Life After 50 Expo

Dear Marci,

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Dear Marci,

I am helping to care for a family member who has a disability and is younger than 65. How can I find out if she qualifies for Medicaid, and what benefits would her Medicaid program cover?

– Oksana (Hoboken, NJ) 

Dear Oksana,

Medicaid is a federal and state program that covers medical care for certain people with limited income and assets. The income and asset limits vary from state to state above federal limits. People who are eligible for Medicare may also beeligible for Medicaid if their income and assets are below the limits in their state.

Each state runs different Medicaid programs for various groups of people. One type of Medicaid is for individuals who are aged, blind, or disabled. This is often called aged, blind, or disabled (ABD) Medicaid.

Generally, an individual needs to apply for Medicaid with their local Medicaid office. Some people automatically qualify for Medicaid because they are receiving Supplemental Security Income (SSI) or because of other Social Security programs. Contact your local Medicaid office to ask how to submit the application. Many states allow you to submit the application online, through the mail, or through community health centers and related organizations. Your state may require a face-to-face meeting at the Medicaid office in order to apply.

States often require documentation to support an individual’s application, such as:

  • Proof of age, like a birth certificate
  • Proof of identity and citizenship or immigration status, like a passport or green card
  • Proof of address, such as a utility bill
  • Proof of income, like a pay stub or Social Security Administration award letter
  • Proof of assets, like a bank statement

All state Medicaid programs are required to cover the following benefits at a minimum. These are known as mandatorybenefits, and include:

  • Inpatient and outpatient hospital services
  • Nursing facility services
  • Home health services
  • Physicians’ services, laboratory services, and x-rays
  • Rural health clinic services
  • Transportation to medical services
  • Family planning services, nurse midwife services, tobacco cessation counseling for pregnant people, state-licensed freestanding birth centers
  • Pediatric and certified family nurse practitioner services  

Note that Medicaid covers inpatient and outpatient hospital services, home health care, and physician services, which are also covered by Medicare.

The following Medicaid benefits are optional, and may not be available in all states:

  • Prescription drugs
  • Physical, occupational, and speech therapy
  • Dental services and dentures
  • Prosthetics
  • Optometry and eyeglasses
  • Chiropractic services
  • Personal care
  • Case management
  • Hospice care
  • Podiatry
  • Private duty nursing   

Coverage is different from state to state. Oksana, you can learn more about your state Medicaid program by contacting your State Health Insurance Assistance Program (SHIP). Visitwww.shiptacenter.org or call 877-839-2675.

– Marci