The Express Word

Medicaid and Medicare are two governmental programs that provide medical and health-related services to specific groups of people in the United States. Although the two programs are very different, they are both managed by the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services.

What is Medicaid?

Medicaid is a means-tested health and medical services program for certain individuals and families with low incomes and few resources. Primary oversight of the program is handled at the federal level, but each state:

• Establishes its own eligibility standards,
• Determines the type, amount, duration, and scope of services,
• Sets the rate of payment for services, and
• Administers its own Medicaid program.

What services are provided with Medicaid?

Although the States are the final deciders of what their Medicaid plans provide, there are some mandatory federal requirements that must be met by the States in order to receive federal matching funds. Required services include:

• Inpatient hospital services
• Outpatient hospital services
• Prenatal care
• Vaccines for children
• Physician services
• Nursing facility services for persons aged 21 or older
• Family planning services and supplies
• Rural health clinic services
• Home health care for persons eligible for skilled-nursing services
• Laboratory and x-ray services
• Pediatric and family nurse practitioner services
• Nurse-midwife services
• Federally qualified health-center (FQHC) services and ambulatory services
• Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21

States may also provide optional services and still receive Federal matching funds. The most common of the 34 approved optional Medicaid services are:

• Diagnostic services
• Clinic services
• Intermediate care facilities for the mentally retarded (ICFs/MR)
• Prescribed drugs and prosthetic devices
• Optometrist services and eyeglasses
• Nursing facility services for children under age 21
• Transportation services
• Rehabilitation and physical therapy services
• Home and community-based care to certain persons with chronic impairments

Who is eligible for Medicaid?

Each state sets its own Medicaid eligibility guidelines. The program is geared towards people with low incomes, but eligibility also depends on meeting other requirements based on age, pregnancy status, disability status, other assets, and citizenship.

• Individuals who meet the requirements for the Aid to Families with Dependent Children (AFDC) program that were in effect in their state on July 16, 1996
• Children under age 6 whose family income is at or below 133% of the Federal poverty level (FPL)
• Pregnant women with family income below 133% of the FPL
• Supplemental Security Income (SSI) recipients
• Recipients of adoption or foster care assistance under Title IV of the Social Security Act
• Special protected groups such as individuals who lose cash assistance due to earnings from work or from increased Social Security benefits
• Children born after September 30, 1983 who are under age 19 and in families with incomes at or below the FPL
• Certain Medicare beneficiaries

source:http://www.medicalnewstoday.com/info/medicare-medicaid/