Medicaid

What is Medicaid?

Medicaid is a collaborative state and federal government funded effort to provide health coverage for individuals and families who live at or below a certain income threshold. Each state sets their own income level and establishes their state-specific eligibility requirements for Medicaid qualification. Medicaid coverage may help support a variety of healthcare expenses including copayments, deductibles, medication costs, and Medicare premiums. In many states, if an individual qualifies for Supplemental Security Income (SSI), a federal program that provides monthly payments to low-income individuals or those with disabilities, it’s very likely they would also qualify for Medicaid for healthcare coverage.

How Does Medicaid Work?

Medicaid is jointly funded by the federal government and each state, but administered individually by the states for individuals with higher needs. Those individuals may include those who are blind, aging, or have been diagnosed with a disability or for those with limited income or financial resources.. The federal government sets baseline rules and covers a share of each state’s costs, while states design their own program within those rules—deciding how it’s run, which optional benefits to include, and how much they’ll pay providers. Many states deliver Medicaid benefits through managed care plans, where the state pays a private insurer a set fee to coordinate each member’s care, though some states still run a traditional fee-for-service model. Covered services generally include doctor visits, hospital care, prescription drugs, and long-term care, along with any additional benefits a state chooses to offer.

What Is the Difference Between Medicaid and Medicare?

While both government programs support health care coverage for qualified individuals, Medicare is a federal program while Medicaid is a state program with federal financial support. Additionally, Medicare eligibility is based on age (65+) or health condition (for those under 65). Since Medicaid is a state program, eligibility thresholds vary depending on where the individual lives, but the criteria is generally based on income, assets, and need. Individuals may qualify for both programs to offset their medical costs.