Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services. If you qualify for Medicaid in your state, you automatically qualify for Extra Help paying your Medicare prescription drug coverage (Part D).
How does it work?
Each state decides how to run its program, what counts as income and resources, who’s eligible, what services are covered, and the cost for services, within federal guidelines. Some states use different names for their Medicaid programs, in Colorado the program is referred to as Health First Colorado.
How can I get Medicaid?
If you can’t afford to pay for the medical care you need, you should apply for Medicaid in the state where you live. States determine your need based on your income and resources. The rules for counting your income and resources vary by state. Resources include money in a checking or savings account, stocks, and bonds. There are also special rules for people who live in nursing homes and for children with disabilities living at home. If you apply and are approved for Medicaid, you’ll get an approval letter, and you also may get a card to use when you get health care services.
How do I know if I qualify?
In addition to having limited income and resources, there are other requirements you’ll have to meet for your state. When you apply, you may be asked these questions to help determine your eligibility:
- How old are you?
- Are you pregnant?
- Are you or your child under 19?* Or, are you the caretaker of a child with Medicaid?
- Do you have a disability or blindness?
- Are you a U.S. citizen or an immigrant who meets certain requirements?
- Are you under 26 and were in foster care before your 18th birthday?
- In some states, the age to qualify as a child under Medicaid may be up to 26 for certain coverage groups, like foster care children.
Note: You may qualify under Medicaid “spend down” rules (described later in this brochure) even if your income is more than Medicaid income levels in your state.
What do I pay?
What you pay for coverage depends on your state’s rules. You may have to pay a small part of your health care costs (like a copayment). If you qualify for both Medicare and Medicaid, most of your health care costs will be covered, and you’ll get Extra Help paying for prescription drugs.
Medicaid generally covers:
- Inpatient hospital services
- Outpatient hospital services
- Pregnancy‑related services
- Vaccines for children
- Doctor services
- Prescription drugs
- Nursing facility services
- Family planning services and supplies
- Rural health clinic (RHC) services
- Home health services
- Laboratory and X‑ray services
- Pediatric and family nurse practitioner services
- Nurse‑midwife services
- Federally qualified health center (FQHC) services
- A broad range of services for children under 21
- Necessary transportation to and from medical providers
Note: States can choose to cover more services than those listed above. Check with your state Medical Assistance (Medicaid) office for a list of what your state covers. Visit Medicare.gov/contacts, or call 1‑800‑MEDICARE (1‑800‑633‑4227) to get your state Medicaid office phone number. TTY users can call 1‑877‑486‑2048. Visit Medicaid.gov or HealthCare.gov to learn about coverage options for you and your family
What’s “Medicaid spend down?”
Even if your income is higher than Medicaid income levels in your state, you may be eligible under Medicaid “spend down” rules. Under “spend down”, you can subtract your uncovered medical expenses from your income until you meet your state’s Medicaid income level. This is called “medically needy.” To be eligible as “medically needy,” your measurable resources (like savings accounts and certificates of deposit) have to be under the resource amount allowed in your state. Call your state Medicaid office to see if you qualify and learn how to apply. Know your rights
- If you’ve been denied Medicaid benefits and disagree with this decision, you can file an appeal.
- People with Medicaid have the right to have their health records kept private.
- The law requires Medicaid to cover and arrange for many medically necessary, Medicaid‑covered services to Medicaid‑eligible children, even if the state’s Medicaid program wouldn’t normally cover the services.
Where can I get more information?
To see if you or your family member qualifies for Medicaid, call your state Medicaid office. To find the phone number and website, visit Medicare.gov/contacts and select State Medical Assistance Office from the menu of options, or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
To learn more about Medicaid, visit this website:
Colorado’s Medicaid Program – Colorado Health First