FirstStep logo How to Use FirstStep Home
General Tips
Benefit Programs
Tools & Resources
search Printer Version
Medicaid

Medicaid

Medicaid Q & A
Source: Centers for Medicare & Medicaid Services

General Questions about Medicaid
Medicaid and Eligibility
Medicaid Application/Interview Process
Medicaid and Immigration

General Questions about Medicaid

What is Medicaid?
Medicaid is a health insurance program for low-income and needy people. Medicaid eligibility is limited to individuals who fall into specified categories. The federal law identifies over 25 different eligibility categories. These categories can be classified into five broad coverage groups:

  • Children
  • Pregnant women
  • Adults in families with dependent children
  • Individuals with disabilities
  • Individuals 65 or over

Where can my clients access more information about Medicaid?
For more information on Medicaid in your state, visit
http://www.cms.hhs.gov/medicaid/statemap.asp.

To get the Medicaid At-a-Glance brochure, visit http://www.cms.hhs.gov/states/maag2002hm.asp

top

Medicaid and Eligibility

Who is eligible for Medicaid?
Your clients may be eligible to receive Medicaid benefits as members of "mandatory" or "optional" eligibility groups. All states must cover the mandatory groups, but states can choose whether or not to cover optional groups. Examples include:

Mandatory

  • Low-income families with children
  • Low-income (“poverty-level”) pregnant women and children
  • Certain low-income Medicare beneficiaries

Optional

  • Individuals who would be eligible for SSI if they were not in medical institutions
  • Individuals receiving only State supplemental payments

Medicaid varies from state to state. For information about the Medicaid plan in your state, visit www.cms.hhs.gov/medicaid/statemap.asp.

For more information about eligible Medicaid groups, visit http://cms.hhs.gov/medicaid/eligibility.

If my client has been incarcerated, does he/she still have access to Medicaid?
Medicaid eligibility is not terminated for individuals on the basis of incarceration. However, payment for medical services provided to individuals during incarceration is prohibited. When released from incarceration, Medicaid is generally available again for that individual, provided the state conducts a re-determination. States sometimes begin the process of re-determination upon notice that an individual is being discharged.

Does Medicaid pay for mental health and substance abuse services?
If your client is eligible for Medicaid, some state Medicaid programs pay for mental health services, such as individual and group psychological therapies, psychosocial services and addiction treatment services. To find out if your state Medicaid program pays for mental health services, visit www.cms.hhs.gov/medicaid/statemap.asp or contact the local Medicaid office.

What is Medicare-Medicaid Dual Eligibility?
A client that is Medicare-Medicaid Dual Eligible qualifies to receive some form of both Medicare and Medicaid. The benefits your client may receive if he/she is a Dual Eligible depends on the category in which he/she falls.

For example, if your client is entitled to Medicare Part A and is eligible for full Medicaid benefits, then he/she is a Qualified Medicare Beneficiary with full Medicaid. In this case, Medicaid would pay for his/her Medicare Part A premiums if there are any, Medicare Part B premiums, Medicare deductibles and co-insurance and full Medicaid benefits.

For more information about Medicare-Medicaid Dual Eligibility, review the Medicare-Medicaid Dual Eligibility section of this CD-ROM or visit www.cms.hhs.gov/dualeligibles/whois.asp.

Once my clients are enrolled in Medicaid, how often will they have to renew their eligibility?
Once your clients are enrolled in Medicaid, they must renew their eligibility at least once a year or when there is a change in their circumstances, such as an increase or decrease in any public assistance they might be receiving. Your state may use longer renewal timeframes if your client is blind or disabled.

During the renewal process, your clients should be able to rely on eligibility information and documentation they provided for other programs to verify continued Medicaid eligibility. This review of eligibility based on available information is called an ex parte redetermination.

Your clients will not be required to provide information that:

  • Is not relevant to their ongoing eligibility
  • Has already been provided or relates to an eligibility factor that is not subject to change such as date of birth or U.S. citizenship

top

Medicaid Application/Interview Process

How should my clients apply for Medicaid?
Please see the list of state Medicaid toll-free phone numbers to contact your state Medicaid officials for more information. These phone numbers can be found at http://cms.hhs.gov/medicaid/allstatecontacts.asp.

How long is the typical turn-around for application approval?
Once your client applies for Medicaid benefits, his/her application should be processed within 45 days from the date the application was submitted. If your client has a disability, the application process may take up to 90 days.

If your client applies for Medicaid through a joint program application (i.e., Medicaid, Food Stamps or TANF application), your state must still determine Medicaid eligibility within the Medicaid time standard.

If processing the application is delayed due to a non-Medicaid related requirement, the Medicaid portion of the application must still be processed in order for a determination to be made in a timely manner consistent with Medicaid rules.

top

Medicaid and Immigration

If my clients are immigrants, are they still eligible for Medicaid?
To be eligible to receive Medicaid, your client must be a U.S. citizen or a qualified alien.

Some qualified aliens are not eligible for Medicaid until they have been in the United States for five years.

For more information on the current rules governing immigrants' eligibility for Medicaid, visit www.cms.hhs.gov/immigrants/default.asp.

top