How does Medicaid Work

Medicaid is a federal and state government program that works to offer medical or health care benefits to individuals and their families that have low income and few assets. Though every state has its own medicaid program and corresponding rules and regulations, the main aim of this program is to assist people who are below federal poverty level by rendering them aids and funds. Besides them, other people who also qualify for medicaid eligibility include, pregnant women, dependent children and seniors, or individuals with disabilities having no or low source of income or no health insurance.

Services Provided by Medicaid

Often mistaken for medicare which provides services for people who are 65 or older and those who have long term disability irrespective of their income and assets, medicaid offer services only to those people who have low income and very few assets. However if you are eligible for both then medicaid has an advantage of paying costs and services that medicare does not cover. The medicaid program provides premiums, deductibles, co-payments for services including prenatal care, midwife services, vaccines for children, physician visits, hospital stays, diagnostic testing and long term nursing home care to people eligible and enrolled in the program. Some medicaid programs also cover services such as physical therapy and rehabilitation, prescription drugs, medical appointments and even transportation.

How Does Medicaid Work

Medicaid program of each state works on the funds raised and contributed by the state and the federal government. However, to receive the matching funds each state medicaid system has to fulfill the requirements or rules set by the federal government. The medicaid program differs from state to state, like a state that has more percentage of families with low income would receive more funds than states having less percentage of such low income families. Likewise, the state medicaid program may also differ with respect to the services offered, funding allocated to each medicaid program as well as the time duration up to which a receiver is eligible.

Moreover, in many states medicaid is also given to people who have income above the state's medicaid eligibility level but have regular medical expenses that are not paid by other program or health insurance. Hence, considering the needed medical cost, each state can determine the amount to spend and the duration up to which the services should be offered. The health care providers or doctors who accept this medicaid are paid according to the payment rates decided by the medicaid program for corresponding medical services. Each state is responsible for deciding the payment rates which should be sufficient enough to include reasonable number of health care providers in the program. Hence, reimbursement rates for physicians and health care providers are decided as per the methodology that assigns a relative amount to the service provided. Hospital and nursing home rates are also decided by a special rate setting commission.

To apply for medicaid one has to fill up a medicaid application form which can be done online or the form can be collected from the state medicaid office. The person is expected to fill in necessary information in the form which would be required to decide whether the person qualifies for the medicaid benefits or not. The entire procedure of verification may take a month or so and once the person satisfies the eligibility criteria, he/she can receive the medical services offered by the medicaid program.