Even though Medicaid is a federally funded program, each state manages the low-cost healthcare program differently. Here you can learn a little bit about the program, who is eligible for coverage, and how to apply.

Medicaid from 1965 to Now

Medicaid and Medicare were both signed into law in 1965 as part of the Social Security Act.  Although it was initially intended as a means to getting health insurance for those who received cash assistance,  today it covers a broad spectrum of people, including low-income families, pregnant women, people with with disabilities, and those who need long-term care.  

The introduction of the Affordable Care Act (ACA) in 2014 altered the qualifying rules for Medicaid. States are now allowed to expand Medicaid eligibility to adults under the age of 65 whose incomes fall below 138% of the Federal Poverty Level (FPA).  However, 19 states have opted not to expand their Medicaid coverage, meaning that some who might be eligible for the coverage are separated from it by state lines.  For example, those living below the FPA in Montana or North Dakota qualify for Medicaid while those with a similar economic profile living in Wyoming or South Dakota might not.   

In these states that have chosen not to expand Medicaid, there are 2.9 million adults and children who fall into the so-called coverage gap. The majority of these are part of a working family whose income is insufficient to meet its needs. These individuals also do not earn enough money to qualify for subsidized care under the ACA. As a result, they have no health insurance and are expected to remain uninsured.

Across the US, 45% of uninsured adults in the coverage gap are White non-Hispanics, 23% are Hispanic, and 28% are Black.  Some studies have shown that Black adults are almost twice as likely as their White or Hispanic counterparts to fall into the coverage gap, mainly because some of the states that have large Black populations (Florida, Georgia, and Texas) have not expanded Medicaid under the ACA. Many worry that this racial health care disparity will only get worse.

Equally worrisome is that more than half of those in the coverage gap are middle-aged (age 35 to 54) or near elderly (age 55 to 64). Aging adults inevitably have increasing health needs, and research shows that uninsured people over the age of 35 are likely to ignore their health needs until they become eligible for Medicare at 64.  

Are You Eligible for Medicaid?

States differ somewhat in their eligibility requirements for Medicaid, but generally, you may be eligible for Medicaid coverage if you have:

  • Low income (income requirements vary by state)
  • Few assets (such as a home)
  • A disability for which you receive SSI (or meet the income and asset requirements)
  • Medical needs in excess of your income and assets
  • A pregnancy and meet the income or asset requirements
  • A breast or cervical cancer diagnosis (in these cases, income and asset requirements are higher so you may qualify even without consideration of your income)

Children born to mothers receiving Medicaid are covered for one year after birth, at which point they are no longer eligible. If you have children and you neither qualify for Medicaid nor can afford private insurance, you may be able to enroll your child in CHIP, the Children’s Health Insurance Program.

How to Get Medicaid Coverage

Since states differ in their eligibility requirements, you need to check your state’s requirements first. Start at Medicaid.gov, which lists Medicaid and CHIP eligibility requirements by state. After reviewing what you need for your state, gather documentation that shows proof of income, identification, citizenship, and age. Then follow the link on Medicaid.gov to apply in your state.

If you apply for Medicaid and are denied, you can appeal the decision. In many states, legal aid offices can assist you at no cost in appealing a Medicaid denial.

Although it is an imperfect program, Medicaid currently helps 68 million Americans- 20% of the US population- to get the insurance that they would not be able to get on their own.  If this applies to you, you should apply for it.  

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