Medicaid is a health insurance program managed by states that pay the medical bills of individuals and families who cannot afford medical care.
1. Hospital in-patient services
2. Hospital out-patient services
3. Doctors' services
4. Laboratory tests
6. Hearing aids
7. Transportation when essential to obtain medical care
8. Nursing home services
9. Home care services (personal care and housekeeping)
11. Dental services
Eligibility for Medicaid
Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home. Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not (however, there is a 5-year limit that applies to lawful permanent residents). Eligibility for children is based on the child's status, not the parent's. Also, if someone else's child lives with you, the child may be eligible even if you are not because your income and resources will not count for the child. In general, you should apply for Medicaid if you have limited income and resources. After the eligibility worker determines that you meet one of these eligibility conditions, the value of all your assets will be added up. Assets are cash, money in checking or savings accounts, credit union accounts, stocks, savings bonds, trusts, annuities, or any other money that you have saved or invested. Assets also include things like boats, trailers, real estate, and life insurance policies or other expensive items you may own. Medicaid does not count as assets the home you live in or personal property (e.g., clothing, furnishings, car). The amount of assets you may have depends on the size of your family and the eligibility group for which you are applying. This will be determined at the time of application.
How to use Madicaid
Medicaid is not accepted everywhere. Not all doctors, pharmacies or laboratories accept Medicaid. If you receive services from a doctor, pharmacy or lab that does not accept Medicaid, the bills will NOT be covered. You will have to pay for that service yourself. Ask your doctor or other service providers if they accept Medicaid. If you have SSI or Public Assistance (PA), and still need a Medicaid Benefit Identification Card, contact their PA worker to get one. The same card is also used as a swipe card to access your monthly PA cash benefits and Food Stamp credit. People who get SSI have to give their SSI award letter or SSI Referral and Notification Form (DSS-2474) to their nearest Medicaid Office. The Medicaid Office will give them a Temporary Medicaid Authorization Form (DSS-2831A) and arrange for a permanent plastic Medicaid Benefit Identification Card. NOTE: The Medicaid Benefit Identification Card can also be called a Medicaid Card or Benefit Card. If you have Public Assistance through HIV/AIDS Services Administration-HASA (formerly DASIS) and still need a Benefit Identification Card, speak to your case manager at HASA. Otherwise, you will receive a Benefit ID card automatically as long as you ask for Medicaid at the time of application. If you have a case manager at HASA, but you do not receive Public Assistance through them, your case manager needs to complete a Medicaid application for you. If you don't receive PA or SSI, you can apply for Medicaid by going directly to your local Medicaid Office.
The application procedure
The application procedures for single persons and families are the same, except that families must give documentation for each person in the household. Single people and families who do not get SSI or Public Assistance benefits may still get Medicaid coverage. You should call first to make an appointment. The Eligibility Specialists can tell you over the phone a list of documents to bring to the appointment. They will help you fill out the application in person. If you are homebound or too sick to travel, Medicaid applications can be filled out in your home. A Medicaid worker will come to your house to interview you. You can make an appointment for a home visit by calling the HRA InfoLine at 1-877-472-8411. You do not have to apply in person. A friend can go to the local Medicaid office and apply for you as long as you give them all the documentation that Medicaid asks for. Be Prepared for the Interview. The Medicaid worker (sometimes called an Eligibility Specialist) will have the application form for Medicaid and a Disability Interview form. These forms will be completed by the worker. You must have a work history narrative. This can be a list of employers and jobs during the last 5 years. A Medical Report for Determination of Disability has to be filled out by your doctor.
1. List to bring for the appointment
1) SSD award letter (to prove your income and residence)
2) Birth Certificate, Passport or Baptismal Certificate
3) Social Security Card (if you do not have your Social Security card, you can use your SSD Award Letter to prove your Social Security number)
4) Diagnosis letter from your doctor (you can use your SSD Award Letter if it shows an AIDS or AIDS Related Complex diagnosis)
5) Green Card and/or Naturalization papers or other INS documentation proving alien status
6) Lease (if your apartment is in your name) or if lease is in a roommate's name, a letter from him or her telling about your living situation. In this letter it should say that you share the rent and utilities equally (give the amounts) and food is bought and prepared separately. You will also have to have a copy of the lease or utility bill showing your roommate's name.
7) Recent rent receipt or above letter
8) Recent electric and/or gas bill
9) Recent phone bill
10) 2 most recent checking account statements
11) Savings account statements or savings passbook showing activity for 24 months
12) Recent health insurance premium statement if you have health insurance. Medicaid can pay this bill for you or it will help reduce your Medicaid Spenddown
13) Proof of residence for each child - school records or physician's or clinic's statement
14) Proof of citizenship or alien status for each child - birth certificate or INS documentation
A Medicaid worker will go over the application and documents with you during the appointment. The worker must see the original documents but has no reason to keep them. Ask that they copy all your papers and have the originals returned to you. After you apply and Medicaid gets your completed application they must, by law, reject or approve it within 30 to 60 days. If they need additional information, the worker will contact you by mail. You should get a permanent plastic Medicaid Benefit Identification Card in the mail two weeks after approval. . If you have SSI you can get a Temporary Medicaid Authorization Form from a Medicaid worker. A Medicaid worker can give a Temporary Medicaid Authorization form to anyone who gets SSI and has an SSI Award Letter or an SSI Referral and Notification Form. The Referral and Notification Form must show that you are eligible for SSI on the same date, or earlier. You can get the Temporary Medicaid Authorization on the same day that you bring the Notice from SSI into the Medicaid office.
Contact Information Regarding Medicaid
Virginia- 804-786-7933 [ Link ]
District of Columbia- 202-671-5000 [ Link ]
Maryland- 410-767-6860 [ Link ]
For more information, visit [ Link ]