Government Programs

What is Medicaid?

We HIGHLY recommend checking out this list of SCI grants to help pay for expenses related to your injury, including health insurance. Many invaluable grant resources are available.

Both the federal US government and your individual state government provide healthcare and additional services for people with disabilities. The federal system -Medicare, and the state system – Medicaid, are two separate entities that are managed, funded, and applied for separately, this is important to understand, and making the two programs names so similar isn’t doing anyone a favor.

*Personal healthcare coverage is unavoidably specific. As an individual you will have a different set up than others. This learning portal will go over the general structure of Medicaid for a typical person with a disability. Please know you may require a different combination of programs. For example:  you may have private health insurance already, which affects the state and federal programs for which you qualify.

*The qualifications and application for Medicaid varies from state to state. You will find websites below to find your states’ Medicaid headquarters, the configurations are similar but you will need to do some research to find exactly how your program works and what it provides.

Half the battle to understanding these programs is knowing your vocabulary. There will be emboldened words with explanations throughout. I know nobody likes learning new terminology, but both Medicare and Medicaid will save you tens of thousands of dollars a year, so study up. Here is a helpful infographic:

Medicare – Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

Medicaid - A joint federal and state program that helps with medical costs for some people with limited income, resources, or certain disabilities. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

We repeated definitions of these programs because it is important to comprehend they are different. This portal will focus on the state provided Disability Based - Medicaid (MA), which is typically the secondary payer on a claim, because you will be recognized as disabled through Social Security you will qualify for federal Medicare, which would typically be your primary payer.

As you read in the definition above, you can also qualify for Medicaid based on income, we are focusing on the disability program. If you take anything away from this learning portal, know this – Medicaid works in tandem with Medicare. To qualify for Medicaid you need to be recognized as disabled with Medicare (which is done by qualifying for Social Security disability – which you can learn about here (link to social security disability and Medicare learning portal)).

Primary Payer (typically Medicare)- the insurance plan that processes the claim first when a member has more than one health insurance plan covering the services.

Secondary Payer (typically Medicaid) - means the plan, insurance policy or program that pays second on a claim for medical care and their payment is only to the extent that payment has not been made. A secondary payer may be either Medicare, Medicaid, or other insurance depending on the situation.

What does Medicaid do?

Medicaid is a health insurance program provided by the state. If you work for Target Corporation, they provide a private health Insurance program, through a health insurance company such as Medica, that will cover the majority of fees when you go to the emergency room, when you see your personal care physician for a stomach ache, you have surgery on a broken finger, or any other non-elective interactions with medical providers.

Even though Target provides this program, you will pay a monthly fee – a premium– to maintain your coverage. Because you are recognized as disabled by the state, Medicaid provides you a similar healthcare coverage program. Depending on your specific situation, you may pay premiums or a spend down to the state to maintain coverage, but typically these are much lower than if you select a healthcare program independently – through the new www.healthcare.gov marketplace.

This is the major benefit, because you’re disabled you will potentially need more frequent and intensive care which costs more and would drive up your personal expenses if covered by standard healthcare programs. Through the government these prices are controlled while still providing the more robust care you may need, which is cool.

Within Disability Based Medicaid there are specific programs for individuals in different scenarios. Check out this portal to find what could work best for you.

And if you have not yet applied for federal Medicare also do that here. You need both programs to get the best coverage: http://www.ssa.gov/planners/disability/dapply.html#&sb=1

Please watch the video below on the basics on Medicaid, and make sure to read our Takeaway Points below.

Video: What is Medicaid?

Takeaway Points

  • Medicaid is funded by both the U.S. government and the individual state you live in
  • You can be on both Medicaid and Medicare if you are eligible
  • You can pay premiums and still maintain your Medicaid if you want to work