- What Exactly is Medicaid, Anyway?
Medicaid is a government-sponsored program that provides health coverage to specific segments of the US population – including the neediest and most vulnerable individuals. Medicaid was created way back in 1965, and it was part of the Social Security Act signed into law by President Lyndon B. Johnson. He also signed Medicare into law during the same period. Medicaid is considered a “public” health insurance program because it is funded by the taxpayer – both on the state and federal levels. One in five Americans is covered under Medicaid, making it one of the most common sources of healthcare coverage in the nation.
- What is the Difference Between Medicaid and Medicare?
While Medicaid is specifically designed for low-income individuals who cannot afford health insurance, Medicare is geared primarily toward Americans who have reached retirement age. Therefore, it is possible to be covered under both Medicare and Medicaid if you have reached retirement age and you’re considered a “low-income” individual. There are many other differences between the two programs, and these differences mainly involve which services are covered and how costs are shared.
- Who Can Apply for Medicaid?
You can apply for Medicaid if you meet certain requirements. Anyone who is below a certain income level can apply for Medicaid. Your income is calculated using the Modified Adjusted Gross Income (MAGI) system. Although eligibility requirements may change from year to year, the general rule is that if your family is 138% below the federal poverty line, you can receive Medicaid coverage. Based on 2020 levels, the federal poverty level is about $30,000 for a family of three. You can also apply for Medicaid if you are pregnant with a low income. Finally, you can get coverage if you are an elderly individual who relies on Social Security Income (SSI). The same applies to disabled people who are on SSI.
- What Does Medicaid Cover?
Medicaid is mostly limited to “mandatory” services. These include:
- Hospital care
- Physician care
- Laboratory services
- X-ray services
- Home health services
- Nursing facility services
For children under 21, Medicaid may provide additional coverage for services such as:
- Early and periodic screening
- Diagnostic and treatment benefit
All states cover prescription drugs, although additional services may vary depending on your home state. In Florida, the following services are covered under Medicaid:
- Family planning
- Dental
- Visual
- Hospice
- Transportation
- Community behavioral health
- Anesthesia
- Allergy services
There are many other services that may be covered by Medicaid, and Florida’s coverage is quite comprehensive.
- Can I Get Kicked Off Medicaid?
It is possible to lose Medicaid coverage under certain circumstances. The most obvious situation involves earning too much money. Even if you receive a slight pay rise, this could make you and your family ineligible for Medicaid – and this is an issue that many American families have to struggle with. Even if your income doesn’t increase, you may lose eligibility if your overall wealth changes. For example, you could inherit money from a relative – or you could win the lottery. Maybe you made a smart investment that turned out to be extremely lucrative.
If you received Medicaid coverage as a child, you might lose eligibility when you reach a certain age. Remember, Medicaid only provides certain benefits up to age 21. On that same note, pregnant women may lose eligibility when they give birth. This is because some women are only eligible for Medicaid because of their pregnancy.
Changes in your household can also change eligibility. For example, the size of your family might have changed, or you might have married. Perhaps you adopted a child. Whatever the case may be, it’s important to report these changes in your household in an accurate manner. If you fail to do this, the consequences could be much worse than you realize.
You may also lose eligibility due to policy changes within Florida. For example, in early 2023, it was reported that up to 1.75 million Florida residents could lose their coverage because of these changes. Specifically, this was due to the expiry of pandemic-era laws that broadened Medicare eligibility. This is in addition to a further 900,000 people who became ineligible for Medicaid in 2023 for other reasons, such as changes in income and families. Florida estimates that an additional 850,000 Medicaid recipients haven’t responded to requests for updated information, putting these individuals at risk of losing their coverage as well.
- What Happens if My Medicaid Application Is Denied?
Because policies and eligibility requirements are constantly changing, it can be difficult to determine why your Medicaid application has been denied. Although this situation can be confusing, it is important not to give up hope. You still have the opportunity to appeal your denied application – and sometimes, this can be enough to gain that all-important Medicaid coverage. You can appeal your denied application with help from a qualified attorney.
The same logic applies to sudden, unexpected loss of coverage. Many people only find out that they have lost coverage after a trip to the pharmacy, with the pharmacist telling them that their insurance is no longer valid. This can be incredibly distressing – especially when you are counting on your prescription medication to get through the day. Once again, a qualified attorney can help you appeal this loss of coverage and regain your health services.
Where Can I Find a Qualified Medicaid Attorney in Miami?
If you have been searching for a qualified, experienced Medicaid attorney in Miami, look no further than the Elderly Care Law Firm. Over the years, we have helped numerous families and individuals seek and maintain their Medicaid coverage. If you are experiencing any kind of issue with your coverage, you should book a consultation at your earliest convenience. A Medicaid attorney can help you get the benefits to which you are legally entitled by guiding you through the process, including appealing any denials. Time is of the essence, so get in touch today and strive for the best results with our assistance.
