Medicaid is a program for those who cannot afford medical care. It is managed by the state and funded by both state and federal government funds, and is the largest source of funding for medical and health services for people with limited resources. It is often confused with Medicare, but Medicare is a Federal program that is not income based and is only for those 65 and older or those who have certain medical conditions.
Medicaid however, is “needs” based and serves those with limited income and resources. A person may be eligible for both Medicare and Medicaid.
There are two general types of Medicaid:
- General or community Medicaid which assists income eligible families or individuals with little or no medical insurance.
- Nursing home coverage through Medicaid which assists an individual with the costs of nursing home care.
Since Medicaid is a state run program, each state sets its own guidelines regarding income eligibility and the services that are covered. But in order for a state to received matching funds from the Federal government, they must provide certain services under their Medicaid program. These services include:
- Prenatal care;
- Vaccinations for children;
- Inpatient hospital care;
- Laboratory and x-ray services;
- Doctor’s services; and
- Pediatric care.
Most states provide additional services under Medicaid, such as:
- Physical therapy;
- Prescription drugs;
- Diagnostic services;
- Eye care and eyeglasses;
- Prosthetics; and
- Clinical services.
Medicaid does not pay money to the covered individual, but sends payments to the health care providers. States make these payments based on a fee-for-service agreement or through prepayment arrangements. Each State is then reimbursed for a share of their Medicaid expenditures from the Federal government.
While states are permitted to charge a copayment or a deductible for certain services, the Federal government requires that minors, pregnant women and nursing home patients be excluded from these payment requirements. Co-pays for emergency and family planning services are also not permitted.
Medicaid may also be needed by the aged who enter a nursing home. For those who are eligible, Medicaid covers room and meals, nurses, therapists, doctor’s visits, some prescription drugs, dental care, and medical equipment. Medicaid often enters the picture when an elderly patient has exhausted all resources to pay for a nursing home.
Medicaid can be a confusing system to navigate, particularly when it comes to the care of a senior citizen who is also Medicare eligible. It helps to have an advocate who is familiar with the coverage and benefits of both systems to best serve the patient.