What Is Covered by Medicaid?

Medicaid is a federal-state partnership program that assists low-income individuals and their families in obtaining health insurance. Medicaid covers a lot of benefits and services, but some are optional. Most Medicaid recipients receive their medical care through managed care plans or fee-for-service, with some receiving coverage through premium assistance programs. These agreements ensure that Medicaid beneficiaries have access to high-quality care while lowering costs.

Children, pregnant women, the elderly, and adults with disabilities who are eligible for income-based benefits are covered by Medicaid. This joint federal and state program covers other medical and health services. For enrolled students, it has long-term advantages such as improved health outcomes and less need for hospitalizations and emergency care.

Medicaid funding varies from state to state. State governments cover the remaining costs after the federal government makes a fixed cost contribution known as the federal medical assistance percentage (FMAP).

Medicaid can adapt to changes in the economy and policy thanks to the FMAP financing structure, allowing state programs to meet the needs of their constituents. However, it also leads to conflict over financing between the federal government and the states. States have benefited from federal funding over the years by taking advantage of legal loopholes, sometimes by entering into financing agreements that artificially inflate the FMAP.

Medicaid provides coverage for various medical services, such as hospital and doctor visits, X-rays, lab work, dental and vision care, home health care, nursing home care, and prescription medications. Children, expectant mothers, seniors, and people with disabilities are also covered.

If they meet certain income eligibility requirements based on their household size, low-income people may be eligible for Medicaid. Some of these are children, expectant mothers, parents, and adults living in poverty. The law also permits Medicaid to cover a wide range of extra benefits. These can include personal care services for senior citizens and people with disabilities, hearing aids, dental and vision care, and dental and vision services.

Medicaid is provided to many low-income families by managed care organizations (MCOs), which have agreements with states to deliver comprehensive services. Others receive care through Medicaid fee-for-service, which pays service providers a set sum. Compared to Medicaid fee-for-service, managed care has lower costs per enrollee, ensuring all beneficiaries have access to the required services.

Medicaid covers long-term care, including nursing home care and many home and community-based services, unlike Medicare and private health insurance. These services support seniors or people with disabilities to live independently and stay as active as possible, including assisted living, adult day care, foster care, and other options. While eligibility for long-term care services varies by state, it is typically correlated with the number of ADLs that a person needs assistance with. This can apply to mobility, eating, dressing, and bathing.

In addition, the state provides managed long-term care (MLTC) plans in New York, which include coverage for these services and other medical needs like prescriptions, medical supplies, and dental and eye care. Participants in MLTC may also pick the primary care doctors they want to see and pay with their supplemental Medicaid and Medicare benefits.

Additionally, some states provide "institutional" Medicaid services, which offer full inpatient benefits in nursing homes, hospitals, and intermediate care facilities for people with intellectual disabilities. These services cover all aspects of the institution's resident care, including lodging and meals.

Medicaid covers a range of mental health services, including face-to-face and online counseling. It also discusses the drugs people can use to control their symptoms and general health better.

The Affordable Care Act mandates that all Marketplace plans include mental health care because low-income people may have trouble affording behavioral health care. This covers psychotherapy and counseling, which are crucial components of treating various mental health disorders.

However, there are still obstacles to using these services, such as small provider networks, lax enforcement of parity laws, and high prices. There must be greater access to mental health services to address the effects of behavioral health issues on people and their families.

States with expanded coverage can now give Medicaid recipients access to services for mental illness and substance use disorders (SUD). This resource can save lives, but states must keep ensuring they have sufficient provider networks and funding to support these services.


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