Everything You Need To Know About The Medicaid Managed Care


Consider that your parent or partner is in the hospital after suffering an accident or a disease. As a primary caregiver, you would have to spend several days stabilizing the patient, speaking with medical professionals, and trying to process what happened. It could feel overpowering and alarming. These occurrences frequently mark significant life changes where the family must accept a loved one’s evolving needs.

Care in a facility or home is very expensive when paid privately. A private room in a nursing home can cost over $100,000 per year. Medicaid is a joint federal-state program that assists low-income Americans of all ages in covering the costs of long-term care and medical expenses. This article explores everything you need to know about Medicaid managed care.

Who Is Eligible For Medicaid:

Only certain low-income people and families who fall into an eligibility category recognized by federal and state law are eligible for Medicaid. Instead of being paid, Medicaid sends payments directly to the healthcare providers. You might also be required to make a co-payment for various medical services, depending on the laws in your state. If you wish to apply for Medicaid, you must fit one of the following descriptions:

  • Pregnant Women
  • Children and Teenagers
  • Elderly and Senior Citizens
  • People with Disability 

Everybody with an income below 138% of the federal poverty line must have access to Medicaid in states that have chosen to expand the program. You can qualify if you’re single with an annual income below $17,608. A family of four must earn under $36,156 annually. 

Factors That Influence Eligibility:

Depending on your state, different people may be eligible for Medicaid. For instance, in some States, Medicaid is available to anybody who is disabled, regardless of income. If your income exceeds a specific amount in some states, you may not be eligible for Medicaid coverage if you have a disability.

  • Most states have a threshold based on your income. Depending on the state, certain application categories, such as the elderly, the disabled, and children in foster care, may additionally need to meet an asset threshold. 
  • If your medical expenses are considerable, Medicaid may still be available to you even if your income and assets are beyond the eligibility threshold. Your income will be reduced after deducting expenses like hospital stays and doctor visits. 
  • Each state has requirements for eligible immigrants. Immigrants who are lawfully present and meet the income requirements are typically eligible for Medicaid. Some states demand that immigrants live in the nation for five years before applying. Qualified refugees are exempt from the five-year waiting period.

How Is Medicaid Beneficial:

Medicaid can be used for a variety of medical treatments. X-rays are among the diagnostic and screening tests that Medicaid will pay for. It aids in financing medical care and hospital stays. Both prescription medications and family planning are included. For those with lesser earnings, it also covers nursing homes and long-term care services. You may also be eligible for financial assistance if your spouse requires nursing home care. 

Moreover, certain states may also provide additional benefits. For instance, in New York, Medicaid covered hearing aids. Other benefits may include prescription medication coverage, eyeglass coverage, optometrist services, medical transportation, physical therapy, prosthetic devices, dental services, and much more.

Final Thoughts:

Medicaid is frequently used to pay for long-term care, which is not covered by Medicare or most private health insurance plans. Nearly 60 million Americans leverage the benefits of Medicaid which is the main provider of long-term care across the country. It frequently pays for nursing homes for people who have run through their funds paying for medical expenses and have no other way to pay for nursing care.