Health insurance is an important part of keeping healthy. Today we’re going to be looking at an overview of Medicaid

Medicaid, not Medicare

Medicaid provides health insurance to over 97 million low-income Americans. Month-to-month, Medicaid has served 32 million children, 28 million adults (who are mostly in low-income families), 6 million seniors, and 9 million people with disabilities. Medicaid can sometimes be confused with Medicare– the federally administered healthcare option for people over 65. However, there is an overlap between the two: 10 million “dual eligibles,” or low-income seniors or people with disabilities, are enrolled in both health insurances.

What is Medicaid?

This health insurance is what is called a counter-cyclical program, which means the enrollment changes to meet the ever-present needs during an economic downturn, which is when people lose their jobs and the health insurance that may come with it. Back in the Great Recession of 07, over 10 million people, with roughly half being children, enrolled in Medicaid. 

As economic crises happen throughout COVID-19 and public health is at risk, Medicaid enrollment will only rise. This helps millions of people without a job stay insured.

Who is eligible for Medicaid?

Medicaid is an “entitlement program,” which means that once you meet the eligibility rules, you have every right to enroll for coverage. States have guaranteed financial assistance for part of the cost of the programs.

You must meet these requirements to be eligible

  • Children through the age of 18 in families with income below 138% of the federal poverty line ($29,974 for a family of 3 in 2020)
  • Pregnant people with an income below 138% of the poverty line
  • Certain parents or caretakers with very low income
  • Most seniors and people with disabilities who receive cash assistance through the Supplemental Security Income (SSI) program

Depending on where you live, your state may have funds to cover ‘optional’ populations. 

  • People in the list above who exceed the limits for “mandatory” coverage
  • Seniors and people with disabilities who don’t receive SSI, whose income is below the poverty line
  • “Medically needy” people whose income exceeds the necessary limit for Medicaid, but have high medical expenses (such as nursing home care) that reduce their monthly wages to below the poverty line

Thanks to the Affordable Care Act (ACA), people with higher incomes who need long-term services and supports, as well as non-disabled adults with income below 138% of the poverty line, including those without children are also eligible for Medicaid.

Not all people with lower incomes are automatically eligible for Medicaid. 15 states have not implemented the ACA Medicaid expansion as of April 2020, so adults over 21 are generally ineligible for Medicaid, no matter how low their incomes are unless they are pregnant, caring for children, elderly, or disabled. If you’re in a non-expansion state, even a parent may be ineligible if their income exceeds just over 42% of the poverty threshold ($9,122 for a family of three).

People who are not U.S. citizens are also ineligible for Medicaid, despite the fact that they have a lawful immigration status. This means that people living in the United States for humanitarian reasons, school, work, or travel are ineligible for Medicaid as a health insurance option. Green card holders are also unable to enroll in Medicaid for the first five years of their citizenship, whether or not they meet the eligibility criteria. It’s the state’s option to extend the eligibility if the green card holder is pregnant or has children.