Medicaid

Medicaid is publicly funded medical assistance. It can be understood as a form of health insurance for special groups and low-income individuals. Medicaid is not a single, national program. Each state, territory, and the District of Columbia has its own, individual Medicaid program.

Medicaid is a federal-state partnership with the states and the federal government each paying to support the program. Medicaid is received through and administered by an individual’s state of residence. The Centers for Medicare and Medicaid Services (CMS) oversee this administration and establishes general program guidelines. Federal law and regulations provide a framework for Medicaid and stipulate the basic requirements that all state programs must have. States must include certain categories of individuals and specific services in their Medicaid coverage and can choose whether to include other groups and services at their discretion.

Medicaid can be seen in two parts – the recipient and the services provided.

Recipients are divided into groups known as eligibility groups. There are three broad Medicaid eligibility groups: categorically needy (mandatory or optional), medically needy, and special groups. Title IV-E adoption assistance is a mandatory group and state-funded is an optional group. States must provide Medicaid to mandatory groups and can choose which, if any, optional groups to cover.

Services are divided into two groups- mandatory and optional. All states, territories, and the District of Columbia must provide mandatory services. These services will be identical across jurisdictions. Optional services are not required and will vary widely across jurisdictions.

Note: All mandatory and elected optional services must be provided to all eligible individuals so that they are sufficient in amount, duration, and scope to reasonably achieve (their) purpose and must be provided throughout the state.

This section provides information on:

Title IV-E adoption assistance

Title IV-E adoption assistance eligibility carries with it an automatic eligibility for Medicaid (Title XIX).

 

This section provides:

State-Funded (Non-Title IV-E) Adoption Assistance and Medicaid

Children eligible for State-Funded Adoption Assistance are not guaranteed Medicaid eligibility if they are placed outside or move from the state that has signed their Adoption Assistance Agreement.

This section includes information on:

 

Medicaid Interstate

Medicaid is received from the state in which you live, and Medicaid services vary by state. Moving from one state to another means exchanging one Medicaid Plan for another. This section provides links to Medicaid and information on receiving Medicaid interstate.

  • What is Medicaid and where can I find information on state, Medicaid programs and Medicaid resources? Note: Medicaid is overseen by the federal government through the agency known as the Centers for Medicare and Medicaid Services (CMS) and operated independently by each state.
                    Medicaid: https://www.medicaid.gov/medicaid/index.html
                    Medicaid Benefits: https://www.medicaid.gov/medicaid/benefits/index.html
                    Medicaid State Overviews: https://www.medicaid.gov/state-overviews/index.html
                    (National map of each state with state’s Medicaid and CHIP profiles.)

 

  • How is Medicaid received interstate? How can families and state, ICAMA staff work together to ensure that Medicaid is received interstate when a child is placed or moves to a new state?
                       Receiving Medicaid: Process and Interstate Implications (Word)
                       Receiving Medicaid: Process and Interstate Implications (PDF)

 

EPSDT

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is one of the mandatory services of the Medicaid program in all states.

EPSDT was developed to provide preventive services and treatment to children under the age of 21 enrolled in Medicaid. The components of EPSDT are:

  • Early: Assessing a child’s health early in life so that potential diseases and disabilities can be prevented or detected in the early stages, when they can be most effectively treated
  • Periodic: Assessing a child’s health at key points in her/his life to assure continued healthy development
  • Screening:Using tests and procedures to determine if children being examined have conditions requiring closer medical (including mental health) or dental attention
  • Diagnostic: Determining the nature and cause of conditions identified by screenings and those that require further attention
  • Treatment: Providing services needed to control, correct, or reduce physical and mental health problems