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11.13 Medicaid

Medicaid provides financial assistance to individuals with limited income and demonstrated medical need. Eligibility is determined by income levels, which typically range from 133% to 138% of the Federal Poverty Level (FPL), depending on the state, and are adjusted based on household size.

Eligibility​

The Medicaid program also provides coverage for individuals receiving public assistance who meet one or more of the following criteria:

  • Age 65 or older
  • Blind or disabled
  • Receiving benefits under the Temporary Assistance for Needy Families (TANF) program
  • Medically needy or indigent refugees residing in the United States (typically for up to 18 months)
  • Pregnant women
  • Individuals residing in skilled nursing or intermediate care facilities
  • Children under age 21, including those in foster care
  • Individuals requiring kidney dialysis due to End-Stage Renal Disease (ESRD)

Benefits​

Medicaid provides coverage for a range of healthcare services, including hospital and outpatient care, physician services, laboratory and X-ray services, prescription drugs, long-term care, certain nursing facility services, and limited home health care, typically after an individual’s available assets have been depleted.

Medicaid is a federal-state partnership program. While the federal government supplies the majority of funding for benefits, each state is responsible for administering the program. Any benefits required by the state that exceed federal requirements must be funded by the state.

Quiz​

1. What is the primary purpose of Medicaid?

A. To provide retirement income

B. To provide healthcare coverage for individuals with limited income and medical need

C. To replace Medicare benefits

D. To provide only prescription drug coverage

Correct Answer: B

Rationale: Medicaid is designed to assist individuals with limited income and demonstrated medical need by providing access to healthcare services.

2. Medicaid eligibility is generally based on income levels relative to which standard?

A. Social Security Index

B. Federal Poverty Level (FPL)

C. Consumer Price Index (CPI)

D. Gross Domestic Product (GDP)

Correct Answer: B

Rationale: Eligibility for Medicaid is typically based on income ranging from 133% to 138% of the Federal Poverty Level (FPL), adjusted for household size.

3. Which of the following individuals would most likely qualify for Medicaid?

A. A healthy adult with high income

B. A retired executive with private insurance

C. A pregnant woman with limited income

D. A person with no medical needs

Correct Answer: C

Rationale: Medicaid covers specific groups, including pregnant women, especially when they meet income eligibility requirements.

4. Which of the following services is typically covered by Medicaid?

A. Cosmetic surgery only

B. Routine travel expenses

C. Hospital and physician services

D. Luxury rehabilitation programs

Correct Answer: C

Rationale: Medicaid covers essential healthcare services, including hospital care, physician services, prescriptions, and long-term care.

5. How is Medicaid funded and administered?

A. Fully funded and administered by private insurers

B. Fully funded and administered by the federal government

C. Funded by the federal government and administered by the states

D. Funded by employers and administered by hospitals

Correct Answer: C

Rationale: Medicaid is a federal-state partnership, where the federal government provides most funding, and states are responsible for administering the program and any additional benefits.