Who Is Covered?

While many Americans know of Medicaid as the plan that covers the cost of nursing homes, the plan is not limited to the elderly.

Medicaid generally supports the healthcare of families near or below the federal poverty level (as long as they include children who are high school age or younger or pregnant women). However, the rules for counting your income and resources to determine eligibility vary from state to state and from group to group. Medicaid always supports children under age 6 and pregnant women in families who are at or below 133% of the poverty level. Medicaid is also available to families who otherwise meet the Aid to Families with Dependent Children requirements.

The poverty level established by the US government in 2008 is based on the number of dependents in a family. For example, for the standard family of four (two adults and two children) in the continental United States, the poverty level is an annual family income of $22,200 or less. It’s about $4,300 higher in Alaska and $2,180 higher Hawaii.

Medicaid also covers people who receive Supplemental Security Income (SSI), a federal cash assistance program for low-income older and disabled people.

What Does My State Cover?

Here's where it can get tricky: Some states also cover people considered "medically needy." This means that although a person or family has too much income or assets to qualify for the main Medicaid categories, they can be covered at least temporarily for certain conditions, sometimes even if they have other insurance. States offering this benefit must cover women when they are pregnant until three months after the child is born, newborns, and some blind persons.

Some states also cover full-time students from ages 19-21, and people with specific diseases, mental handicaps, and those residing in institutions.

In some cases, Medicaid will help pay for Medicare, which is the assistance program provided to all persons over the age of 65 and certain disabled people, or for COBRA insurance after a job is lost. Some states combine Medicaid with whatever health insurance plan they have in place to cover children, as well.

The only way to know what your state offers is to contact your local department of social services. Because the states vary so widely in their plans and whom they cover, it's a good idea to ask specifically about your situation. As health services become more expensive, some states cast even wider safety nets, while others have been forced to cut back. At least part of your expenses may be met by Medicaid, sometimes going back as far as three months.

What Is Covered?

These are some of the basic needs usually covered by Medicaid to eligible persons:

• Most necessary hospital stays
• Outpatient services provided by certain facilities
• Laboratory and x-ray fees
• Nursing home services
• Family planning
• Doctors' services
• Medical and surgical dental treatment
• Some home healthcare services
• Some home medical supplies and appliances
• Pregnancy, delivery, and postpartum care from various sources, including nurse-midwife services
• Some physical, speech, hearing, and occupational therapy
• Approved prescription drugs
• Eyeglasses
• Screening and preventive services
• Some mental health services
• Hospice care
• Transportation to medical appointments

Some states also supply training and employment services to people with disabilities.

And some provide wider services, including respite for caregivers who need some time for themselves, and various support systems that permit disabled persons to live in the community or in housing that meets specific needs.

As with Medicare and all insurance policies, covered fees are limited by what administrators consider customary and reasonable charges.

How Do I Apply?

To apply for Medicaid, contact your state or local chapter of the US Department of Health and Human Services (DHHS) for more information. Visit the DHHS’ Centers for Medicare and Medicaid Services website, and click on “Choose a state” to find specific contact and eligibility information for your state.

Virtually all states will require an interview and will ask you for various kinds of proof of eligibility, including:

• A birth certificate or other proof of age
• Citizenship papers or other proof of legal alien status (although benefits generally extend to all children regardless of their parents' citizenship status, as well as to pregnant women and anyone needing emergency care)
• Pay stubs and paperwork from other sources of income including retirement, veterans' benefits, Social Security, and so forth
• A rent receipt or other proof of where you live, although homeless persons are also covered
• Other documents including bank books and insurance policies
• Medicare benefit card