Medicaid Benefits, Eligibility Rules & Requirements

There are many benefits that go along with the Medicaid program. As long as you meet eligibility guidelines and requirements, you will have access to these benefits. Medicaid is executed state to state but the funding is made through reimbursements from the federal government.

Apply for Medicaid Online

Currently, there are 25 categories of eligibility which can be classified into five coverage groups. These groups include children, individuals over the age of 65, individuals with disabilities and adults with dependent children. The eligibility will differ from state to state, but all states are required to cover mandatory groups. However, the state can decide whether to cover groups that are categorized as optionally eligible. Most states have forms online that you can download and print out, however no states currently allow you to submit an online application for Medicaid.

Mandatory Medicaid Groups

These groups include pregnant women, children and low-income families who have dependent children. The income level of these groups must be lower than the poverty level. Some Medicare beneficiaries may also be eligible for additional coverage by Medicaid.

Optionally Eligible Medicaid Groups

These beneficiaries will vary from one state to another. Each state is allowed to use their own discretion to provide benefits to these groups. Always be sure to check the eligibility requirements for your state when planning an application for Medicaid. If you believe you have met the requirements and have been denied coverage, you have the right to appeal the decision. Any appeal information will be printed on your eligibility notice that will be received in the mail.

Applying for Medicaid

To apply for Medicaid, you can obtain an application at an office run by your state government. You cannot yet apply for Medicaid online. If you fill out an application at an office, the office is responsible for processing the application. While the application process does take some time, most states are required to complete the application within 45 days. If the application is based on a disability, the state has up to 90 days. The most common reason for denial is an incomplete application, so make sure all parts of the forms are completed when filling out the application. Also be sure to have all required documentation available to include with the application.

Medicare and Medicaid

In some cases, if you are receiving Medicare, Medicaid may pay for some of the premiums, coinsurances and deductibles. You could also be eligible for Medicare related expense payment if your income is more than 100% or less than 120% of the poverty level. If you are disabled, Medicaid will pay for Medicare Part A premiums if you have lost your Medicare coverage due to employment. Your income must be below 200% of the poverty level.

Health Care Help through Medicaid

For state run programs to be eligible for funding there are certain services that must be provided to certain populations. The health care help must include services including hospital services, payment for physician services, nursing facilities for people over 21 years of age, surgical dental services, family planning, midwife services, x-rays, laboratory services, pediatric services, rural health clinic costs and federally-qualified health center services. An optionally eligible Medicaid program will cover clinical services, prescription drugs, dental, prosthetics, optometry, nursing facilities and intermediate care for the mentally retarded.

Duration of Medical Benefits

Each state will determine the duration of all Medicaid benefits. Federal guidelines must be followed and they require that the amount and duration of service is reasonable. Each state is responsible for placing a limit on benefits thereafter. In most cases, those on Medicaid are allowed to choose between health care providers. The state may also elect to run the program through an HMO. Always check with the state laws and guidelines for Medicaid to know what benefits are available.

Payment of Medicaid Benefits

Medicaid payments are made directly to the health care providers. Providers are required to accept all Medicaid reimbursements in full. However, the state is allowed to change the copayments and deductibles for certain recipients. For emergency care and family planning services, the state cannot make these changes. Pregnant women, children under 18 and individuals in nursing homes are exempt from copayments.

Caps on Medicaid Benefits

Currently, there is no limit or cap on the services received under Medicaid. The federal government is required to match what each state provides. The reimbursement rates must be sufficient so that providers will be attracted. This allows Medicaid benefits and services to be available to the qualifying population in the state.

Get Help on Your Medicaid Application

Don’t apply for Medicaid alone. You only get one chance to submit your application the right way – so make sure you do not make an error that could cost you hundreds of thousands or make you ineligible altogether. Contact Estate Street Partners for information on how you may be able to save hundreds of thousands by properly filling out your Medicaid application today: Wouldn’t you rather give your heirs your life savings that you worked so hard for, then the overpriced nursing home? Call us toll-free now: (888) 938-5872.