1/26/2023
The medical system in the United States is clearly oriented towards private insurance, being necessary to have a good insurance company that covers as many pathologies as possible, which means having to pay a good amount of money for the policy.
At the same time, there are a good number of low-income individuals and families who cannot afford to pay for private health insurance. For them there are government assistance programs, such as Medicaid.
You may be interested in: What is Medicare and what does it covers?
What is Medicaid?
Medicaid provides health coverage to low-income citizens, allowing either full reimbursement of medical expenses or the application of a co-payment.
It is a federal and state medical assistance program that each state can apply differently, within certain parameters and supervised by the federal agency Centers for Medicare & Medicaid Services (CMS).
Thus, several states have their own public health programs through which the federal Medicaid program is applied, such as California's Medi-Cal or New Jersey's NJ FamilyCare.
Requirements to apply for Medicaid
Thanks to the Affordable Care Act, the law colloquially known as Obamacare and which gave so much to talk about during its passage, since 2019 the states that adopted it extended coverage to a greater number of citizens thanks to the relaxation of the conditions to apply for Medicaid.
However, not all states have implemented this expansion, although the vast majority have, such as California, New York, New Jersey, Illinois or Pennsylvania.
Financial Criteria
Individuals and families eligible for Medicaid coverage are those with incomes that do not exceed 133% of the Federal Poverty Level established by the U.S. Department of Health and Human Services.
Thus, according to the levels published for 2023, an individual would be eligible for Medicaid if his or her annual income does not exceed $19,391 (133% of $14,580).
In the case of a family of 4, coverage would be accessible if the joint annual income does not exceed $39,900 (133% of $30,000).
How income is calculated
Obamacare also replaced the previous way of determining a Medicaid applicant's income, which was based on Aid to Families with Dependent Children (AFDC) criteria, with the MAGI methodology.
MAGI stands for Modified Adjusted Gross Income, and is a method that is used in a unified way for different medical and financial assistance programs, such as premium tax credits or the Children's Health Insurance Program (CHIP).
In the case of persons over age 65 or with blindness or disability, the Social Security Administration's Supplemental Security Income (SSI) program methodologies are used to determine their income for Medicaid coverage.
Non-Financial Criteria
In addition to the requirement of not exceeding a certain income level, there are also some non-financial conditions for eligibility to apply for Medicaid coverage, which may vary somewhat from state to state but typically include:
- Residing in the state in which Medicaid is received.
- U.S. citizenship or permanent U.S. residency.
- Other criteria of age, pregnancy or relationship.
You may be interested in: Hospitals and medical centers in Los Angeles County near me
What does Medicaid cover?
The benefits provided by this federal medical assistance program depend on the state in which you reside because, although there are a number of coverages that are mandatory for all states, there are also a number of optional services that each state may choose to apply or not.
Mandatory Medicaid Coverage
The following services must be subsidized by Medicaid in all states:
- Medical Assistance.
- Federally qualified health centers.
- Nursing facility services.
- Rural medical clinics.
- Inpatient care.
- Outpatient care.
- Home health services.
- Preventive and periodic screening and treatment services.
- Transportation to medical centers.
- X-ray services.
- Laboratory services.
- Family planning.
- Midwives.
- Pediatrics.
- Independent maternity centers.
- Smoking cessation assistance for pregnant women.
Optional Medicaid Coverage
The non-mandatory services offered by Medicaid depend on the state in which you reside, since each region can apply the ones it considers and with more or less coverage. Optional services include the following:
- Clinical services.
- Prosthetics.
- Prescription eyeglasses.
- Physical and occupational therapy.
- Speech or hearing disorder services.
- Chiropractic services.
- Respiratory care.
- Prescription drugs.
- Podiatry.
- Optometry.
- Dental services.
- Dentures.
Which doctors accept Medicaid?
As mentioned above, Medicaid coverage depends on the state in which you reside. You can check the state specifics by selecting it on this page of the Medicaid website.
Therefore, the doctors covered by the medical assistance program will depend on where you live, although there are certain specialties that are covered in all states by obligation.
Thus, family doctors, pediatricians and doctors of other specialties in case of medical emergencies accept Medicaid as medical insurance for their patients. You will also have the service of nurses, midwives and other specialists such as x-ray technicians or laboratory technicians.
Depending on where you live, you may also have access to dentists, podiatrists, chiropractors and other doctors and medical technicians.
How is Medicaid different from Medicare?
Both Medicare and Medicaid are health coverage programs offered by the government, but there are certain differences in their structure and application that distinguish them.
The main difference is who each program covers. On the one hand, Medicare is primarily intended for people over the age of 65 and for citizens who have certain types of illness or disability. In Medicaid, on the other hand, all individuals or families below a certain income level can enroll.
Another difference is that Medicare is a nationwide program, which is applied fairly uniformly across the country, while Medicaid has more variable coverage depending on the state in which you reside.
Medicare has different parts that can be purchased separately or together, in different coverage packages. Medicaid is uniform in that way and the coverage it offers only depends on where you reside within the United States.
Español: Qué es Medicaid, qué cubre y qué doctores lo aceptan