Medicaid Benefits

The Medicaid benefits that you receive can vary from state to state because the Medicaid program is managed by each state. In general,  Medicaid will pay for your hospital bills, doctor bills, health care in your home, and long-term care in a nursing home.

States may elect to provide additional benefits and Medicaid coverage, known as Medicaid waivers, which may include medical transportation, services at a clinic, prescribed drugs, vision care, prosthetic devices, speech therapy, and occupational therapy. You will need to check with your State Medicaid program to determine which Medicaid benefits they provide.

Medicaid Can Pay Medicare Premiums

Medicaid pays Medicare premiums, deductibles and coinsurance for Qualified Medicare Beneficiaries (QMBs) or individuals whose income is at or below 100% of the established Federal poverty level and whose resources are at or below twice the standard allowed under the Supplemental Security Income (SSI) program.

There are additional groups for whom Medicare related expenses are paid by Medicaid or Medicare beneficiaries with income greater than 100% but less than 135% of the Federal poverty level.

* Qualified Working Disabled People.

* Individual States may also improve access to employment, training, and placement of people with disabilities who want to work through expanded Medicaid program eligibility.

Medicaid and Long-term Care

All states provide community Long-term Care services for certain individuals who are Medicaid eligible and qualify for institutional care. Most states use eligibility requirements for such individuals that are more liberal than those normally used in the communities.

State Children's Health Insurance Programs

In addition to a State's Medicaid program, states have a health insurance program for children up to age 19 years of age, known as the State Children's Health Insurance Program (SCHIP). 

In some states the program is part of the State's Medicaid program, in other states it is separate, and in some states it is a combination of both types of programs. These programs are for children whose parents have too many resources to be eligible for Medicaid, but not enough to buy private insurance.

Most of the states offer this insurance coverage to children in families whose income is at or below 200% of the Federal poverty level. However, because states have different income eligibility requirements, you need to find out about the Medicaid program in your state.

Medicaid Benefits Payments

Medicaid payments are made directly to the health care providers that participate in the Medicaid program. These Medicaid providers have agreed to accept the Medicaid payments as full payment for the services.

Individual states can charge small deductibles, copayments, and coinsurance for certain Medicaid services to some Medicaid recipients. States can not charge copayments for family planning services or emergency care. Also exempt from copayments are children under the age of 18, women that are pregnant, patients of nursing homes or hospitals that are contributing most of their income toward their care, and people that are enrolled in certain HMO programs.

There is no preset limit on federal Medicaid payments and the federal government must match the amount that each state is willing to spend on Medicaid. Currently, the only requirement is that the rate of reimbursement to providers must be adequate to attract enough providers so they can provide the proper services for residents of the state.

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The official U.S. Government Medicare Web site is cms.gov.