Medicaid – Overview

Medicaid

As mentioned above, most SSI disabled recipients receive Medicaid coverage for their health expenses. Medicaid was established in 1965 as a joint federal/state program to provide medical coverage to the needy. States administer the program and, within federal guidelines, establish their own eligibility standards, types and levels of services, and rates of payment. Since the establishment of the SSI program in 1974, most SSI recipients have been eligible for Medicaid benefits, although in some states SSI is not a specific eligibility category. However, most SSI recipients in those states qualify for Medicaid under another eligibility category.

In some states, a Medicaid “buy-in” is available for certain categories of disabled individuals. The buy-in permits them to enroll in Medicaid even though they would not otherwise qualify because of income or resource considerations. The states may require the individual to share the cost of Medicaid by paying a premium or through some other cost-sharing arrangement, although these arrangements are generally assessed on a sliding scale based on income.

The federal government pays a percentage of total state Medicaid expenses. The federal percentage is determined by a formula based on state per capita income, with higher-income states receiving a smaller federal contribution rate. The federal contribution cannot be lower than 50 percent or higher than 83 percent. States may impose deductibles, copayments, or both for some services. And, as mentioned above, some categories of persons eligible for a Medicaid buy-in pay part or all of the cost of the coverage. For persons eligible for both Medicare and Medicaid, Medicare is the primary payer and Medicaid supplements payments.

 

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