Medicaid Description and Features

Medicaid is jointly funded by the Federal and State governments to provide medical care to low-income United States citizens. The Federal government under Title XIX requires each State provide the following basic services under Medicaid:

  • In- and out-patient services (which include skilled nursing facilities if you are 21 or older)
  • Professional services/physicians' visits
  • Home health and hospice services
  • Family planning services including nurse midwives
  • Medical and surgical dental services
  • Early and periodic screening, diagnosis and treatment (EPSDT) for children up to the age of 21.

The Federal government allows each State to customize their programs by adding any or all of the following optional services:

  • Nursing care facilities for those under the age of 21
  • Institutional care for those with mental impairments
  • Optometrist services/coverage of glasses
  • Prescription benefits
  • TB-related services
  • Dental care
  • Prosthetic devices (such as artificial limbs)

Each State must allow Medicaid recipients the freedom to choose their own doctors from a list of providers. States may also offer a HMO program. States may choose to impose a low deductible or co-pay.

To qualify, you must file an application with your State. Eligibility is limited only to the State where you live and is based on assets, resources and income. To apply, you must bring proof of income to your local Social Services department.

Benefits vary greatly from state to state. In some states, coverage will include custodial care in the form of In Home Supportive Services or In Home Services if you qualify. In Home Supportive Services provides "unskilled" custodial support. For example, if you are in need of assistance with routine activities of daily living (ADL's) such as bathing and dressing and you have Medicaid, you may qualify for IHSS.

In Home Supportive Services should not be confused with In Home Services!!! In Home Services (IHS) provides skilled/licensed care of a registered nurse (RN) or Licensed Vocational Nurse (LVN). If you are dependent on a breathing machine (ventilator) or have other complex medical needs, you may qualify for IHS.

A State social worker evaluation is required to determine if you qualify for either IHS or IHSS services. Please be aware, the waiting lists for In Home Services (IHS) and In Home Support Services (IHSS) are quite long and IHS and IHSS programs are not available in all states!

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