Medicaid 101

What is Medicaid?
Medicaid is a program that pays for medical assistance for certain individuals and families with low incomes and resources. Medicaid is the largest source of funding for medical and health-related services for people with limited income. Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services.

Who is Eligible for Medicaid?
Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services.

Medicaid eligibility is limited to individuals who fall into specified categories. The federal statute identifies over 25 different eligibility categories for which federal funds are available. These categories can be classified in to five broad coverage groups:

1. Pregnant Women
   Apply for Medicaid if you think you are pregnant. You may be eligible if you are married or single. If you are on Medicaid when your child is born, both you and your child will be covered.

2. Children and Teenagers
   Apply for Medicaid if you are the parent or guardian of a child who is 18 years old or younger and your family's income is low, or if your child is sick enough to need nursing home care, but could stay home with good quality care at home. If you are a teenager living on your own, the state may allow you to apply for Medicaid on your own behalf or any adult may apply for you. Many states also cover children up to age 21.

3. Person who is Aged, Blind, and/or Disabled
   Apply if you are aged (65 years old or older), blind, or disabled and have low income and few resources. Apply if you are terminally ill and want to receive hospice services. Apply if you are aged, blind, or disabled; live in a nursing home; and have low income and limited resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have low income and limited resources.

4. Some Other Situations
   Apply if you are leaving welfare and need health coverage. Apply if you are a family with children under 18 and have very low income and few resources. (You do not need to be receiving a welfare check.) Apply if you have very high medical bills, which you cannot pay (and you are pregnant, under 18 or over 65, blind, or disabled).

For more information on Medicaid:

Centers for Medicare & Medicaid Services

For more information on eligibility rules in your state, go to:

State Medicaid Programs