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What is Medicaid?
Medicaid is a program of health services and medical testing to individuals and families with low income and few resources. Master Control Program is administered at the federal level but each state:
- Establishes its own eligibility standards
- Sets the rate of payment for services
- Administers its own Medicaid program
- Determines the type, amount, duration, and scope of services
What services are provided with Medicaid?
Although states are responsible for ultimately deciding that plans to offer Medicaid, there are mandatory requirements of the federal government should be respected by states to receive federal funding. The services required include:
- Prenatal care
- Laboratory and x-ray services
- Physician services
- Inpatient hospital services
- Rural health clinic services
- Nursing facility services for persons aged 21 or older
- Federally qualified health-center (FQHC) services and ambulatory services
- Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21
- Family planning services and supplies
- Pediatric and family nurse practitioner services
- Outpatient hospital services
- Nurse-midwife services
- Home health care for persons eligible for skilled-nursing services
- Vaccines for children
States may also provide optional services and continue to receive federal funds. The most common of the 34 approved optional Medicaid services include:
- Intermediate care facilities for the mentally retarded (ICFs/MR)
- Nursing facility services for children under age 21
- Rehabilitation and physical therapy services
- Prescribed drugs and prosthetic devices
- Home and community-based care to certain persons with chronic impairments
- Optometrist services and eyeglasses
- Diagnostic services
- Transportation services
- Clinic services
Who is eligible for Medicaid?
Each state sets its own eligibility criteria for Medicaid. The program is designed for people with low income, but eligibility depends also meet other requirements based on age, pregnancy status, disability status, other assets, and citizenship . States must provide Medicaid benefits for people entering certain categories of needs that the state receives federal matching funds. For example, it is necessary to provide coverage for certain persons who receive federal payments for income support and maintenance of similar groups not receiving cash payments. Other groups that the federal government considers "categorically needy" and who should be eligible for Medicaid include:
- Pregnant women with family income below 133% of the FPL
- Children under age 6 whose family income is at or below 133% of the Federal poverty level (FPL)
- Children born after September 30, 1983 who are under age 19 and in families with incomes at or below the FPL
- Recipients of adoption or foster care assistance under Title IV of the Social Security Act
- Individuals who meet the requirements for the Aid to Families with Dependent Children (AFDC) program that were in effect in their state on July 16, 1996
- Special protected groups such as individuals who lose cash assistance due to earnings from work or from increased Social Security benefits
- Supplemental Security Income (SSI) recipients
- Certain Medicare beneficiaries
States may also choose to offer Medicaid coverage to other groups that share similar characteristics with the above, but are more broadly defined. These include:
- Certain aged, blind, or disabled adults with incomes below the FPL
- Certain low-income and low-resource children under the age of 21
- Infants up to age 1 and pregnant women whose family income is not more than a state-determined percentage of the FPL
- Certain uninsured or low-income women who are screened for breast or cervical cancer
- Certain working-and-disabled persons with family income less than 250 percent of the FPL
- Some individuals infected with tuberculosis
- Low-income institutionalized individuals
People who qualify for Medicaid under mandatory or optional groups, except that their income and / or resources above the eligibility level set by their state. Medicaid does not provide medical assistance to the poor. In fact, it is estimated that approximately 60% of America's poor are not covered by the program.
Who pays for services provided by Medicaid?
Medicaid does not pay money to individuals, but works in a program that sends payments to providers. States make these payments is based on a rate of service agreement or agreements for early repayment, such as organizations of integrated health care (HMOs). Each state is reimbursed for part of their Medicaid costs the federal government. The Federal Medical Assistance Percentage (FMAP) is determined each year and depends on the state average per capita income level. Richer states receive a lower share of poor countries, but by the law of the MWRA should be between 50% and 83%.
Member States may impose nominal deductibles, coinsurance, copayments, or some Medicaid beneficiaries for certain services. However, the following must be submitted to Medicaid beneficiaries, cost-sharing.
- Children under age 18
- Pregnant women
- Hospital or nursing home patients who are expected to contribute most of their income to institutional care.
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