Medicaid (federally subsidized health coverage)

What Is Medicaid?

Medicaid is health coverage provided by the federal government for those who are eligible.  Although it is funded by both states and the federal government, the states are responsible for administering and maintaining the program and must follow federal requirements.

Approximately 70 million people take advantage of this program today, and it is the largest source of health coverage in the country. Depending on the state that a person is in, they may be required to pay premiums to access this health coverage, and they may also have out-of-pocket expenses like copayments.

When Was Medicaid Put Into Effect?

The law that led to Medicare and Medicaid being implemented was came in the form of a bill which was signed on July 30, 1965 by President Lyndon B. Johnson. In the intervening years, the law has undergone significant changes, and the most recent of these is the expansion to low-income individuals in many states with the passage of the Affordable Care Act.  

Who Is Eligible for Medicaid?

This program is designed for individuals who may have limited financial resources or be in a position where obtaining health coverage is challenging. People who are likely to be eligible include those who are:

  • Low income 
  • Elderly (must be at least 65 years old to be eligible)
  • Disabled
  • Pregnant 
  • Children

Income and Family Size

Generally speaking, whether or not someone will be required to pay premiums or out-of-pocket expenses will depend on their household income in relation to the federal poverty line. If someone makes more than 150% of the poverty line, they may be expected to pay for access to this health coverage. 

Other Eligibility Factors

Certain individuals who are considered to be particularly vulnerable, such as children and pregnant women, may be exempt from having to pay out-of-pocket costs for Medicaid. Low-income individuals may also be eligible for Medicaid. Whether or not someone with limited income is eligible depends on if they live in a state that expanded the program's coverage with the passage of the Affordable Care Act.  

What Does Medicaid Cover?

In general, it covers the same type of needs that standard health insurance covers. Visits to a doctor's office, hospital expenses and a variety of medical treatments are typically covered. Medicaid can also cover long-term care costs both at home and in facilities while Medicare does not.

It does not cover the cost of prescription drugs. However, if you're eligible for the program, it may cover the costs of Medicare Part D, which covers many prescription drugs.