Medicaid allows low-income families or those with disabilities to seek the proper medical care they need. It seeks to cover those who wouldn’t have access to adequate care due to financial and physical need. Having patients who don’t have access to a proper health insurance plan is risky business for a healthcare organization, which is why it’s important to know what options are available for coverage.
Medicaid and Eligibility
Medicaid is a government-regulated and -sponsored health insurance program balanced between the federal and individual state governments in both coverage requirements and funding. Standards and minimum regulations for the program are laid down by Congress. State legislatures then have the option of whether to implement it and how (the “how” often involves appeals to the federal government for waivers and adjustments).
Medicaid regulations also change frequently in the federal government, requiring state lawmakers and citizens alike to keep track of its evolution and determine best practices for implementation and eligibility. In most states in which Medicaid changes have been fully adopted, the current income standard for eligibility indicates that those who make less than 138 percent of the federal poverty line (FPL) may be able to receive Medicaid coverage.
However, this does give states the opportunity to customize coverage to their needs and include various requirements that citizens must meet and benefits they can receive upon meeting them. For instance, some states require those covered under Medicaid to clock a certain amount of community- or economically-beneficial work activity such as holding a job, volunteering or taking college classes. In terms of benefits, some states have back-pay policies in which Medicaid covers a patient’s medical bills from before they were insured, assuming they can successfully apply for and receive Medicaid coverage within a certain time frame post-treatment.
The process of becoming eligible for Medicaid is complicated, and requires time, paperwork and the collection of patient financial and medical information. However, if a patient without other options is eligible and can manage to be covered by Medicaid, it will prove beneficial to a healthcare organization’s revenue cycle and cuts down on uncompensated care costs.
Benefits of Being Qualified for Medicaid
Medicaid provides a safety net for a large portion of America’s citizens, those whose financial situation is extremely limited or who are medically disabled and unable to work. Because it serves a diverse population of people with many different reasons for not being covered by private or corporate insurance plans, it also offers a diverse set of benefits, in an effort to meet whatever needs are present.
Depending on which state the patient lives in, they may have coverage under Medicaid for prescription medication, physical therapy, dental care, eyeglasses, advanced hospital testing, outpatient procedures, surgeries, and more. Some of these coverage areas are required by the federal government, while others are optional additions chosen by the state. That’s why it’s important to stay up-to-date on what coverage options are available in your state.
How DECO Can Help
Medicaid eligibility and coverage are complex and time-intensive topics. But this is where we at DECO excel. Our primary goals are to determine insurance eligibility for patients and get hospitals and healthcare organizations compensated for the care they provide so that they can have an effective revenue cycle. Our team works on the front lines with hospital staff and obtains patient information before they leave the healthcare establishment so we know that every base is covered. Then we do the legwork for the patients so they can become eligible for the care they deserve.
Additionally, with Medicaid often proving to be a difficult system to work through, we offer a special resource: a state-by-state Medicaid regulations guide. This guide will show you where your state stands on Medicaid and its recent expansion so you can be informed.
If your healthcare organization is having uncompensated care or revenue cycle management issues, we’re here to help. Contact us today!
