Mediacaid - Part 1

Summary

The Medicaid program offers health insurance and long term care to people with disabilities. This chapter will discuss eligibility for Medicaid, the various medicaid waivers in Utah and how to apply for this benefit. It will also cover methods for successfully accessing the services provided by Medicaid.

Overview

Medicaid is a partnership between the states and the federal government to provide health insurance and long term care services to certain groups of people who are low income and have few assets. States are not required to offer Medicaid. States choose to participate in the program. At this time, all states offer a Medicaid program, but not all state Medicaid programs are alike. The states may offer a wide range of health care programs under Medicaid. If a Medicaid program is offered in a state, it is an entitlement for those found eligible.

If a state chooses to partner with the federal government and offer Medicaid, the state is required to pay a portion of the program costs. The federal government provides an incentive for states to take part in Medicaid by matching the money the state pays. The federal matching money is important for the Medicaid program to operate.

Who is eligible for Medicaid coverage?

A state must follow the federal government?s rules for Medicaid programs. The rules say that a state must provide benefits to three mandatory populations: children and their parents, the elderly, and people with disabilities. In order to qualify an individual must be a US citizen or meet immigration and residency requirements. An individual must also have a low income and have few assets. A state, however, can choose to provide coverage to other populations (know as optional populations) beyond the Federal government?s mandatory groups.

Utah?s Medicaid programs provide coverage for 49 different eligibility groups of which 28 are mandatory and 21 are optional. Each eligibility group has separate income and asset level requirements. The groups break down into the following categories:

Mandatory populations

  • Pregnant women whose incomes are less than 133% of the federal poverty level (FPL)
  • Children birth to age 6 at 133% of FPL
  • Low income parents up to 54 to 60% of FPL
  • Senior citizens 65 or older up to 100% of FPL
  • Persons who are blind up to 100%
  • People with disabilities up to 100% of FPL

Optional populations

  • Children age 6 ? 18 up to 100% of FPL
  • Children age birth ? 18 with family incomes up to 200% of FPL through the Children?s Health Insurance Program (CHIP)
  • Adults 19- 65 without dependent children to 150% through the Primary Care Network (PCN a waiver program)
  • People with disabilities who are employed up to 250% of FPL
  • Coverage for people with tuberculosis up to 200% of FPL
  • Coverage for people with breast or cervical cancer up to 250% of FPL
  • Medically needy up to 50% of FPL or spenddown to 50% of FPL
  • Senior citizens 65 or older with incomes above 100% of FPL who spenddown to 100% of FPL
  • Persons who are blind with incomes above 100% of FPL who spenddown to 100% of FPL
  • People with disabilities up with incomes above 100% of FPL who spenddown to 100% of FPL

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