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Medicaid: U.S. Public Health Care Safety Net

  • Published: 2011-11-19 (Revised/Updated 2016-10-08) : Author: Weiner & McCulloch PLLC : Contact: elderlawhousing.com
  • Synopsis: Exactly which medical expenses are covered by Medicaid and for whom varies from state to state.

Quote: "Sometimes when facing a long-term care crisis, a person must spend down his or her assets to meet Medicaid financial-eligibility guidelines."

Main Document

Medicaid is jointly funded by the federal and state governments, but administered by each state individually according to its own guidelines. Both federal and state Medicaid laws and regulations are notorious for their complexity.

Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the U.S. state and federal governments, and is managed by the individual states.

Medicaid is a publicly funded health care program started by Congress in 1965 to help certain low-income people with medical expenses.

Medicaid is jointly funded by the federal and state governments, but administered by each state individually according to its own guidelines. Both federal and state Medicaid laws and regulations are notorious for their complexity.

Medicaid expenditures are a huge part of government spending.

In Texas, for example, according to the state Health and Human Services Commission, Medicaid accounted for roughly a quarter of the appropriated state budget in the 2009 fiscal year. However, HHSC also reports that in that same year Texas had the highest percentage of its population uninsured of all the states. Roughly one in eight Texans got Medicaid that year.

Eligibility

Whether an individual or family is eligible for Medicaid is rarely a simple question.

Eligibility rules vary from state to state, but generally to be eligible an applicant must fall within certain asset and income limits and be a member of a covered group. In most states covered groups include senior citizens, children, certain low-income families, people with disabilities, the blind, and pregnant women.

Normally eligibility requires citizenship or lawful admission to the country, although there are exceptions for certain emergency services.

The federal government recommends that potential applicants not shy away from the system because of its daunting details.

If someone has limited resources and potentially falls into a covered group, he or she should apply and have his or her state look closer at the particular situation. That said, it can be extremely difficult for the average person to navigate the system. Consulting an informed attorney with Medicaid experience is often crucial to successful enrollment.

Covered Services

Exactly which medical expenses are covered and for whom varies from state to state, but most states cover routine health care, hospitalization, medical testing, nursing home and some other institutional care, home health care and prescriptions.

Long-Term Care

Medicaid may pay for long-term care when disability, illness or advanced age restricts a person's ability to take care of him or herself. That care may include nursing-home placement, or certain home- or community-based services.

Many people need Medicaid to help them pay for nursing home care because it is too expensive for most low and middle-class people. For example, the average daily rate for a semiprivate room in a Houston nursing home in 2010 was $144, according to MetLife, Inc.

Sometimes when facing a long-term care crisis, a person must spend down his or her assets to meet Medicaid financial-eligibility guidelines. The legal requirements about when and how assets may be disposed of can be a landmine for the uninformed. The earlier this type of asset management and long-term care planning can start, the better.

If you or a loved one is approaching advanced age or are concerned about long-term care needs related to a disability or illness, talk to an elder law attorney as soon as possible about Medicaid planning.

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