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  • Medicaid is health insurance for the disabled, children, and low-income residents
  • Medicaid participation depends on annual income
  • Those that cannot afford Marketplace policies may qualify for Medicaid
  • Medicaid coverage meets the requirements of the individual mandate


Medicaid health coverage is comprehensive health care. It includes hospitalization, medical insurance, and transportation. Medicaid provides medically necessary equipment , skilled services, and home care.

Medicaid operates through private insurance companies as well as a government-run open network of providers.

Medicaid includes the essential benefits of Marketplace coverage, and the prevention and wellness services that The Affordable Care Act has placed into every policy.

Search Medicaid private coverage options by entering your zip code above!

Medicaid Health Coverage


Today, Medicaid health coverage consists of managed care from private companies as well as fixed price coverage in which cardholders can select doctors and providers that work with Medicaid.

Managed care companies provide support and information such as the primary care physician in a Medicaid HMO. Without an HMO or PPO structure, consumers can select providers as they see fit without regard to networks or permissions or referrals.

Medicaid uses managed care providers such as the following:

  • HMO uses a primary care physician to provide care. The primary care physician makes referrals to network resources.
  • PPO uses a network but does not require referrals or permission. Outside resources may have a higher cost to the user such as a higher copay.

History of Medicaid


Medicaid was enacted in 1965 by President Johnson during the height of the Vietnam War and in the aftermath of the assassination of President John Kennedy. The President’s anti-poverty efforts were urban and social programs. They took shape in what was later called the Great Society.

Along with Medicare, Medicaid provided health care protection to a vulnerable part of the US population. Medicare protected older Americans and Medicaid protected those with low-incomes and insufficient resources to pay for quality medical care.

The Children’s Health Insurance Program came some decades later, but it completed the national healthcare picture by promoting medical, dental, and mental health access for children and teens.

The Social Safety Net


In providing national medical care for the young, old, and low-income groups, the United States made a commitment to healthcare. It was a commitment that served many purposes including reducing long-term medical and health costs by promoting prevention and wellness services.

The national medical care system consists of the following programs:

  • Medicare is the national health insurance program for elderly Americans. It covers hospital care, medical insurance, prescription drug benefits, and major medical combination plans.
  • Medicaid is the national health care program for low-income individuals and families. It provides comprehensive care at the recipient’s ability to pay.
  • CHIP is the Children’s Health Insurance Program. It provides health insurance and medical care to children in need.
  • The Affordable Care Act or Obamacare is the national health insurance law. It requires every eligible person to get and keep qualified health insurance or pay the penalty.

Affordable Care Act Requires Coverage

The individual mandate requires that every person have and keep qualified health insurance. Eligible residents can meet this requirement with qualified health insurance coverage. ”Qualified” means that it has minimum content minimum value, and that it contains the essential health benefits.

Qualified Health Insurance

Medicaid is qualified health insurance coverage; those covered by Medicaid will not face the tax penalty for no insurance. The Centers for Medicare and Medicaid administer the Medicaid program.

The CMS is part of the Federal Department of Health and Human Services. It works with the governments of the 50 states and the territories to provide health insurance for low-income residents.

Comparison shopping is the effective tool for reviewing health care plans and considering them along with Medicare and Medicaid for those eligible.

Medicaid Enrollment is Always Open


Medicaid is open 365 days per year for enrollment, and it has no closed enrollment season. Eligible participants can join at any time and start getting benefits. States usually control eligibility and intake, but applicants for Marketplace policies get the routine referral to Medicaid agencies.

The impact of state-federal partnership in Medicaid is visible everywhere. It protects local institutions against a greater weight of unpaid medical bills from uninsured patients. It protects a vulnerable population against the effects of poor or non-existent access to medical care.

The items below describe Medicaid impact:

  • Serves those with low incomes
  • Helps individuals, children and families.
  • Brings regular medical care to uninsured Americans

Medicaid Expansion Eligibility

In states that accepted Medicaid Expansion, applicants can join based solely on income in the range of 133–138 percent of the federal poverty guideline. This simple standard helps promote greater insurance coverage and reduces the burden on local medical services institutions

Affordable Care Act

The individual mandate requires that every person has and keeps qualified health insurance. The ACA also made state requirements more uniform and less likely to exclude persons in need of assistance. For example, many states excluded needy people that had no children.

The CHIP, Medicare, and Medicaid meet the requirements for insurance coverage in the Affordable Care Act. The ACA has made state eligibility and participation standards more uniform.

Medicaid is a State Run Program


The state governments operate Medicaid, there are in effect 50 Medicaid agencies. The federal government sets standards and provides degrees of funding. Each state sets rules for participation in its Medicaid program and benefits.

In some states, eligibility is lower than the federal poverty guideline; these states use the federal poverty guideline to limit the number of people who can get benefits.

Forms of Managed Care in Medicaid

States often administer Medicaid as a private fixed-fee-for-services system. This situation permits members to use any doctor or provider that accepts Medicaid. Those that prefer more structure might choose a PPO or HMO-style of managed care plan within Medicaid.

The choices of managed care within Medicaid can be confusing. They may not involve large differences in copays or coinsurance, but they can involve significant differences in freedom to choose health services and providers.

Comparison shopping is an excellent way to determine which form of managed care is best for the individual or family situation.

Medicaid Protects Community Hospitals and Medical Offices


In the decades before the enactment of the Affordable Care Act, the healthcare situation was remarkable for the heavy debt carried by local hospitals and medical care institutions. The high rates of unpaid expenses was due to services provided to patients without the means to pay medical bills.

Some uninsured patients were victims of violent crimes; others were simply unable to get regular medical care before their conditions deteriorated. The net result was an enormous burden of debt.

Medicaid as a source of health insurance and medical care played a critical role in managing this debt. While not nearly relieving it completely, Medicaid absorbed enough of the patient costs to help thousands of local institutions keep operating.

Crisis in Costs

In the years before the enactment of the Affordable Care Act, medical costs rose in astounding annual leaps. Part of which was due to the burdening of the local systems of doctors and hospitals with patients that could not afford the rising costs of medical care. Against this backdrop, Congress passed the Affordable Care Act and strengthened Medicare and Medicaid.

Medicaid Gap

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After the passage of the Affordable Care Act, it was apparent that a large number of families might remain uninsured. They lived in states with low limits on income for Medicaid. States have some leeway is setting the levels of income that qualify for Medicaid.

The lower limit for Obamacare policies was higher than the upper limits for Medicaid in many states. To erase the gap, Congress passed Medicaid Expansion

Medicaid Expansion

The Congress passed a Medicaid Expansion to help reduce the numbers of uninsured individuals and families.

Medicaid Expansion raised the income limit for Medicaid eligibility to 137 percent of the federal poverty guideline.

This expansion of Medicaid eligibility would leave no one outside the possibility of qualified health insurance coverage. Medicaid Expansion had a potential for removing millions of American families from the ranks of the uninsured.

Medicaid has an Important Role in Health Insurance


Medicaid plays a critical role in the nation’s healthcare system. Medicaid coverage avoids the tax and penalty of the individual mandate, and it is qualified health insurance. It provides the services and access to facilities needed to diagnose and treat a large, diverse population.

Comparison shopping is an excellent way to rate health plans. Health insurance has many costs, and affordable health care means keeping costs low. Medicaid to cover costs and expenses related to health care.

Find out of you qualify for Medicaid coverage and compare policies by entering your zip code below!

[su_spoiler title=”References:” icon=”caret-square” style=”fancy” open=”yes”]

  1. https://www.medicaid.gov/
  2. https://www.medicaid.gov/medicaid/managed-care/index.html
  3. http://obamacarefacts.com/federal-poverty-level/
  4. http://obamacarefacts.com/2016/04/12/the-difference-between-medicare-and-medicaid/
  5. http://obamacarefacts.com/obamacare-individual-mandate/
  6. http://obamacarefacts.com/obamacare-open-enrollment/
  7. https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/
  8. https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
  9. https://www.healthcare.gov/medicaid-chip/cancelling-marketplace-plan/
  10. https://www.healthcare.gov/choose-a-plan/plan-types/
  11. http://obamacarefacts.com/healthcare-facts/
  12. http://obamacarefacts.com/obamacare-deficit-debt/
  13. http://obamacarefacts.com/obamacares-medicaid-expansion/
  14. http://obamacarefacts.com/insurance-exchange/qualified-health-plan/