Medicaid 101

Medicaid is a free public health insurance program. It is not welfare. Because of the nature of our site, while we describe the groups that qualify for Medicaid, out focus is on people who qualify because of a disabling health condition.

Medicaid is a program of both the Federal government and the states. Working under Federal guidelines, each state sets and administers its own program. For instance, each state decides who qualifies, what benefits are provided, and the rate of payments to health care providers for services. Because of the variety among the states, our discussion is general. However, we point you in the direction to learn the information you need in your state.

It is best to prepare for applying for Medicaid before actually applying. (For instance, there are some days and times better than others to apply for Medicaid.) If you are also applying for Supplemental Security Income (SSI), it is advisable to apply for SSI before applying for Medicaid.

• Most states offer quick approval of Medicaid through a process known as Presumptive Medicaid. It allows virtually immediate access to Medicaid on the basis that your medical condition is so severe that you need the coverage now without having to complete all the paperwork - although the paperwork will still need to be completed.  If you believe your medical condition makes you disabled, and intend to apply for Presumptive Medicaid, tell the Worker at the interview. Bring with you a statement about your medical condition from your doctor. 

After the interview, a different Analyst will review your medical records to determine if you are "disabled" for purposes of Medicaid. There may be additional forms for you to fill out. If the Analyst requests a Consultative Exam, you have the right to request that your own doctor do it.

If your claim for Medicaid is denied, you have the right to appeal that decision.  

Following are a few notes to consider before we list the links to our practical Medicaid content:

• If you have assets, you can give them away and qualify for Medicaid except for long term care which requires advance planning.
• Medicaid coverage will last as long as you meet the criteria for eligibility. If, for example, you have income in a month that exceeds the maximum allowable for eligibility, then you are not eligible for Medicaid for that month. If you don't report the income immediately, Medicaid will make you ineligible when the income is discovered. Medicaid will also seek reimbursement for expenses paid during the month you were ineligible.  Medicaid conducts annual financial reviews to assure that you still meet the eligibility requirements. 
• You can receive both Medicaid and Medicare. 
• All Medicaid programs have Presumptive Medicaid which permits coverage to start at the time of applying for some, but not all, classes of applicants.
• If you weren't working when you qualify for Medicaid, you can return to work and still keep Medicaid.
• If you use Medicaid and have assets when you die (we're all going to die someday), Medicaid has a mandate to try to recover what it spent from your estate.  States vary about how aggressive each one is in seeking recovery.

To learn about Medicaid in your state (including contact information for the Medicaid office; eligiblity requirements; how to apply and description of benefits), see: See http://www.colorado2.com/medicaid/states.html  

Before taking an action about Medicaid, check the facts in your state.

• What Medicaid covers
  • Medicaid and Long Term Care
  • Medicaid Aged and Disabled Medicaid Waiver Program
  • Medicaid Custodial Care: Permitted Spousal Income Modifications
• Eligibility for Medicaid
  • Who is eligible for Medicaid?
  • Eligibility: Spousal Impoverishment Rules With Respect To Nursing Homes
• How to qualify for Medicaid  
  • Sample letter from a co-worker
  • Sample letter from a housemate
  • Medicaid spend downs (also known as "Medically Needy")
  • How to plan ahead for long term care coverage (such as care in a nursing home)
• Applying for Medicaid
  • How To Apply For Medicaid
  • Forms an analyst may ask you to complete (supplemental questionnaires)
  • Additional information about applying for or living with Medicaid (Medi-cal in Califiornia)
• How To Appeal If Your Request For Medicaid Is Turned Down
• When Medicaid Is Effective
• How To Maximize Use Of Medicaid
• Medicaid As A Supplement To Medicare
• Long Term Custodial Care "(Institutional Care") - such as care in nursing homes
• Return to work: TWWIIA and Medicaid
• Right to Reimbursement From Your Estate
• Medicare and Medicaid (when you have both)
• Frequently Asked Questions About Medicaid
  • What if my income or assets are too high to qualify for Medicaid?  
  • I have Medicare. Can I also qualify for Medicaid?  
  • If I think I am eligible for Medicaid, should i cancel any other health insurance i might already have? 
  • If I can't leave the house, can I still apply?   
  • If I have more income and/or assets than permitted, can I still apply for Medicaid?
  • Can Medicaid pay for medical expenses I incurred before applying?  
  • How do I find out information about the state in which I live?

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