Medicaid is the U.S. health care program for eligible persons and families with low incomes and resources. It acts as the primary source of funding for health and medical services particularly to individuals not capable of acquiring long term care due to financial restrictions which is jointly funded by state and federal governments. The groups of people served by this government-supported program are eligible U.S. citizens, foreign residents, including low-income adults and children, and some people with disabilities.
This program is not solely funded at the federal level. It is a means-tested, needs-based social welfare or social protection rather than a social insurance program that helps provide health coverage or nursing home coverage to certain categories of low-asset individuals, including children, pregnant women, parents of eligible children, people with disabilities and elderly needing nursing home care. Compared with Medicare, Medicaid covers a wider range of health care services and its eligibility is determined mainly by income.
The main criterion to determine Medicaid eligibility is limited income and financial resources. And, it comes in two general types of coverage namely, community Medicaid and nursing home coverage. Community Medicaid helps eligible individuals who have little or no medical insurance while Medicaid nursing home coverage pays all of the costs of nursing homes for eligible individuals except that the recipient pays most of his/her income toward the nursing home costs.
However, eligibility for Medicaid varies from one state to another and its rules differ as well although states follow the same program framework. To acquire eligibility, having limited assets is one of the primary requirements. But this does not mean a person is qualified due to poverty, he should also fall into one of the defined eligibility categories to qualify.
There are a number of Medicaid eligibility categories; within each category there are requirements other than income that must be met. These other requirements include assets, age, pregnancy, disability, blindness, income and resources, and one’s status as a U.S. citizen or a lawfully admitted immigrant and special rules exist and are applied for those living in a nursing home and disabled children living at home as well.
To reach out for more individuals who are deeply in need of assistance, Medicaid’s Manage Care system was created to help offer further health benefits and additional services. It comes in two main forms, “risk-based MCOs” and “primary care case management (PCCM).”
Manage care has become widespread in various states, and today, it is considered as the most common health care delivery system in Medicaid.
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