Medicaid Eligibility

Medicaid is a state and federal government medical program that is designed to benefit families and individuals who have low incomes and fewer resources than most. Funded by both respective states and the federal government as well, this program serves U.S. citizens as well as alien residents who earn low income, have certain disabilities and the vulnerable persons as the basic Medicaid eligibility provision.

The federal government supervises the running of the program, but under certain broad provisions and restrictions, every state:

• Establishes up with its own kind, cost, time frame, and way of providing Medicaid services
• Sets up its own Medicaid eligibility requirements
• Decides its own payment rates for services
• Manages its medical program

The federal government has broad restrictions and requirements that must be applied by individual states when establishing Medicaid programs in order for them to get federal funding. Services provided by Medicaid are:

• Inpatient and outpatient services
• Children vaccination services
• Family planning services
• Prenatal services
• Lab and X-ray services
• Midwifery services
• Physician cervices
• Rural clinic services

Additional services provided by states and are federal funded include:

• Clinic services
• Intermediate services for the mentally handicapped
• Drugs under prescription
• Nursing services for children under 21 years.
• Diagnostic services
• Community based care for specific persons

Each individual state sets its own Medicaid eligibility criteria. The basic requirement for Medicaid eligibility is low income together with other requirements that are based on disability, pregnancy, age, citizenship and assets count. For every state to receive funding, it is required to make Medicaid provision available for vulnerable persons under a certain categories of vulnerable persons. For instance those who do not receive cash payments and those who get maintenance incomes.

Other such categories that are considered as needy and eligible are:

• Aid for Families with Dependent Children program beneficiaries
• Under 6 years children in homes with an income below 133% of (FPL)
• Pregnant mothers with an income that is below 133% as per the FPL
• Beneficiaries of foster care program falling under the Social Security Act part IV
• Individuals who cannot get cash assistance due to low income
• Specific Medicaid beneficiaries

The Medicaid program pays affiliate doctors and health practitioners for services rendered. Every state is required to make payments on a fee-for-service basis or through organizations such as (HMOs). The state is then compensated a share of the expenses incurred by the Federal government. These medical funds are provided on the basis of the state’s income level for the year. This basically means that richer states get a relatively lower share than poorer states, though the law provides that FMAP be between 50 and 83%.

A beneficiary who meets all Medicaid eligibility requirements may find it very difficult to get a Medicaid doctor, as most doctors do not accept new federally-funded beneficiaries. It is advisable that you visit the US Health and Human Department to obtain a list of Medicaid doctors.

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