An Introduction To Medicaid

What is Medicaid? Who is eligible? What does it pay for? Here are the answers.

Medicaid was begun in 1965 as a joint program between the Federal and state governments to help the states provide adequate medical care to low-income individuals. Because the Federal government offers the program in conjunction with individual states, each state is responsible for establishing its own eligibility standards; determining the type and scope of Medicaid coverage; setting payment rates, and administering the program. Therefore, Medicaid rules and regulations vary greatly from state to state.

Covered Services

Some optional services provided by Medicaid department in many states include:

  • Continuous home care in crisis situations—primarily nursing care to manage acute medical symptoms for persons requiring at least 8 hours of care per 24-hour day.
  • Hospice services for individuals certified as terminally ill (life expectancy of 6 months or less) that provide for the management of terminal illness and/or related conditions in a home or nursing home hospice facility that meets Medicaid requirements.
  • Personal care services (e.g., bathing, dressing, eating, light housework, personal hygiene, etc.). These services must be (1) authorized by a doctor in accordance with a service plan approved by the state, (2) provided by a qualified person who is not a family member, and (3) furnished in the home or alternate location.
  • Physical or occupational therapy as prescribed by a physician or licensed practitioner and including any related supplies and equipment.
  • Rehabilitation services recommended by a physician or other licensed practitioner. These may include individual or group therapy and psychosocial services.
  • Respite care to relieve the caregiver of his or her responsibilities on an occasional basis, for no more than five days at a time.
  • Services for individuals with speech, hearing, and language disorders. May include diagnostic, screening, preventive, or corrective services provided by a speech pathologist or audiologist.
  • Short-term, inpatient care in a participating hospital unit or hospice facility for pain control or acute or chronic symptom management.
  • Nursing facilities for individuals 21 years and older who qualify, as well as related home health services (home medical equipment and supplies, part-time or intermittent services by a home health agency). Regardless of state, nursing facilities in the
    • Medicaid program must provide or arrange for:
      An on-going activity program that meets the mental, physical, and psychosocial needs of patients
    • Dietary services that meet residents’ nutritional and special dietary needs
    • Nursing and specialized rehabilitative services
    • Medical treatment
    • Pharmaceutical services
    • Routine and emergency dental services
    • Services needed by residents with mental illnesses or developmental disabilities
    • To find out if your loved one is eligible for Medicaid, contact your state Medicaid office. The easiest way to do so is by looking in the Yellow Pages for the local number.

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