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Medicaid Explained

Medicaid Explained

Medicaid is a government provided insurance program in the United States. While Medicare

Medicaid eligibility is prescribed on a case to case basis. The eligibility categories under the Medicaid program include children, women during pregnancy, adults with children that qualify for the program, and those suffering from disabilities. Again, in order to qualify for Medicaid benefits, applicants must be in a low income situation. Simply suffering from poverty does not guarantee Medicaid benefits. The Center for Medicare and Medicaid Services

Other eligibility criteria for Medicaid benefits include age, disability, blindness, income, and pregnancy. In regard to children, Medicaid benefits may be applied to a child who is a United States citizen or permanent resident. Even though the child can receive benefits, the child’s parent may not be eligible.

Medicaid benefits also extend to those with HIV and AIDS. Under Medicaid guidelines, an applicant with a T-cell count, or white blood cell count, below 200 can qualify for benefits. However, the Journal of the American Medical Association (JAMA) recommends treatment and care for individuals with a T-cell count below 350. Also, those low income applicants must have a condition that has progressed to AIDS to qualify in most situations.

Medicaid is provided by each state, though it is operated and administered differently in each state. Each state’s Medicaid program is then monitored by the CMS. States often pay up to half of the cost of Medicaid benefits for participants unlike Medicare which is paid for through designated Medicare taxes. Medicaid also differs from Medicare in that it is needs based not simply available for all citizens of a certain demographic.

State guidelines and provided benefits also vary in degrees of coverage, eligibility, and payment for Medicaid applicants. In addition to providing Medicaid benefits, some states offer applicants an option to enroll in the Health Insurance Premium Payment Program (HIPP). This allows participants to receive private health insurance paid for in part, or whole, by the Medicaid program.

States receive additional federal support to pay for Medicaid services. The amount of federal aid given to each state is based on a formula known as the Federal Medical Assistance Percentage. This percentage is based on the poverty level of each individual state. This percentage also helps to match payments made by each state to the Medicaid program.