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Medicaid and the Health Care Law

What is Medicaid?

Medicaid is a government program that covers the cost of medical care for low-income people who meet certain criteria. To enroll in Medicaid, your family’s income and assets must be below a certain level. These levels vary from state to state. While Medicaid is a publicly funded program, care is provided by both public and private health care providers and plans.

Am I eligible for Medicaid coverage?

Some examples of people who have long been eligible for Medicaid include: pregnant women, children, adults with dependent children, people with disabilities, and seniors who have low incomes. Under the new health care law, states have the option to broaden access to Medicaid coverage to include everyone below a certain income level – about $15,000 for one person and roughly $30,000 for a family of 4 –whether or not they fall into one of the groups listed above.

In states that choose to accept federal money to improve access to Medicaid, millions of people across the country who don’t have insurance now will be able to get lifesaving preventive care and treatments for cancer and other serious diseases. Legal permanent residents (also known as green card holders) may have to wait 5 years before they can enroll in Medicaid. Undocumented immigrants are generally not eligible for Medicaid.

In states that have not broadened access to Medicaid coverage, many low-income people will not qualify for Medicaid. Some of the poorest of these people also won’t qualify for help paying for private insurance in the health insurance marketplace.

Will Medicaid provide the health coverage I need?

In the past, Medicaid has covered a range of health services, including doctor visits, hospital care, lab and x-ray services, and prescription drugs. These services will still be offered to the groups that have had this coverage in the past (the eligible groups listed above). People who are “newly eligible” in states that expand access to Medicaid will also be covered for health care services to prevent and treat a serious disease such as cancer.

Not all health providers take patients with Medicaid. It’s important to be sure that the doctor you want to see will take Medicaid patients before making an appointment. If they don’t, you may have to pay for the full cost of the visit.

How do I enroll?

You should be able to find out whether you qualify for Medicaid through your state’s health insurance marketplace. The marketplace is where people who need to find health coverage on their own can get information about health plans that are available to them. Enrollment starts October 1, 2013 and coverage begins January 1, 2014.

If you don’t qualify for Medicaid, you may be able to buy a private health plan sold in the health insurance marketplace. Many uninsured people who aren't eligible for Medicaid can get help to purchase a plan in the marketplace. This will depend on their income and whether they already have the option of getting health insurance option through a job.

You can find your state’s marketplace and enroll at www.Healthcare.gov/Marketplace, or by phone at 1-800-318-2596. Help will also be offered through community groups and trained “navigators” who can assist you. Visit www.Healthcare.gov, or www.GetCoveredAmerica.org to get more information and learn more about how to enroll. You can also contact your state Medicaid department to find out if you are eligible. To apply, you’ll need to provide basic information, including your social security number, household size, and estimated income.

Where can I get help?

Information is available in multiple languages through www.Healthcare.gov and www.GetCoveredAmerica.org, and through a toll-free call center at 1-800-318-2596.

In-person help at community health centers, libraries, hospitals, and other such places will be available to help people apply online or by mail. These people can help you find out if you’re eligible and help you enroll through the marketplace.

Last Medical Review: 07/25/2013
Last Revised: 07/25/2013