Medicaid is a federal healthcare program that offers free or low-cost healthcare to qualifying adults and children with low incomes. The program is federally and state-funded, and each state has control over its own Medicaid program — for example MassHealth in Massachusetts.

While the eligibility rules for Medicaid vary from state to state, there are some elements of these programs that are similar across the board. For example, every Medicaid program is only made available for people who have low incomes and few assets. However, not every low-asset, low-income person will meet the requirements to qualify.   There are several eligibility categories , including age, disability and pregnancy.

A person with a disability can qualify for Medicaid if they meet their state’s income and asset requirements, and in many cases will automatically qualify if they receive supplemental security income (SSI). Pregnant women who meet asset and income requirements can also qualify for Medicaid, and children are automatically covered for at least a year after they are born to a mother on Medicaid.

Senior citizens (65 or older) who have incomes at or below 133% of the poverty level can also be eligible for Medicaid even if not disabled and if they do not have children.

It’s important to note that only American citizens or lawful permanent residents are eligible to receive Medicaid. The application process includes providing proof of citizenship and/or immigration status.

What will Medicaid cover for me?

Just as every state is able to determine its own eligibility requirements for its Medicaid programs, each state is also able to specify the services that can be covered by its Medicaid program, though there are some services that are required by federal law to be covered. These mandatory coverages include inpatient or outpatient hospital bills, long-term care services, prescriptions, transportation to and from medical appointments, children’s vision and dental care and certain types of lab fees. Beyond these required coverages, some states choose to add coverage for items such as hearing aids, mental healthcare, physical therapy, glasses and hospice.

Depending on where a person lives, though, it might be difficult to find a provider nearby who will accept Medicaid as payment for certain types of healthcare services. This is especially problematic in some of the more rural areas of the country.

Finally, Medicaid recipients are also required to prove the service for which they’ll be billing Medicaid is absolutely necessary so the program isn’t put on the hook for paying for completely voluntary/elective types of treatments and procedures.

To learn more about Medicaid and MassHealth, your ability to qualify for the program and the covered services including paying for nursing home and long-term care services, contact our team of attorneys at Baker Law Group, P.C.