Who should apply for Medicaid?

Who should apply for Medicaid?

Medicaid is a better alternative to the expensive care home fees. Most seniors, low-income families and disabled individual embrace Medicaid for health care services. While Medicaid is free, it is not designed for everyone. This program which is funded by the federal and state government covers a plethora of health care services like inpatient and outpatient hospital services, physician services, etc.

As said earlier, Medicaid isn’t made for everyone. Thus, before you consider applying for this program, it makes sense to determine if you should apply for not. In this article, I have I’ll reveal who needs to apply for Medicaid.

What is Medicaid?

Medicaid is regarded as a state and federal government health care program for individuals with little income. It offers low-cost or free health care to:

  • Low-income adults
  • Low-income families including children
  • Individuals with disabilities
  • Certain order adults who use Medicare 

The federal government sets simple rules for the types of care you can acquire with Medicaid and how much, if anything, you pay for the program. However, Medicaid benefits vary from one state to another. States can provide additional services. In a few cases, individuals must pay something towards the cost of their care, while similar services may be free in another state. There can be other differences, as well.

Some states have other special program to assist low-income individuals who don’t qualify for Medicaid.

What does it cover?

Medicaid covers a few medical services such as inpatient and outpatient hospital services, physician services, laboratory and x-ray services, including home health services, etc. Optional benefits include services including prescription drugs, physical therapy, including occupational therapy.

Who pays for Medicaid?

Medicaid enrollees don’t get payment from Medicaid. Instead, Medicaid sends payment directly to healthcare providers.  States make these payments based on a fee-for-service agreement or via prepayments arrangements, like health maintenance organizations (HMOs). The federal government then refunds each state for a percentage share of their Medicaid expenses.

The Federal Medicaid Assistance Percentage (FMAP) changes every year and hinges on the state’s average per capital income level. The refund rate starts at 50% and gets to 77% in 2020. Wealthier states gets a smaller percentage than states with little money.

In states that decides to broaden their coverage under the Affordable Care Act, more adults and families on inadequate income are eligible with the new provision allowing enrolment at up to 138% of the Federal Poverty Income Level. In return, the federal government covers all expansion costs for the first three years and more than 90% of the cost in the future.

Who should apply for Medicaid?

Medicaid is not designed for everyone. That said, the following people can apply for Medicaid.

  • Low-income adults
  • Children
  • Pregnant women
  • Elderly adults
  • People with disabilities 

All seniors are advised to apply for Medicaid due to the rising cost of health care. Generally, seniors are eligible for Medicaid. However, if their income and assets is above a certain threshold, they’ll be deemed ineligible. They’ll need to either spend down their assets or protect it by setting up a Medicaid asset protection trust.

A Medicaid asset protection trust is exactly what it is: a trust designed to protect your assets from being counted by Medicaid. Before applying for Medicaid, ensure you talk to a Medicaid attorney or an elder law attorney.

Do you need an Elder law attorney?

If you need an elder law attorney for matters regarding your elderly loved one, don’t hesitate to call our office. Or if you are a senior and you need help with applying for Medicaid, you can also contact us for assistance. In addition, in the event that your assets and income are above the threshold, signaling your ineligibility for Medicaid, you can contact us if you wish to set up a Medicaid Asset protection Trust. However, you must have the Medicaid look back period in mind. This means that, after placing your assets in this trust, you are to wait for the next 5 years before applying for Medicaid to avoid any form of sanction.


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