation or appeal this decision to try and be granted Medicaid health insurance. When appealing this decision, it’s best to do so within 30 to 90 days or ideally within 45 days.  

Takeaway 

If you or a loved one is planning to get Medicaid cover, it’s prudent to get as much information as possible about it. Only then can you be in a position to determine whether this healthcare program is a suitable fit for you. This guide has done that by explaining in detail everything you need to know about Medicaid. Hopefully, you’ll be in a better position to know whether or not to go for it.



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