Medicaid Q & A
Source: Centers for Medicare & Medicaid
Questions about Medicaid
General Questions about
What is Medicaid?
Medicaid is a health insurance program for low-income and needy people. Medicaid
eligibility is limited to individuals who fall into specified categories.
The federal law identifies over 25 different eligibility categories. These
categories can be classified into five broad coverage groups:
- Pregnant women
- Adults in families with
- Individuals with disabilities
- Individuals 65 or over
Where can my clients access more
information about Medicaid?
For more information on Medicaid in your state, visit
To get the Medicaid At-a-Glance
brochure, visit http://www.cms.hhs.gov/states/maag2002hm.asp
Who is eligible for Medicaid?
Your clients may be eligible to receive Medicaid benefits as members of "mandatory" or "optional" eligibility
groups. All states must cover the mandatory groups, but states can choose whether
or not to cover optional groups. Examples include:
- Low-income families with
- Low-income (“poverty-level”)
pregnant women and children
- Certain low-income Medicare beneficiaries
- Individuals who would be
eligible for SSI if they were not in medical institutions
- Individuals receiving only State supplemental
Medicaid varies from state to state. For information
about the Medicaid plan in your state, visit www.cms.hhs.gov/medicaid/statemap.asp.
For more information about eligible Medicaid groups,
If my client
has been incarcerated, does he/she still have
access to Medicaid?
Medicaid eligibility is not terminated for individuals on the basis
of incarceration. However, payment for medical services provided
to individuals during incarceration is prohibited. When released
from incarceration, Medicaid is generally available again for that individual,
provided the state conducts a re-determination. States sometimes begin
the process of re-determination upon notice that an individual is being discharged.
Does Medicaid pay for mental health and substance abuse services?
If your client is eligible for Medicaid, some state Medicaid programs
pay for mental health services, such as individual and group psychological
therapies, psychosocial services and addiction treatment services.
To find out if your state Medicaid program pays for mental health
services, visit www.cms.hhs.gov/medicaid/statemap.asp or contact
the local Medicaid office.
What is Medicare-Medicaid Dual Eligibility?
A client that is Medicare-Medicaid Dual Eligible qualifies to receive
some form of both Medicare and Medicaid. The benefits your client
may receive if he/she is a Dual Eligible depends on the category
in which he/she falls.
For example, if your client is entitled to
Medicare Part A and is eligible for full Medicaid benefits, then
he/she is a Qualified Medicare
Beneficiary with full Medicaid. In this case, Medicaid would pay
for his/her Medicare Part A premiums if there are any, Medicare
Part B premiums, Medicare deductibles and co-insurance and full Medicaid
For more information about Medicare-Medicaid
Dual Eligibility, review the Medicare-Medicaid
Dual Eligibility section of this CD-ROM or visit
Once my clients are enrolled in Medicaid, how often will they have to
renew their eligibility?
Once your clients are enrolled in Medicaid, they must renew their
eligibility at least once a year or when there is a change in
their circumstances, such as an increase or decrease in any public
assistance they might be receiving. Your state may use longer
renewal timeframes if your client is blind or disabled.
During the renewal process, your clients should be able
to rely on eligibility information and documentation
they provided for other programs to verify continued
Medicaid eligibility. This review of eligibility
based on available information is called an ex
Your clients will not be required
to provide information that:
- Is not relevant to their
- Has already been provided or relates
to an eligibility factor that is not subject to change such as date of birth or U.S. citizenship
How should my clients apply for Medicaid?
Please see the list of state
Medicaid toll-free phone numbers to contact your
state Medicaid officials for more information.
These phone numbers can be found at http://cms.hhs.gov/medicaid/allstatecontacts.asp.
How long is the typical turn-around for
Once your client applies for Medicaid benefits, his/her application should
be processed within 45 days from the date the application was submitted. If
your client has a disability, the application process may take up to 90 days.
If your client applies for Medicaid through a joint
program application (i.e., Medicaid, Food Stamps or TANF application),
your state must still determine
Medicaid eligibility within the Medicaid time standard.
If processing the
application is delayed due to a non-Medicaid related requirement,
the Medicaid portion of the application must still be processed in
for a determination to be made in a timely manner consistent with Medicaid
If my clients are immigrants, are
they still eligible for Medicaid?
To be eligible to receive Medicaid, your client
must be a U.S. citizen or a qualified alien.
aliens are not eligible for Medicaid until they have been in the United
States for five years.
For more information on the current rules governing
immigrants' eligibility for Medicaid, visit www.cms.hhs.gov/immigrants/default.asp.