Medicaid

To get Medicaid, you have to be a U.S. citizen, Green Card holder or refugee.

• Low-income adults.
• People over 65-years-old.
• Children under 18-years-old.
• Pregnant women.
• Blind or disabled people.
• Have high medical bills.
• Receive food stamps.
• Receive Supplemental Security Income.
• Have low or no income.

• A single person: less than $18,075 per year.
• Family of 2 (husband-wife, or mother-Child<18 or father-child < 18): less than $24,353 per year.
• Family of 3: less than $30,630.
• Family of 4: less than $36,908.
• Family of 5: less than $43,186.
• Family of 6: less than $49,463.
• Family of 7: less than $55,741.
• Family of 8: less than $62,018.
• For more than 8 members, $62,018 and add $6,277 per person after 8 people.

• Mail to the local social service office.
• Call the local social service office. 
• Call 1-800-318-2596.
• You may also apply online at www.healthcare.gov/get-coverage/.
• Some local health insurance agents who participate in Medicaid program.

If you are:

• Older than 65-years-old.
• Disabled.
• In foster care.
• Require long term care.

You must call/mail/go to a social service office to apply.

If you are:

• 19-64 years-old.
• Pregnant.
• Under 18-years-old.

You can apply online or at a social service office.

• Birth certificate or driver's license or state ID or passport.
• Green card or US birth certificate or passport.
• Pay checks or Tax Return or Supplemental Security or any other income.
• Bank statements or other financial resources.
• Proof of disability if needed.
• Copy of rent receipts or mortgage or recent mail sent to you at your current address.

Medicaid needs to be renewed each year. You will get a renewal application every year. If there are any changes to your address, income or family members, you need to put that in the application.

If you have Medicaid, you may have to pick a Managed Care Plan. Managed Care Plans are when insurance companies take care of your Medicaid. If you do not pick a Managed Care Plan, or insurance company, then one will be picked for you. Some people do not have to pick a plan. These are called exempt or excluded.

The following person can choose a managed care plan if they want to:

• Individuals with long term medical conditions.
• Native Americans.
• Homeless.

The following persons do not have a Managed Care Plan:

• Eligible for both Medicaid and Medicare.
• Foster children.
• Individuals covered under other insurance.
• Residents of residential health care facilities.
• Infants weighing less than 12 grams, or other.

If you have Medicaid Managed Care, most basic health care will cost you little or no money.

The following health services will be free:

• Emergency Care.
• Family Care.
• Pregnancy-related services.
• Preventive-care services for children.
• Most services for children under 18.

The following health services may require small copay or none. It mostly depends on where you live and your family income level:

• Physician services.
• Inpatient and outpatient health care.
• Selected preventive care (early and periodic screening, diagnostic and treatment services).
• Nursing facility care.
• Laboratory tests and x-rays.
• Vision, speech and hearing services.
• Short-term rehabilitation.
• Prescribed drugs, mostly generic.
• Durable medical equipment.
• Mental health, alcohol and substance abuse treatment.
• Nurse, midwife and freestanding birth center services.
• Transportation to medical care.

Medicaid Managed Care health plan provides care by working with a group of doctors, clinics, hospitals and pharmacies. Choosing the plan that’s best suited for you is important.  You may want to join a plan to keep seeing a particular doctor or other provider. You may also want to consider the following situation.

• Does the plan have doctors located near you?
• Do they have visiting hours that fit your schedule?
• Does the plan offer a special program for some health conditions, e.g., pregnancy, diabetes, asthma, etc.? 

People with long term illnesses or disabilities may require care on a daily basis. They normally need care for a long period of time. They may need assistance even with simple activities like bathing, dressing and eating. In some cases, Medicaid will cover the costs of long-term care. Applicants must meet some eligibility conditions to receive Medicaid for long term care.

There are three types of requirements. Individuals need to meet all of them for long term Medicaid care.

• Age 65 or older or permanently disabled or blind.
• U.S. citizenship or lawfully admitted immigrants.
• Be a resident of the state where you apply.

A state medical specialist will test the applicant to make sure they need long term care by checking if they can perform the following activities.

• Bathing.
• Dressing.
• Using the toilet.
• Moving to or from a bed or chair.
• Control their urination.
• Eating.

Applicants must have very low income and assets. The level of low income and assets varies from state to state. An applicant has to provide proof of income and assets.

An official will review your income. Some living costs are taken off your income. The exact amount depends on your financial situation.

The following counts as income sources:

• Social Security retirement or disability payments.
• Veterans’ benefits.
• Pensions.
• Salaries.
• Wages.
• Interest from bank accounts.
• Dividends from stocks and bonds.

Medicaid generally does not count the below as income source:

• Food stamps.
• Housing assistance.
• Home energy assistance.

The state will calculate how much money you have and how much your possessions are worth. They will also look at your last five years. Things the state will count include:

• Checking and savings accounts.
• Stocks and bonds.
• Certificates of deposit.
• Real property other than your home.
• Cars if you have more than one.

Things not counted for eligibility:

• Your home.
• Personal property and household things.
• One car.
• Life insurance with a face value under $1,500.
• Up to $1,500 in funds for burial.

Applicants need to apply to your local department of social service office. You can apply by using any of the following ways.

• By mail.
• Over phone.
• Visiting the local DSS.

Applicants will have to:

1. Fill out a general Medicaid application form.

2. Provide documentation to verify general and financial requirements.

3. If the above requirements are met, the applicant’s functional eligibility will be evaluated.