Medicaid
Medicaid is a joint federal and state program designed to provide health insurance assistance to individuals and families with low income and limited resources. Established under Title XIX of the 1965 amendment to the Social Security Act, Medicaid aims to offer comprehensive medical coverage to eligible participants. Each state operates its own Medicaid program and thus has flexibility over benefits, eligibility, service delivery, and payment rates.
Examples
- Individual with Low Income: A single adult who earns below the federal poverty line can qualify for Medicaid in many states.
- Elderly Person: An elderly individual who qualifies for Supplemental Security Income (SSI) might be eligible for Medicaid to cover medical expenses not fully paid by Medicare.
- Pregnant Women: Pregnant women who meet specific income guidelines are eligible for Medicaid in many states to ensure they receive adequate prenatal and postnatal care.
Frequently Asked Questions
Q1: Who is eligible for Medicaid?
A1: Eligibility criteria vary by state but typically include low-income individuals, families, pregnant women, elderly adults, and people with disabilities.
Q2: Can someone be enrolled in both Medicare and Medicaid?
A2: Yes, individuals who qualify may be enrolled in both programs and are known as “dual eligibles.”
Q3: Is Medicaid free?
A3: Medicaid may require minimal co-payments or premiums in some states, but it generally offers free or low-cost coverage.
Q4: How do I apply for Medicaid?
A4: Applications can be submitted through state Medicaid agencies, HealthCare.gov options, or local health departments.
Q5: Are all healthcare services covered under Medicaid?
A5: Coverage varies by state, but mandatory federal benefits include inpatient and outpatient hospital services, physician services, and laboratory and X-ray services.
- Medicare: A federal health insurance program for people aged 65 and older, and for some younger individuals with disabilities or particular diseases.
- SCHIP (State Children’s Health Insurance Program): Federal-state program offering health coverage for children in families with incomes too high to qualify for Medicaid but too low to afford private coverage.
- SSI (Supplemental Security Income): A federal program providing financial aid to elderly, blind, and disabled individuals with little to no income.
Online References
Suggested Books for Further Studies
- “Medicaid Politics and Policy” by David G. Smith and Judith D. Moore
- “Health Policy Issues: An Economic Perspective” by Paul J. Feldstein
- “Medicaid and Devolution: A View from the States” by Frank J. Thompson and John J. Dilulio Jr.
Fundamentals of Medicaid: Health Insurance Basics Quiz
### Who provides the eligibility criteria and coverage options for Medicaid?
- [ ] Only the federal government
- [x] Both federal and state governments
- [ ] Local municipalities
- [ ] Private insurance companies
> **Explanation:** Medicaid is a joint program between federal and state governments, meaning both entities contribute to setting eligibility criteria and coverage options.
### What year was Medicaid established under the Social Security Act?
- [ ] 1945
- [x] 1965
- [ ] 1990
- [ ] 2001
> **Explanation:** Medicaid was established under Title XIX of the Social Security Act in 1965.
### Can Medicaid cover services not covered by Medicare?
- [x] Yes
- [ ] No
- [ ] Only in emergency situations
- [ ] If additional private insurance is available
> **Explanation:** Medicaid can cover additional services that Medicare doesn't cover, particularly for individuals who are dual eligible.
### What group of individuals is specifically targeted for Medicaid coverage?
- [ ] Wealthy individuals
- [x] Low-income individuals
- [ ] Middle-income families
- [ ] Corporate employees
> **Explanation:** Medicaid is specifically designed to provide health coverage for low-income individuals.
### How are Medicaid services funded?
- [ ] Entirely by state taxes
- [ ] Entirely by federal taxes
- [x] Jointly by federal and state funds
- [ ] Through private donations
> **Explanation:** Medicaid services are funded jointly by federal and state funds.
### Is it possible for children in higher-income families than the Medicaid threshold to get healthcare assistance?
- [ ] No
- [ ] Only through private insurance
- [ ] If services are matched dollar for dollar by parents
- [x] Yes, through programs like SCHIP
> **Explanation:** Children in families with higher incomes than the Medicaid threshold can receive healthcare assistance through programs like the State Children's Health Insurance Program (SCHIP).
### What type of institution would typically run a state's Medicaid program?
- [x] State welfare or human services agencies
- [ ] Private health care providers
- [ ] Federal agencies directly
- [ ] Local municipalities
> **Explanation:** State welfare or human services agencies usually run state Medicaid programs.
### Can an elderly person qualify for Medicaid?
- [x] Yes, particularly if they meet SSI eligibility
- [ ] No, Medicaid only covers children and adults under 65
- [ ] Only if they have no family
- [ ] If they own their home outright
> **Explanation:** Elderly individuals, especially those who qualify for Supplemental Security Income (SSI), can qualify for Medicaid.
### How might someone apply for Medicaid?
- [ ] Only through a medical practitioner's referral
- [ ] At any hospital emergency room
- [x] Through state Medicaid agencies, HealthCare.gov, or local health departments
- [ ] At their job
> **Explanation:** People can apply for Medicaid through state Medicaid agencies, HealthCare.gov, or local health departments.
### What principle underpins the Medicaid program?
- [ ] Only covering accidental injuries
- [ ] Providing the highest cost treatment available
- [ ] Ensuring excellent coverage for the wealthy
- [x] Offering healthcare assistance to low-income and resource-limited individuals
> **Explanation:** The Medicaid program is built on the principle of offering healthcare assistance to individuals with low income and limited resources.
Thank you for exploring the essentials of Medicaid and testing your knowledge through our thoughtful quiz! Continue deepening your understanding of health insurance programs!
