Medicaid Medical Insurance Program

A State-Administered Program

Medicaid Options

certain states.

Medicaid Spend-Down (sometimes called Medically Needy, Share of Cost or Medicaid Deductible) compares your medical costs and income to decide if you meet the rules.

The Medicaid Buy-In program, for workers with disabilities in some states, helps pay their premiums if they want private health insurance.

Waiver programs put aside certain Medicaid eligibility rules, so people who cannot get Medicaid but need “nursing-facility level of care” might become eligible.

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Some states offer different Medicaid options. For example:

Expansion Medicaid is available to all low-income adults in certain states.
Medicaid Spend-Down (sometimes called Medically Needy, Share of Cost or Medicaid Deductible) compares your medical costs and income to decide if you meet the rules.
The Medicaid Buy-In program, for workers with disabilities in some states, helps pay their premiums if they want private health insurance.
Waiver programs put aside certain Medicaid eligibility rules, so people who cannot get Medicaid but need “nursing-facility level of care” might become eligible.

certain states.

Medicaid Spend-Down (sometimes called Medically Needy, Share of Cost or Medicaid Deductible) compares your medical costs and income to decide if you meet the rules.

The Medicaid Buy-In program, for workers with disabilities in some states, helps pay their premiums if they want private health insurance.

Waiver programs put aside certain Medicaid eligibility rules, so people who cannot get Medicaid but need “nursing-facility level of care” might become eligible.

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Some states offer different Medicaid options. For example:

Expansion Medicaid is available to all low-income adults in certain states.
Medicaid Spend-Down (sometimes called Medically Needy, Share of Cost or Medicaid Deductible) compares your medical costs and income to decide if you meet the rules.
The Medicaid Buy-In program, for workers with disabilities in some states, helps pay their premiums if they want private health insurance.
Waiver programs put aside certain Medicaid eligibility rules, so people who cannot get Medicaid but need “nursing-facility level of care” might become eligible.

Extra Services

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Many states offer extra services for people who are eligible:

Transportation to appointments with doctors
Home-safety and durable medical equipment
Incontinence supplies
Case management
Home health care (nursing, home health aide, skilled therapies)
Home accessibility modifications
Program of All-Inclusive Care for the Elderly (PACE) is a model of care program designed to help seniors 55 years and older remain in the community rather than receive care in a nursing home. PACE provides medical and long-term care services under Medicare and is available in states that have chosen to offer this program under Medicaid. Watch a short video clip that describes PACE.

states that have chosen to offer this program under Medicaid. Watch a short video clip that describes PACE." c-nmssatomrichtext_nmssatomrichtext-host="">

Many states offer extra services for people who are eligible:

Transportation to appointments with doctors
Home-safety and durable medical equipment
Incontinence supplies
Case management
Home health care (nursing, home health aide, skilled therapies)
Home accessibility modifications
Program of All-Inclusive Care for the Elderly (PACE) is a model of care program designed to help seniors 55 years and older remain in the community rather than receive care in a nursing home. PACE provides medical and long-term care services under Medicare and is available in states that have chosen to offer this program under Medicaid. Watch a short video clip that describes PACE.

Qualifying for Medicaid

answer a few questions, fill out an application for the Health Insurance Marketplace or call 1-800-318-2596 anytime (TTY: 1-855-889-4325). A customer service representative will help you with the application and enrollment process. Counselors in your area may also be available to help. Visit HealthCare.gov or call 1-800-318-2596.

When people qualify for both Medicare and Medicaid, Medicare is the primary payer, and Medicaid pays for all other medically necessary costs not covered by Medicare. Even Medicare beneficiaries who do not qualify for Medicaid may be eligible for help through a Medicare Savings Program. These programs help pay for some of the costs that Medicare doesn’t cover. They are administered through state Medicaid offices.

In addition to Medicaid, every state operates a Children’s Health Insurance Program (CHIP). Sometimes children living in a household qualify for CHIP and the adults qualify for Medicaid, Medicare or an individual insurance policy with a premium tax credit. Learn more about CHIP coverage and how to apply on Healthcare.gov.

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To see if you qualify for Medicaid, answer a few questions, fill out an application for the Health Insurance Marketplace or call 1-800-318-2596 anytime (TTY: 1-855-889-4325). A customer service representative will help you with the application and enrollment process. Counselors in your area may also be available to help. Visit HealthCare.gov or call 1-800-318-2596.
When people qualify for both Medicare and Medicaid, Medicare is the primary payer, and Medicaid pays for all other medically necessary costs not covered by Medicare. Even Medicare beneficiaries who do not qualify for Medicaid may be eligible for help through a Medicare Savings Program. These programs help pay for some of the costs that Medicare doesn’t cover. They are administered through state Medicaid offices.
In addition to Medicaid, every state operates a Children’s Health Insurance Program (CHIP). Sometimes children living in a household qualify for CHIP and the adults qualify for Medicaid, Medicare or an individual insurance policy with a premium tax credit. Learn more about CHIP coverage and how to apply on Healthcare.gov.

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To see if you qualify for Medicaid, answer a few questions, fill out an application for the Health Insurance Marketplace or call 1-800-318-2596 anytime (TTY: 1-855-889-4325). A customer service representative will help you with the application and enrollment process. Counselors in your area may also be available to help. Visit HealthCare.gov or call 1-800-318-2596.
When people qualify for both Medicare and Medicaid, Medicare is the primary payer, and Medicaid pays for all other medically necessary costs not covered by Medicare. Even Medicare beneficiaries who do not qualify for Medicaid may be eligible for help through a Medicare Savings Program. These programs help pay for some of the costs that Medicare doesn’t cover. They are administered through state Medicaid offices.
In addition to Medicaid, every state operates a Children’s Health Insurance Program (CHIP). Sometimes children living in a household qualify for CHIP and the adults qualify for Medicaid, Medicare or an individual insurance policy with a premium tax credit. Learn more about CHIP coverage and how to apply on Healthcare.gov.

Medicaid Planning

Medicaid eligibility are very complicated

The application and review process is time-consuming

Your income is too high, or you have too many assets to qualify for Medicaid and you want to set up a trust

You are worried that Medicaid may someday seek reimbursement for the cost of care, a process called estate recovery

Find Medicaid Planning Help

Search for a certified Medicaid planner (CMP) through the American Council on Aging. CMPs have deep knowledge of Medicaid requirements and application procedures. Elder law attorneys can assist with Medicaid as well as legal issues related to elderly care and estate planning.To find an eldercare or Medicaid planning attorney, you may also see these organizations:

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Medicaid planning can help you qualify for Medicaid benefits. It involves help preparing your Medicaid application. It’s best to get this assistance before you apply for Medicaid. Depending on what you need, the planner may be a volunteer or a professional.You may want to get help because:

The rules around Medicaid eligibility are very complicated
The application and review process is time-consuming
Your income is too high, or you have too many assets to qualify for Medicaid and you want to set up a trust
You are worried that Medicaid may someday seek reimbursement for the cost of care, a process called estate recovery

Find Medicaid Planning Help

Medicaid eligibility are very complicated

The application and review process is time-consuming

Your income is too high, or you have too many assets to qualify for Medicaid and you want to set up a trust

You are worried that Medicaid may someday seek reimbursement for the cost of care, a process called estate recovery

Find Medicaid Planning Help

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The rules around Medicaid eligibility are very complicated
The application and review process is time-consuming
Your income is too high, or you have too many assets to qualify for Medicaid and you want to set up a trust
You are worried that Medicaid may someday seek reimbursement for the cost of care, a process called estate recovery