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Medicaid
Medicaid is the nation’s primary health insurance program for low-income and high-need Americans, covering 60 million low-income Americans, including nearly 30 million low-income children, 15 million adults and 8 million non-elderly people with disabilities.1
Eligibility
Many groups of people are covered by Medicaid, but even within these groups there are certain requirements. Considerations may include:
- age;
- pregnancy;
- disability;
- blindness;
- income and resources (like bank accounts, real property, or other items that can be sold for cash);
- and whether you are a U.S. citizen or a lawfully admitted immigrant.
Children may be eligible for coverage if they are U.S. citizens or lawfully admitted immigrants (there is a five-year limit that applies to lawful permanent residents). Eligibility for children is based on the child's status, not the parent's.
Also, if someone else's child lives with you, the child may be eligible even if the adult is not because income and resources will not count for the child.
In general, one should apply for Medicaid if their income is low and they match one of the descriptions of the Eligibility Groups. Even if you are not sure whether you qualify, you should apply for Medicaid and have a qualified Connecticut caseworker in your state evaluate your situation.
In April 2012, HHS finalized the Community First Choice rule, which is a new state plan option under Medicaid, which encourages primary care practices to provide home-based care to chronically ill Medicare patients.
When Eligibility Starts
Coverage may start retroactive to any or all of the three months prior to application, if the individual would have been eligible during the retroactive period. Coverage generally stops at the end of the month in which a person's circumstances change. Most states have additional "State-only" programs to provide medical assistance for specified poor persons who do not qualify for the Medicaid program. No federal funds are provided for state-only programs.
What is Not Covered
Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups. Low income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. As noted earlier, categorically needy persons who are eligible for Medicaid may or may not also receive cash assistance from the TANF program or from the SSI program. Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses.
Centers for Medicare & Medicaid Services
The Centers for Medicare & Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. It is the federal agency that administers the Medicare program and monitors the Medicaid programs offered by each state. Find additional information on CMS and it's other programs available.2
Older Adults and Long-Term Care
Medicaid is the dominant source of coverage and financing for long-term care in the U.S., covering six of every 10 nursing home residents and financing more than 40 percent of nursing home and total long-term care spending. For people with disabilities and the elderly, Medicaid is also a growing source of financing for home and community-based long-term care services.
Older adults may qualify for Medicaid. To qualify, monthly income must be less than the federal poverty level, and assets cannot exceed certain limits. Medicaid will only cover people in Medicaid-approved nursing homes that offer the level of necessary care. Under certain circumstances, Medicaid will pay for home health care.
The State of Connecticut has a long–term care insurance program, Connecticut Partnership for Long-Term Care. which is designed to help people with the financial impact of spending down to meet Medicaid eligibility standards. Under this “partnership” program, when people buy a federally qualified partnership policy, they can receive partial protection against the normal Medicaid requirement to spend down their assets to become eligible.3
Medicaid and CHIP, the Connecticut Children’s Health Insurance Program, are the nation’s major public health coverage programs for low-income people in the United States. CHIP is available to children whose parents do not qualify for Medicaid.
Overall in the U.S., Medicaid provides coverage for about 28 million poor and near-poor children and CHIP provides health coverage for an additional 6 million low-income children. Together they provide health coverage for 25% of all children in the US and 50% of all low-income children in the US.
Many more children qualify for Medicaid or CHIP coverage but are not currently enrolled in either program. In many cases, parents are unaware that their children may qualify for these programs.4
Children's Health Insurance Programs (CHIP)
Medicaid coverage for children is available in Connecticut and every other state for children living below the federal poverty level ($18,310 for a family of three in 2009) and children up to age 21 are eligible. In addition, all states including Connecticut must provide Medicaid coverage for children up to age six with incomes below 133% of the federal poverty level ($24,413 for a family of three in 2009). The Medicaid program served over 29 million children in the U.S. in 2006.
Medicaid pays for a full set of services for children, including:
- preventive care;
- screening and treatment of health conditions;
- routine check-ups;
- immunizations;
- inpatient and outpatient hospital care;
- laboratory and x-ray services;
- physician and hospital visits;
- vision care;
- and dental care.
In Connecticut, uninsured children under the age of 19, whose families earn up to $44,100 a year (for a family of four) are eligible.6
Children's Health Insurance Programs Reauthorization Act (CHIPRA)
On February 4, 2009, President Obama signed the Children's Health Insurance Program Reauthorization Act (CHIPRA), which renews and expands coverage of the Children's Health Insurance Program (CHIP) from seven million children to 11 million children. CHIP was previously known as the State Children's Health Insurance Program (SCHIP).
Originally created in 1997, CHIP is Title XXI of the Social Security Act and is a state and federal partnership that targets uninsured children and pregnant women in families with incomes too high to qualify for most state Medicaid programs, but often too low to afford private coverage. Within Federal guidelines, each State determines the design of its individual CHIP program, including eligibility parameters, benefit packages, payment levels for coverage, and administrative procedures.
In addition to renewing the CHIP program, the new legislation makes it easier for certain groups to access CHIP health care, including uninsured children from families with higher incomes and uninsured low-income pregnant women.7
1Kaiser Family Foundation Explaining Health Care Reform: Questions About Medicaid’s Role, Issue Brief http://www.kff.org/healthreform/7920.cfm
2Center for Medicare and Medicaid Services http://www.cms.gov/
3Kaiser Family Foundation Explaining Health Care Reform: Questions About Medicaid’s Role, Issue Brief http://www.kff.org/healthreform/7920.cfm
4HealthPAC Online, Health Care for Children http://www.healthpaconline.net/health-care-for-children.htm
5Insure Kids Now http://www.insurekidsnow.gov/medicaid/index.html
6Center for Medicare and Medicaid Services http://www.cms.gov/
7Center for Medicare and Medicaid Services http://www.cms.gov/NationalCHIPPolicy/01_Overview.asp#TopOfPage
