11 Facts to Know About Medicaid Health Insurance

Medicaid is a health insurance program the United States federal government outlines for low-income adults, children without other health insurance options, senior citizens, and the disabled. Medicaid is funded by both federal funds and state funds and is managed by each individual state.  There are federal requirements for Mandatory Benefits that all states must offer as well as a list of Optional Benefits that states can offer, and each state can include additional benefits.  

Medicaid eligibility requirements for income are 138% below the federal poverty level.  For real numbers instead of percentages, use the American Council on Aging calculations for different percentages of federal poverty level income levels. 

Medicaid can be a healthcare option that provides long-term services for those in need, such as pregnant women, senior citizens, and those with disabilities.  An individual under 19 years old would qualify for the Children's Health Insurance Program or CHIP.  Why 19 years old?  CHIP provides health coverage to children through the age of 18, meaning they don't need Medicaid until they turn 19.  

The Affordable Care Act was the catalyst for Medicaid expansion.  The Medicaid expansion allows adults with a household income of up to 133% of the federal poverty level to qualify for health insurance.   While this increased Medicaid spending across all states, it gave more adults access to affordable health care.  This change in regulations may be helpful for adults whose disabilities aren't considered 'qualifying' according to SSA, but that impacts their ability to work and receive employer-provided health insurance.  

Now that you know a little backstory about Medicaid, you probably have some questions (it's only natural)...

11 Common Questions about Medicaid:

1. Can I Keep Medicaid if I Get a Job?

YES, if you qualify for Medicaid because of a disability!  Starting a new job will not automatically disqualify you from Medicaid benefits.  Continuing to be covered by Medicaid is a work incentive for those who receive SSI payments.  Part of the law allows those who receive SSI cash payments because of a disability to continue to receive Medicaid health insurance.   According to the Social Security Administration, Continued Medicaid Eligibility or 1619(b) states that individuals can continue to receive Medicaid if they get a job if they:

• "Have been eligible for an SSI cash payment for at least 1 month;
• Still meet the disability requirement; and
• Still meet all other non-disability SSI requirements; and
• Need Medicaid benefits to continue to work; and
• Have gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services"

(Source, Social Security Administration Website, 2024)

For those worried about their earned income limit, the Social Security Administration provides additional insight about continuing Medicaid Eligibility.  For specifics about your state's threshold, contact your local Social Security office.  

2. Do I Need a Social Security Number to get Medicaid?

YES and NO!  Individuals who have a Social Security Number, ITIN number (for non-resident or resident alien), or are interested in applying for a SSN, can apply for Medicaid coverage.  The Medicaid application process will allow an application to be submitted without a SSN listed, but it will need to be provided later.  

While there is a 5-year wait from when an individual was given immigration status, some states have removed that wait for eligible pregnant women and children.  

3. Does Medicaid Pay for Adult Diapers?

YES!  Medicaid covers diapers for adults!  You can find a full list of digital proof from each state confirming Medicaid coverage for adult diapers if there is a medical need.  

4.  Is Medicaid the Same as Medicare?

NO!  Yes, both Medicaid and Medicare are health insurance programs.  Yes, both are federal government programs.  But they are different programs and have different eligibility criteria.  

Medicaid is a health insurance program for those with low income (based on an individual's or family income), qualified pregnant women and children, or those receiving SSI due to a disability.

Medicare is a health insurance program for individuals 65 years and older or for those who receive disability benefits, like SSDI. 

5.  Can I have Medicaid and Medicare?

YES!  An individual can be eligible for and receive both Medicare & Medicaid health insurance.  This might happen when an individual with disabilities meets the criteria for Medicaid eligibility due to their disability and receives DAC benefits from a retired and deceased parent or primary caregiver.  While Medicare tends to be viewed more favorably than Medicaid, it comes down to the individual's needs and how the two programs can work together to get the health coverage they need.  

6.  Can I Get Medicaid if I Receive SSI?

YES!  If you were approved by the Social Security Administration for Supplemental Security Income or SSI, then you are automatically qualified for Medicaid benefits.  Individuals approved for SSA disability benefits are part of an automatic eligibility group for Medicaid health insurance.   If you receive other Social Security benefits, like DAC, in addition to SSI payments, then you would become eligible for an additional health insurance program, Medicare (after a 2-year wait).  

7.  Who Pays First, Medicare or Medicaid?

Medicare!  For individuals who are covered by both their state Medicaid program and Medicare coverage or who are 'dually eligible,' Medicare is the primary payer and will pay for medical costs first.  This means that Medicaid will be the secondary payer.  

Medicare is also known for having different plans, including Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Drug Plan Part D (prescription drugs). If you have Original Medicare, this includes Part A and Part B.  

8.  Can I have Medicaid and Private Insurance?

YES!  Individuals with special needs can have private health insurance coverage from family members or as a benefit from their job AND have Medicaid health insurance.   While it may not seem necessary to enroll in Medicaid if current health care needs are covered by a family member's private insurance, Medicaid may pay for some costs that private insurance doesn't cover and other benefits not related to a medical need.  For example, the Home and Community-Based Services (HCBS) waiver requires applicants to apply to Medicaid programs because it is a Medicaid waiver program.  

If you are local to Illinois, the PUNS is the waiting list for the HCBS waiver.  

9. Does Medicaid Pay for Transportation?

YES!  One of the Medicaid-covered services Mandatory Benefits in the Medicaid federal law states must provide is transportation.  State Medicaid programs are to ensure that Medicaid members have necessary transportation to and from medical services and medical appointments, including non-emergency medical transportation.  This isn't a blanket 'free ride' benefit.   There are two criteria for covered transportation, including the Least Costly/Most Appropriate means of transportation and the Nearest Qualified Medical Provider.  Least Costly may be a local public transit option.

An individual can't choose just any transportation provider to get them to and from appointments for Medicaid services; drivers must meet minimum requirements.  

See page 16 of the transportation access requirements to learn more.  

10.  Does Medicaid Include Coverage for Dental?

MAYBE!  Dental Services is an Optional Medicaid Benefit that state Medicaid programs can choose to include in their coverage.  

According to the Social Security Act, "Dental services are comprised of diagnostic, preventive, or corrective procedures that treat: (1) the teeth and other structures of the oral cavity and (2) disease, injury, or impairment that may affect the oral or general health of the recipient [Social Security Act 1905(a)(10); 42 CPR 440.100]." (Source, Social Security Act, page 3)

The official website for Medicaid covers adult dental coverage in slightly more detail.  There is an initiative to increase access to dental health preventative care.  At the time of this blog post, 25 states have Oral Health Action Plans, 

Since dental coverage varies by state and I'm most familiar with Illinois (if you are new around here), I checked out my state's dental plan.  Illinois uses an online program, DentaQuest, to help adults find dental providers and I was able to locate the dental services covered for both children and adults.  If you live outside of Illinois, check out your state's public health department website and/or state Medicaid website for details on dental coverage.  

11. What is My Medicaid Identification Number?

Once approved for Medicaid, an ID card or letter with the Medicaid ID number and identifying information for household members who are also covered for Medicaid services.  If you receive a letter, it may just be a placeholder so you can begin to access health coverage while you wait for the ID card to arrive in the mail.  Read the letter fully to know what to expect in your state.  

Each state uses different terminology to identify Medicaid enrollees.  Your Medicaid ID number may be referred to as a:

• Recipient Identification Number (RIN)
• Member Identification Number
• Client Identification Number 
• Medicaid Enrollee
• Beneficiary Number

When using a Medicaid card to cover health expenses, be sure to have an ID to confirm personal information (name, birthday) on the Medicaid card.  

Can't find your Medicaid ID card or letter?  Contact your state's Medicaid office and request a new card (and if you live in Illinois, a replacement card is free!).  Many states also have a hotline if you are curious about whether you still have Medicaid coverage or if a medical need is covered.  

(il buy Medicaid graphic)  

Disclaimer:  The author is not a licensed attorney nor a government or Medicaid employee.  This blog post is not legal or medical advice and should not replace information given by federal or state Medicaid employees or a licensed attorney.