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Needed to read PDF's
Medicaid
What is Medicaid?
Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.
Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services. In general, you should apply for Medicaid if you have limited income and resources.
Who can get Medicaid?
You must match one of the descriptions below:
Pregnant Women
Apply for Medicaid if you think you are pregnant. You may be eligible if you are married or single. If you are on Medicaid when your child is born, both you and your child will be covered.
Children and Teenagers
Apply for Medicaid if you are the parent or guardian of a child who is 18 years old or younger and your family's income is limited, or if your child is sick enough to need nursing home care, but could stay home with good quality care at home. If you are a teenager living on your own, the state may allow you to apply for Medicaid on your own behalf or any adult may apply for you. Many states also cover children up to age 21.
Person who is Aged, Blind, and/or Disabled
Apply if you are aged (65 years old or older), 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.
Other Situations
Apply if you are leaving welfare and need health coverage. Apply if you are a family with children under age 18 and have limited income and resources. (You do not need to be receiving a welfare check.) Apply if you have very high medical bills, which you cannot pay (and you are pregnant, under age 18 or over age 65, blind, or disabled).
Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. To learn more, see: http://www.medicaid.gov/.
Who's eligible for Medicaid?
You may qualify for free or low-cost health care through Medicaid based on your income and family size. Eligibility rules differ among states.
In all states, Medicaid gives health coverage to some individuals and families, including children, parents, people who are pregnant, elderly people with certain incomes, and people with disabilities. Some states have expanded their Medicaid programs to cover other adults below a certain income level.
Find out if your state has expanded Medicaid coverage and what that means for you.
There are two ways you can apply for Medicaid:
- Directly with your state. Check list below to find your state information.
- The Health Insurance Marketplace was created by the Affordable Care Act and helps you find health coverage that fits your needs and budget. Every health plan in the Marketplace offers the same set of essential health benefits, including doctor visits, preventive care, hospitalization, prescriptions, and more. You can compare plans based on price, benefits, quality, and other features important to you before you make a choice. People in most states use HealthCare.gov to apply for and enroll in health coverage.
With one application, you'll see if you qualify for free or low-cost coverage through Medicaid or CHIP, or for savings on a Marketplace plan. Most people who apply will qualify for some kind of savings. For more information, visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596, 24 hours a day, 7 days a week. TTY users should call 1-855-889-4325.
If your state runs its own Marketplace, you won't use HealthCare.gov. You'll use your state's website to enroll in individual/family or small business health coverage, or both. For a list of State-based Marketplaces, please visit: https://www.healthcare.gov/marketplace-in-your-state/.
Access to Care
Medicaid and the Children’s Health Insurance Program (CHIP) provide critical health coverage for millions of people. Through these programs, the Centers for Medicare and Medicaid Services (CMS) supports access to care in many ways. Most importantly, people gain access to health care services that may not be affordable without Medicaid or CHIP. Additionally, some programs and benefits include special protections—such as provider network and payment methods—that help ensure services are accessible.
Preventive care and other services help people stay healthy and avoid more costly care. CMS offers materials, toolkits, and other resources for states to help Medicaid and CHIP beneficiaries learn about these services and how to access them. CMS also supports many efforts to measure access, share the results, and promote progress.
Home & Community Based Services
Home and community based services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own homes or communities rather than institutions or other isolated settings. These programs serve a variety of targeted groups, such as older adults, people with intellectual or developmental disabilities, physical disabilities, or mental health and substance use disorders.
Managed Care
Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.
By contracting with various types of MCOs to deliver Medicaid program health care services to their beneficiaries, states can reduce Medicaid program costs and better manage utilization of health services. Improvement in health plan performance, health care quality, and outcomes are key objectives of Medicaid managed care.
Some states are implementing a range of initiatives to coordinate and integrate care beyond traditional managed care. These initiatives are focused on improving care for populations with chronic and complex conditions, aligning payment incentives with performance goals, and building in accountability for high quality care.
Medicaid & CHIP coverage
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Some states expanded their Medicaid programs to cover all people below certain income levels.
Even if you don't qualify for Medicaid based on income, you should apply. You may qualify for your state's program, especially if you have children, are pregnant, or have a disability. You can apply for Medicaid and CHIP any time of year.
Apply for Medicaid and CHIP 2 ways:
1. Fill out an application through the Marketplace
- If it looks like anyone in your household qualifies for Medicaid or CHIP, they'll send your information to your state agency. They'll contact you about enrollment.
- When you submit your Marketplace application, you'll also find out if you qualify for cost savings on a Marketplace plan. Plans may be more affordable than you think.
Create an account to start a Marketplace application.
2. Or, apply directly through your state Medicaid agency
Find your state below to get your Medicaid agency's contact information.
Where Can People Get Help With Medicaid & CHIP?
You Must Contact Your State Medicaid Agency to:
- Apply for Medicaid or CHIP
- See if you're eligible for Medicaid or CHIP
- Check on a Medicaid or CHIP application
- Get a Medicaid or CHIP replacement card
- Check on Medicaid or CHIP claims
- Find a Medicaid or CHIP health care provider
Choose your state below for the contact information you need to get started.
You may also check the status of your renewal coverage by contacting your State Medicaid Agency.
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