What Is Medicaid?

Medicaid is a state and federal partnership. 

      If a state chooses to participate in the Medicaid program it must provide a minimum level of coverage to certain mandatory populations.  In return, the federal government pays a percentage of the costs of the program.  In Nebraska, the federal government pays 60% of the costs of the program and the state pays the remaining 40%.

Medicaid is an entitlement program. 

      This means if you meet the eligibility requirements, you are entitled, under federal law, to receive the benefit.

Medicaid is a pay-as-you-go benefit. 

      This means payments are made directly to providers and are only made once the medical costs have been incurred.

Medicaid is only available to certain groups of low-income people. 

      In Nebraska, Medicaid is only available low-income children and their parents, pregnant women, the aged, and the disabled.  The income eligibility limit is different for each category.  Low-income parents are only eligible for Medicaid if their income is below 49% of the federal poverty level or $9482.00 annually for a household of four.  The aged and disabled are eligible up to 100% of the federal poverty level or $19,350 annually for a household of four.  Pregnant women and children are covered up to 185% of the federal poverty level or $35,798 annually for a household of four. 

Medicaid only covers services that are medically necessary. 

      Medically necessary services are those that are necessary to meet the basic health needs of the client and are rendered in the most cost efficient manner.

Medicaid provides free choice of providers. 

      Medicaid clients may receive services from any provider that has been approved to participate in the Medicaid program.

Medicaid helps rural families and communities.

      Medicaid plays a critical role in providing health care for people in Nebraska’s rural areas, filling in the gaps in the private insurance system.  Nearly 16% of people who live in rural areas have Medicaid coverage – compared with about 10% of people in urban areas.  Higher rates of Medicaid enrollment in rural areas help to offset lower rates of employer coverage, reducing the number of rural uninsured.[1]  One in four children in rural areas is covered by Medicaid.   

Link to the Nebraska Appleseed Center - www.NeAppleseed.org