Medicaid is a federal and state program designed to provide low-cost or no-cost health care coverage to specific groups of people, such as those with low incomes or limited resources. It is the largest program providing health-related and medical services to low-income people.
States are required by law to provide certain mandatory benefits to cover particular population groups. But states also have the ability to expand their program, so more groups are eligible and additional benefits and services are provided.
Eligibility
Eligibility requirements vary per state. However, the main eligibility groups covered by most states include:
- Children under age 19 who are below a specified percentage of the federal poverty level, infants born to women covered by Medicaid, some children in foster care, some children with disabilities, and those who use long-term services
- Some adults with disabilities including physical conditions, developmental or intellectual disabilities, or serious mental illness and who meet the financial limits
- Adults aged 65 and over who have a low income and few assets
- Some low-income adults who meet the financial limits, including pregnant women, parents, and caregivers who have a low income
Coverage
Medicaid provides coverage for individuals and families who meet the federal and the specific state’s eligibility requirements.
Coverage varies since states are allowed to provide optional Medicaid benefits like prescription drugs, dental services, and more.
However, federal law requires that all states provide certain mandatory benefits, including:
- Inpatient and outpatient hospital services
- Nursing home facility services
- Early and periodic screening and treatment services
- Physician services
- Laboratory and X-ray services
- Family planning, nurse midwife, and certified pediatric and family nurse practitioner services
- Transportation to medical care
- Tobacco cessation counseling for pregnant women
While prescription drug coverage is an optional benefit, all states include some form of coverage as of 2020.