Medicaid in the US

Medicaid was created by the Social Security Act with the intention of providing medical care for individuals and families with low income.

Your home state has established its own Medicaid standards for eligibility as well as the payment schedules for providers and medical centers.  Your state must administer the plan within the constraints of the broad national guidelines established by the Federal Medicaid statutes.

Health Insurance Plans

The individual states must comply in order to receive Federal matching funds, certain basic services must be offered to the needy population in any state sponsored program.

The basic services below can also be found at www.cms.hhs.gov/medicaid/mservice.asp

  • Inpatient hospital services
  • Outpatient hospital services
  • Physician Services
  • Medical and surgical dental services
  • Nursing facility services for individuals aged 21 or older
  • Home health care for persons eligible for nursing facility services
  • Family Planning services and supplies
  • Rural health clinic services and any other ambulatory services offered by a rural health clinic that are otherwise covered under the state plan
  • Laboratory and x-ray services
  • Pediatric and family nurse practitioner services
  • Federally-qualified health centers services and any other ambulatory services offered by a federally-qualified health center that are otherwise covered under the state plan
  • Nurse-midwife services
  • Early and periodic screening, diagnosis, and treatment

States may also allow the medically needy population to qualify for Medicaid and the state must provide minimum services as well.  Several states offer Medicaid HMO’s.

The Federal Medical Assistance Percentage is the percentage the government pays for each state’s programs and can vary depending on each state’s economy.  By law, the FMAP cannot be lower than 50% or higher than 83%.  According to the CMS website, the average percent paid to each state was 56.6% with Mississippi having the highest rate at 76.6%.

 

Many states have expanded their Medicaid programs to include more individuals under the Affordable Care Act, thus insuring more low-income individuals. In these states, if you earn up to 138 percent of poverty, you may qualify for coverage.