Medicaid
K N O W YO U R R I G H T S
If you have been denied Medicaid be
nefits and disagree
Medicaid
with this decision, you ma
y file an appeal and ask for a
fair hearing. People with Medicaid are entitled to have
CENTERS FOR MEDICARE & MEDICAID SER VICES
their medical information kept private. A federal law
requires Medicaid to provide all medically-necessary
G E T T I N G S T A R T E D
health care services to Medicaid-eligible children even
WHERE C AN I GE T MORE INFORMATION?
if the state’s Medicaid program wouldn’t normally cover
the services.
You ca
n find helpful phone numbers and websites for the
organizations below by visiting www.medicare.gov or calling
1-800-MEDICARE (1-800-633-4227). TTY users should call
W H AT I S S P E N D D O W N?
1-877-486-2048.
Under the “spend down” process, some states allow you to
• To see if you qualify, call your State Medical Assistance
become eligible for Medicaid as “medically needy” even if
(Medicaid) offi ce.
you have too much income to qualify.
This process allows
• For free health insurance counseling and personalized help
you to “spend down” or subtract your medical expenses
with insurance questions, call your State Health Insurance
(like the cost of hospital care or doctor’s visits) from your
Assistance Program (SHIP).
income to become Medicaid eligible. Subtracting medical
• To learn more about the Medicaid program, visit
expenses from income can reduce your income to a level
An Overview of
www.cms.hhs.gov/home/medicaid.asp.
below the maximum allowed by your state’s Medicaid
program. In order to be eligible as “medically needy,”
Medicaid
your countable resources (savings accounts, certifi cate
of deposits, etc.) also have to be under the established
resource standard in your state.
ask
www.medicare.gov
CMS Publication No. 11409
Medicare
April 2009
L E T ’S G E T S TA R T E D
AM I ELIGIBLE?
WHAT’S COVERED?
Medicaid (also called Medical Assistance) is a joint
If you meet the requirements for your state, you may be eligible for
Medicaid generally o ffers the following:
Medicaid. In addition to having limited income and resources, you
Federal and state program that helps pay medical
• Outpatient and inpatient hospital services
may be asked the following questions:
costs for certain people and families who have limited
• Pregnancy-related services
• What is your age?
income and resources. Medicaid will pay participating
• Vaccines for children
• Are you pregnant?
doctors, pharmacists, hospitals, or other providers for
• Doctor services
• Are you a child? Or, are you the parent or caretaker of a child
your care.
with Medicaid?
• Nursing facility services for people 21 or older
Each state decides what counts as income and
• Are you disabled?
• Family planning services and supplies
resources, who is eligible, what services are covered,
• Are you blind?
• Rural health clinic services
and the cost for services. States also can decide how
• Are you a U.S. citizen or an immigrant who meets certain
• Home health care for people eligible for skilled-nursing
to run their program as long as they follow the
requirements?
facility services
Federal guidelines. As a result, there are 56 diff erent
• Laboratory and x-ray services
Medicaid programs—one for each state, territory, and
WHAT DO I PAY?
• Pediatric and family nurse practitioner services
the District of Columbia.
• Nurse-midwife services
Depending on your state’s rules, you may have to pay a small part
• Federally qu
alified health center (FQHC) services
In general, you should apply for Medicaid in the
of the cost (such as a copayment) for some medical services. If you
qualify for both Medicare and Medicaid, most of your health care
• Early and periodic screening, diagnostic, and treatment
state where you live if you have limited income and
costs will be covered. If you have Medicare and Medicaid, you will
services for children under 21
resources. The rules for counting your income and
automatically get extra help paying for prescription drugs.
• Emergency transportation services
resources vary by state. Resources include money in a
checking or savings account, stocks, and bonds. There
Note: States can decide to cover more services than those listed
above. Check with your State Medical Assistance (Medicaid)
are also special rules for those who live in nursing
office for an exact list of what your state covers.
homes and for disabled children living at home.
If you apply and are approved for Medicaid, you will
get an approval letter, and you also may get a card to
use when you get health care services.
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