Did you know that Medicaid is the largest insurance provider in America? In fact, 1 in 5 Americans is covered by some form of Medicaid.
While it can provide essential services for children, disabled people, seniors, and others, filling out the Medicaid application form can be confusing. Luckily, we’re here to help.
Check out this guide to learn how to get enrolled in Medicaid today.
How Do I Know if I Qualify for Medicaid?
Before you get bogged down in the process of applying for Medicaid, you should first determine whether or not you are eligible. There are a few factors to consider here.
It Depends on What State You Live In
While Medicaid and Medicare are both publicly-run health insurance offerings, they differ in one key way. Medicare is run entirely by the federal government, whereas Medicaid is administered jointly by both the state and federal governments.
With Medicare, every American is eligible to enroll once they reach age 65. For Medicaid, however, the rules vary by state.
Groups that States Must Cover
While each state has some freedom in how they choose to administer the Medicaid program, there are certain groups that the federal government requires every state to cover.
These mandatory coverage populations include low-income pregnant women and children, individuals with certain disabilities, and seniors receiving social security. Within these groups, states can decide what income thresholds individuals must fall under to qualify.
Expansion Under the Affordable Care Act
With the passage of the Affordable Care Act, states were given the option to expand Medicaid coverage to low-income adults under the age of 65. Previously, adults were only able to qualify for Medicaid if they were disabled, if they were pregnant, if they had children, or if they were elderly.
While the majority of states have chosen to expand Medicaid, a few have chosen not to. This includes the highly populous states of Texas and Florida.
Medicaid for Seniors
If you or someone you help provide care for is over the age of 65, you are probably accustomed to getting care through the Medicare program. But for many seniors, Medicaid is an essential source of health care.
For instance, seniors who are low-income may qualify for Medicaid to pay for all or part of their Medicare Part B premium. In other instances, however, a senior may not need Medicaid until they need long term care.
For seniors who need care in a nursing home or skilled nursing facility, Medicare is only able to cover 100 days of treatment. Medicaid, however, can be used to cover the remainder of their care, and is accepted at many facilities nationwide.
So far, we’ve discussed the rules of who is allowed to apply for Medicaid. In some cases, however, the government may issue a waiver to allow someone to apply for Medicaid who would not usually qualify.
There are a variety of waivers available, so it would be impossible to get into all of them. One of the most common ones that families apply for, however, is a Medicaid waiver for children or adults with developmental disabilities.
These waivers allow individuals with developmental disabilities to be enrolled in Medicaid even if their household income exceeds the threshold. The purpose of these waivers is to help families care for family members with disabilities at home, rather than institutionalizing them.
Again, states differ in who they deem eligible for these waivers and how they distribute them. Unfortunately, many states have long waiting lists for these programs. In most cases, eligible families are encouraged to apply as soon as possible to reduce their wait time.
Applying for Medicaid
If you think you might be eligible for Medicaid in your state based on these requirements, the next step is to apply. Even if you are not sure whether you qualify, you should apply anyway. The rules in your state may be complicated, so sometimes the easiest way to get an answer is to let the agency make a decision.
There are a few steps you’ll need to follow.
Get the Necessary Documentation
To support your Medicaid application, you will need certain documentation to demonstrate your eligibility for the program. This includes proof of citizenship, residency, income, and disability (if relevant).
For proof of citizenship, you can use a driver’s license, state ID, or passport. You may also need one or two pieces of mail to establish your residency.
Next, you will need to gather proof of all income, including social security, retirement, and any assets. Then, if you are applying due to a disability, you will need medical documentation demonstrating this.
Finally, if you receive any other health insurance, such as Medicare, you will need to provide documentation of this coverage.
Submitting and Renewing Your Application
Once you have gathered the necessary documents, you will need to submit your application. States typically respond within 45 business days.
If you are approved for Medicaid, you will need to reapply every year to verify that you are still eligible. In subsequent years, the process may be easier, as your state will keep certain documents on file.
What if I’m Denied?
In some cases, an individual may apply for Medicaid, believing they meet the eligibility requirements, and be denied anyway. In this scenario, the person in question is entitled to appeal the decision.
Once again, each state structures its appeals process differently. Consider reaching out to your local State Representative for guidance on how to navigate this appeals process.
Get Started With the Medicaid Application Form
With these tips, you will be able to fill out the Medicaid application form and get the care you need.
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