Medicaid is a joint federal-state program that provides health coverage or nursing home coverage to certain low-income individuals. The program covers children, pregnant women, parents of eligible children, low-income adults, former foster care children, aged, blind and disabled individuals. There are many myths associated with Medicaid, including how to qualify for it, and what coverage it provides. In this post on Medicaid Facts and Myths, we will demystify Medicaid – separating facts from the most common myths associated with the program.
What is Medicaid?
Medicaid is a state-run health insurance program that pays for a broad range of medical services for people with low income and resources. Each state runs its own Medicaid program, so eligibility and additional program benefits may vary by state. Most people pay very little — and some pay nothing at all — for Medicaid.
What’s covered under Medicaid?
Basic services include:
- Doctor visits
- Inpatient and outpatient hospital services
- Checkups and immunizations for children
- Lab tests
- X-rays
- Medical transportation
- Family planning services
- Nursing facility services
- Home health
- Nurse practitioner services
Additionally, Medicaid also administers the federally funded Medicare Savings Programs.
Medicaid Facts and Myths
Here are the top Medicaid myths and associated facts to help you understand what you need to know.
MYTH #1: Medicaid does not provide quality health care. Medicaid expansion, therefore, leads to worse care.
There is a perception that Americans who have insurance through work or have private insurance, and even those without coverage, receive better care than Medicaid enrollees.
While this is a popular perception about Medicaid, the facts actually do not support this view:
In fact, 84 percent of Medicaid enrollees reported regular access to the care they need.
Also, a survey conducted in 10 states that expanded Medicaid found that appointment
availability actually increased by over 5 percent and wait times decreased by more than 6
percent after expansion.
MYTH #2: Medicaid coverage discourages people from working
Here again, the facts do not support this view:
Actually, approximately 62 percent of adult Medicaid enrollees are already working.
Most don’t have employer coverage or don’t make enough money to afford private insurance for themselves or their family.
Additionally, many of the few remaining adult Medicaid enrollees not working report they are currently looking for
work.
For example, in the state of Ohio, more than half of working enrollees said their Medicaid coverage helps them maintain
their employment.
Furthermore, recent data also show that adding new populations to Medicaid has not resulted in decreases
in employment rates or the number of hours worked.
In fact, one study showed an increase in employment for Americans with disabilities living in Medicaid expansion states.
MYTH #3: If you have Medicare, you cannot get Medicaid
Actually, this is not true.
People who have Medicare can also receive Medicaid if they meet their state’s Medicaid eligibility criteria.
For state by state Medicaid eligibility, click here.
People in this category are often called “dual eligibles” or “duals.”
In fact, 1 in 5 people with Medicare also depend on Medicaid for health care, especially the disabled and elderly.
Furthermore, Medicaid helps pay for Medicare out-of-pocket costs for seniors with low incomes.
Medicaid can cover Medicare co-payments and deductibles and services not covered by Medicare that may be available in your state’s Medicaid program, such as vision, hearing, and dental care.
However, Medicaid is no longer the primary payer of prescription drugs for people who are enrolled in Medicare.
People who have both Medicaid and Medicare will receive help paying for their prescriptions through Medicare Part D.
Additionally, in certain states, Medicaid may cover certain drugs that Medicare does not.
Furthermore, people who are enrolled in both Medicaid and Medicare will automatically qualify for the Medicare Part D Low Income Subsidy (LIS).
MYTH #4: If you have Medicare, you cannot get Medicaid
Again, the facts do not support this myth:
Actually, 39% of children in the U.S. depend on Medicaid for their health care.
Furthermore, millions of children get health care because of Medicaid, including babies, foster kids, children with special health needs, and kids whose parents don’t have health insurance.
MYTH #5: Medicaid is a welfare program for children and pregnant women
While the majority of people enrolled in Medicaid are children and families, here is one fact that most people don’t realize about Medicaid:
Most Medicaid spending goes for services provided to people aged 65 and over and people with disabilities.
According to the Congressional Budget Office, in the 2010 fiscal year, 77 percent of people enrolled in Medicaid were children and families, while 23 percent were elderly or disabled.
However, 64 percent of Medicaid spending was for older Americans and people with disabilities, while 36 percent went to children and families.
MYTH #6: Medicare, not Medicaid Pays for Long Term Care
This is perhaps one of the biggest misconceptions out there about Medicaid.
According to the Washington Post, half of the approximately 800 baby boomers who responded to a 2019 Insured Retirement Institute survey said they expected to rely on Medicare to pay for their long-term care needs.
Additionally, a 2016 AP-NORC poll found that, among respondents age 40 and older, the largest share, 38 percent, expected Medicare to foot the bill for long-term care.
This is a myth.
Traditional Medicare does not pay for long-term care.
While some Medicare managed-care plans are beginning to provide modest long-term support and services, these benefits are limited
By contrast, Medicaid pays for about half of all long-term care costs.
However, Medicaid long-term support and services are available only to those with relatively low incomes and modest financial assets.
As a result, families often pay these costs out of pocket or provide care on their own with no paid support.
MYTH #7: Cuts in Medicaid spending will help reduce the federal deficit
This is not supported by facts. Cuts in Medicaid spending will only shift costs elsewhere.
For example, the costs of essential care and services do not disappear; they merely are shifted to other
programs and other payers.
Additionally, a cut in Medicaid spending will likely lead to an increase in Medicare costs and an increase in the overall health care costs for the general
population.
For example, if seniors’ health and long-term services and support needs are not met, their condition ultimately can deteriorate.
Furthermore, this will cause some seniors to be in much worse shape they will need to be hospitalized or admitted to a skilled nursing facility.
MYTH #8: Most doctors do not accept Medicaid.
There are certain private doctors’ offices that do not accept Medicaid health insurance or only take a certain percentage of patients that have Medicaid.
However, most community health centers accept nearly all insurances and offer multiple services such as primary care, mental health, dentistry, pharmacy, and OB/GYN care.
In addition, hospitals also accept Medicaid.
MYTH #9: I need to be totally broke to qualify for Long Term Care Medicaid
To qualify for long-term care Medicaid, the individual receiving care must have less than $2,000 in assets.
However, that amount can be higher depending on the state.
Additionally, if you’re married, your spouse can retain up to $126,420 (2019) in joint assets, which also varies by state.
Furthermore, your primary residence is not a countable asset as long as your home equity is less than $585,000.
Also, the value of your home is excluded regardless of equity if your spouse or a dependent lives there.
MYTH #10: I can’t apply for Medicaid because I work
This is also a common myth that is simply not true.
Most adults who have Medicaid do work.
In fact, approximately 62 percent of adult Medicaid enrollees are already working.
Also, having access to health insurance, no matter whether it is through your job, the Affordable Care Act, the government or the state, is important for you and your family to remain healthy.
Medicaid Facts and Myths Summary
We hope this post on Medicaid Facts and Myths was helpful to you.
If you have any questions about Medicaid, you can ask us in the comments section below.
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Be sure to check out our other articles about Medicaid.
How to Apply for Coverage by State
Medicaid Income Limits by State
Medicaid Phone Number for Florida
Income limits for Florida Medicaid
Alabama Income Limits and How to Apply
Alaska Income Limits and Chart
