Medicaid Health Insurance
What is Medicaid?
Medicaid is a joint federal and state program that provides health insurance for low-income families, pregnant women, some disabled people, individuals and children who qualify. Although the federal government sets certain standards for this program, each state administers its own version — in California, it’s known as Medi-Cal.
The federal government and the states pay for Medicaid jointly. Individuals and families must meet certain income or disability thresholds to be eligible. Children who meet eligibility guidelines receive care from the Children’s Health Insurance Program (CHIP), which in California operates under Medi-Cal. Also paid for by federal and state funds, CHIP is designed to provide health coverage for children of families whose income is too high to qualify for Medicaid, but who cannot afford private coverage.
At Freeway, we want to help you find the healthcare you and your family needs. Freeway’s licensed and bilingual agents can help you navigate through the Medi-Cal maze.
What Are the Benefits of Coverage?
Medical coverage includes the most common forms of healthcare, including at least the same healthcare services that Medicare does, as well as some services that Medicare doesn’t cover. It also pays Medicare premiums, deductibles, and co-payments for people who are enrolled in both programs.
It isn’t always a free plan—states have the option to charge small premiums or set out-of-pocket limits (cost-sharing) for certain groups of enrollees. Medi-Cal follows these same federal guidelines in California, though most members do not pay anything out of pocket.
What Do Medicaid Services Cover?
Although the coverage in individual states is different, there are some mandatory federal requirements that must be met in order to receive federal matching funds. Required services include:
- Inpatient hospital services
- Outpatient hospital services
- Prenatal care
- Vaccines for children
- Physician services
- Nursing facility services for persons aged 21 or older
- Family planning services and supplies
- Rural health clinic services
- Home health care for persons eligible for skilled-nursing services
- Laboratory and x-ray services
- Pediatric and family nurse practitioner services
- Nurse-midwife services
- Federally-qualified health-center (FQHC) services and ambulatory services
- Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21
In California, Medi-Cal covers all these benefits and includes additional programs such as dental, vision, and behavioral health care.
Who is Eligible for Medicaid?
Each state sets its own Medicaid eligibility guidelines. The program is geared towards people with low incomes, but eligibility also depends on meeting other requirements based on age, pregnancy status, disability status, other assets, and citizenship.
States must provide these services for individuals who fall under certain categories of need in order for the state to receive federal matching funds. For example, it is required to provide coverage to certain individuals who receive federally assisted income-maintenance payments and similar groups who do not receive cash payments. Other groups that the federal government considers “categorically needy” and who must be eligible include:
- Individuals who meet the requirements for the Aid to Families with Dependent Children (AFDC) program that were in effect in their state on July 16, 1996
- Children under age 6 whose family income is at or below 133% of the Federal poverty level (FPL)
- Pregnant women with family income below 133% of the FPL
- Supplemental Security Income (SSI) recipients
- Recipients of adoption or foster care assistance under Title IV of the Social Security Act
- Special protected groups, such as individuals who lose cash assistance due to earnings from work or from increased Social Security benefits
- Children born after September 30, 1983 who are under age 19 and in families with incomes at or below the FPL
- Certain Medicare beneficiaries
- People who lost their Medicaid coverage at the end of the COVID Public Health Emergency but still qualify under income guidelines
California follows these federal categories and has expanded eligibility to adults earning up to 138% of the FPL through Medi-Cal.
How to Find Out if You are Eligible for Coverage
Even if you were told you didn’t qualify in the past, you may qualify under new rules. You can see if you qualify in two ways:
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Visit your state’s Medicaid website and apply directly. If you qualify, coverage can begin immediately.
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If you live in California, start an application through Covered California. If you appear eligible, your information will automatically be sent to your county Medi-Cal office for enrollment.
At Freeway Insurance, we can help you determine which program fits your household —Medicaid, Medi-Cal, or CHIP— at no cost.
What is the Difference Between ACA, Medicare and Medicaid?
Medicare is federal health coverage for people 65 and older or with certain disabilities. The Affordable Care Act (ACA) is a law that allows people to buy private insurance — or get coverage through their employer — often with government subsidies.
Medicaid, on the other hand, is a partnership between the federal government and the states that provides free or low-cost healthcare to qualifying individuals and families. In California, this program is called Medi-Cal and is administered by the Department of Health Care Services (DHCS).
Who Pays for Health Services Provided by Medicaid?
The federal government and the states share the cost of Medicaid services. States pay providers directly and are then reimbursed by the federal government for a portion of the costs.
Each state may also require small copays or coinsurance from some beneficiaries. However, these groups are exempt from cost-sharing:
- Pregnant women
- Children under age 18
- Hospital or nursing home patients who are expected to contribute most of their income to institutional care
Medi-Cal follows the same cost-sharing protections and covers most services at no cost to eligible members.
Find Affordable Health Insurance Today
Freeway Insurance agents are bilingual and experienced in helping people find their way through the health coverage maze – even Medicaid. Freeway has partnered with many insurance carriers to help customers find affordable health plans at low or no cost. And, as always, Freeway’s services and your healthcare quotes are 100% free! Give us a call today at 800-777-5620 or visit us at one of our many convenient locations.