Medicaid is a federally subsidized state-run program that provides basic health insurance coverage for the poor, certain children, the handicapped and the indigent. First introduced, along with Medicare, as part of President Lyndon Johnson's "Great Society" program in 1965, the program is a means-based program administered at the state level, with each state free to determine how it implements the program. However, the federal government has established a minimum baseline of required programs and services.
Mandatory Eligibility
The federal government has mandated Medicaid coverage in all states for the following groups of people: children under age 6 and pregnant women, when their family income is below 133 percent of the federal poverty level as defined for families of comparable size. Some states establish more generous income allowances. States must also cover all infants born to Medicaid recipients for at least one year as long as the child is living with the mother and the mother maintains eligibility. States must also cover those receiving Supplemental Security Income, including the elderly, blind and disabled. Finally, the federal government requires states to provide coverage for certain low-income families with children.
State Discretionary Benefits
States have the option of providing benefits for additional classes of recipients. Specifics, obviously, differ state by state, but possible state discretionary benefits include children under age 21 who do not qualify for Aid to Families with Dependent Children, although they are low-income, blind, disabled or elderly people whose incomes are below the federal poverty level but whose incomes are too high to qualify for mandatory coverage, tuberculosis patients, infants up to age 1 and pregnant women who earn too much to qualify under mandatory rules.
Income and Assets
The federal government has established monthly and annual income guidelines defining the poverty level for families of various sizes. Medicaid rules express income eligibility requirements as a percentage of the poverty line. The poverty line is $10,830 per year, or $902 per month, for individuals living alone and $22,050 for a family of four; 133 percent of the poverty level is $14,403.90 per year for an individual living alone and $29,326 per year for a family of four. Different guidelines apply to Hawaii and Alaska.
Medical Neediness
States can also identify certain individuals as "medically needy" and extend Medicaid benefits to these individuals as well, even if they earn too much to qualify under federal rules. Examples of medically needy populations include those with end-stage renal disease and other chronic populations. States frequently allow the medically needy to "spend down" their own assets and incomes on medical expenses to the point at which they become Medicaid eligible. States do not need to have a medically needy program, but if they do elect to do so, they must include certain children and pregnant woman who would be eligible except for their income and assets.
Tags: federal government, medically needy, poverty level, also cover, blind disabled, certain children, children under
