is a social welfare program co-administered by the Centers for Medicare & Medicaid Services (CMS
) and state Medicaid agencies.
Because state governments are also involved, Medicaid benefits vary from state to state. In some cases, states run their own medical care assistance programs.
Medicaid provided medical care assistance to an estimated 55 million needy and low-income Americans in 2006. According to the Department of Health and Human Services, 47.6% of Medicaid recipients were children, 26.3% were adults, 16.5% were disabled, and 9.6% were elderly. Persons may be eligible to receive Medicaid and Medicare
benefits. Medicaid may pay for Medicare insurance premiums
, for example. Contact your state Medicaid agency for more information. (See table, below, for a list of state Medicaid agencies.)
In general, Medicaid is aimed at helping out only the most impoverished citizens, young and old alike. If you expect to depend on Medicaid to pay your medical bills, you may wish to consult a financial adviser to discuss your estate. It's unlikely that you will be able to qualify if you have an estate of $200,000, for instance. The Medicaid agency is likely to require you to "spend down" your assets in order to qualify for Medicaid. This may require gifting some of your estate to charitable organizations or your loved ones.
The following tables link you to state agencies responsible for administering Medicaid programs:
According to the CMS, some of the major categories of needy persons that must be provided Medicaid benefits include:
Individuals who qualify for benefits from the Aid to Families with Dependent Children (AFDC) federal program in effect in their state in July 1996. States have the discretion to make the qualification rules easier.
Children under age 6 whose family income is at or below 133% of the federal poverty level.
Pregnant women whose family income is below 133% of the federal poverty level.
Recipients of Supplemental Security Income (SSI
) in most states. (Some states may use more restrictive criteria for eligibility.)
Certain Medicare beneficiaries.
The CMS gives states the option to include other needy categories. However, these categories do not mandate coverage the way the categories above do. The categories that may include senior citizens are:
Institutionalized individuals eligible to receive a special income level that may be up to three times the federal Supplemental Security Income limit.
Individuals receiving home- or community service-based care that would otherwise be institutionalized.
Certain aged, blind, or disabled adults with incomes high enough to exclude them from receiving mandatory Medicaid coverage but whose incomes are below the federal poverty level.
Recipients of state supplementary income payments.
Certain medically needy persons. These include persons who earn too much but would otherwise qualify for the mandatory or optional categories. These persons may qualify automatically or they may have to use up their assets in order to qualify as medically needy.
The Balanced Budget Act of 1997 also established a nursing care program for persons who are age 55 or older called Programs of All-inclusive Care for the Elderly (PACE
). PACE programs are run by state Medicaid agencies at their discretion.
Another feature of some state programs is that they may use cost sharing with Medicaid recipients. Forms of cost sharing include the use of nominal deductibles
, and coinsurance.
The above information is educational and should not be interpreted as financial advice. For advice that is specific to your circumstances, you should consult your state Medicaid agency.