MediCaid

 
Medicaid
 
The Medicaid Program was enacted into law in 1965 as part of the Social Security Act (Title XIX). The primary purpose of Medicaid is to provide medical coverage for the indigent, those with little or no money. The State Children's Health Insurance Program (SCHIP) has similar goals, though offering coverage to a broader range of incomes. Medicaid is administered by each individual state. States may choose whether or not to participate in the Medicaid Program.
 
The states administer their Medicaid programs within broad federal requirements and guidelines. This causes a great deal of variation from state to state. Each state is allowed to define eligibility, the structure of benefits, reimbursement and payment levels. The items covered by Medicaid also vary in different states. In order to qualify for federal funding, the state is mandated to provide specific basic services as listed below:
 

• Hospital inpatient care
• Hospital outpatient care
• Laboratory and x-ray services
• Skilled nursing facility services for those aged 21 and older
• Home health services
• Physician services
• Family planning
• Rural health clinic services
• Early and periodic screening, diagnosis and treatment for children under 21 years of age
• Nurse, midwife services
•  

It is important to note that specific provision to provide home medical equipment (HME) is not mandated by the program. However, in most states, HME providers are issued provider numbers and are an active part of the program.
 
 
Eligibility
 
The Medicaid program was designed to cover those people eligible to receive cash payments under the two existing welfare programs established under Social Security Aid to Families with Dependent Children (AFDC) or Supplemental Security Income (SSI). Each state determines income and asset level for cash assistance and medical eligibility. Medicaid recipients are issued a card identifying them as a recipient of the program.
 
 
Method Of Payment
 
The reimbursement levels and payments vary from state to state. Payment may be based on a predetermined fee schedule (much like Medicare), a negotiated rate between the supplier and the state, or a reimbursement on the cost of the item plus a percentage (cost plus percentage mark-up) depending on the state policy. Claims to the Medicaid carrier must be submitted by the provider and are submitted directly to the state. Payments are made directly to the provider. Medicaid programs will not make payment to the beneficiary. Providers must accept the Medicaid reimbursement level as payment in full.