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How Medicaid Works


Eligibility

In addition to low-income Americans, other eligible groups include people with serious illness and unmet health care needs; this includes women with breast cancer or cervical cancer, as well as adults who need treatment for tuberculosis. Some states offer programs tailored to help people who are considered medically needy but otherwise wouldn't qualify for benefits; these Medicaid programs are available to individuals with serious but unmet health care needs who also have an income too high to traditionally qualify for coverage through public insurance -- these programs are usually administered in what's called a "spend-down" style, a method where health benefits begin only after a patient's income has been depleted enough by health care costs to qualify as below the poverty line.

Medicaid also provides coverage for roughly 10 million Americans who need long-term medical services and support (LTSS), such as long-term home-based or institutional care. Medicaid benefits cover at least 60 percent of nursing home residents, for example, a benefit not offered through Medicare [source: KCMU].

Medicaid and Medicare are often confused with one another; they're not the same thing. They're both government-sponsored health insurance programs (and both run by the U.S. Department of Health and Human Services, and they were created at the same time), but they cover different demographics and offer different benefits. About 45 million Americans use Medicare programs, which provide health benefits to senior citizens (individuals age 65 and older), individuals younger than age 65 diagnosed with Lou Gehrig's disease or any condition that qualifies for Social Security disability benefits, and anyone with kidney failure requiring dialysis or a transplant [sources: Koba, WebMD]. Depending on their circumstance, some people may qualify for both Medicaid and Medicare, a situation described as dual eligible; a low-income senior, for example, is considered dual eligible. More than 17 percent of people benefiting from Medicaid coverage are dual eligible [source: Medicaid.gov].

Lawful immigrants may be eligible for benefits after a five-year waiting period, but may not qualify for full benefits -- the state where you live has the final say as to whether or not you're eligible. Undocumented immigrants aren't eligible for Medicaid benefits at all (although Medicaid does cover emergency services for all immigrants).


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