Medicaid

Medicaid Explained

Healthcare in the U.S. can be expensive, but Medicaid is a lifeline for millions of people.

What Is Medicaid?

Medicaid is a joint federal and state program that provides healthcare coverage to low-income individuals, families, pregnant women, seniors, and people with disabilities. Unlike Medicare, which is primarily for those 65 and older, Medicaid is based on financial need and other eligibility factors.
It often covers medical services at little to no cost.

Who Qualifies for Medicaid?

Eligibility for Medicaid varies by state, but it typically includes:

✅ Low-income individuals and families

✅ Pregnant women and children

✅ People with disabilities

✅ Seniors with limited income and resources

✅ Some adults without children (depending on state expansion policies)

Each state has its own rules, so checking your state’s Medicaid website is key to understanding your specific options. Click here to find your site.

What Does Medicaid Cover?

Medicaid provides comprehensive coverage, including:

✔️ Doctor visits and hospital stays

✔️ Preventive care (vaccines, screenings, wellness visits)

✔️ Prescription drugs

✔️ Maternity and newborn care

✔️ Mental health services

✔️ Long-term care for seniors and individuals with disabilities. Keep reading about nonskill vs skill care.

Some states offer additional benefits; like dental, vision, and physical therapy.

Skilled vs. Non-Skilled Care:

When it comes to long-term care, understanding the difference between skilled and non-skilled care is important.
These distinctions below help determine whether Medicaid or Medicare will cover the services.

Skilled Care (Medical Care)

- Provided by licensed medical professionals (nurses, therapists, doctors).

- Includes services like wound care, IV therapy, physical therapy, and rehabilitation.

- Typically needed after hospitalization or for chronic conditions requiring ongoing skilled treatment.

- Medicare covers skilled nursing care for a limited time (usually up to 100 days under specific conditions.

- Medicaid may cover skilled care for individuals who meet financial and medical eligibility requirements or if patient does not have Medicare.

Non-Skilled Care (Custodial Care)

- Focuses on daily living assistance rather than medical treatment.

- Includes help with bathing, dressing, eating, and mobility.

- Typically provided by persons providing custodial care only not medical professionals.

- Medicare does NOT cover non-skilled care unless it's part of a skilled care plan.

- Medicaid covers non-skilled care for eligible individuals, especially those in long-term care facilities or receiving home-based care services.

Click here for more on skill vs nonskill

How to Apply for Medicaid

1️⃣ Check your eligibility on your state’s Medicaid website. Find your site here.

2️⃣ Gather necessary documents like proof of income, residency, and citizenship or legal status.

3️⃣ Complete an application online, by phone, or in person at your local Medicaid office.

4️⃣ Wait for approval (processing times vary, but you’ll be notified once a decision is made).

Important Consideration

Medicaid vs. Medicare: What’s the Difference?**

People often confuse these two programs. Many think Medicare covers assistance with custodial care. It usually does not (if that is the only care needed) and depends on your insurance coverage overall. Here’s a simple breakdown:

- Medicaid = Income-based and for all ages. Covers both skilled and non-skilled long-term care.

- Medicare = Age-based (65+) or for certain disabilities. Covers only skilled nursing care for a limited time.

Some individuals qualify for both (known as “dual eligibility”), which can help reduce healthcare costs even further.

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