What is Medicaid?

What Is Medicaid?

Simply put, Medicaid is healthcare coverage for people with low incomes. It’s a federal program administered by the states.

In North Carolina, Medicaid also encompasses Health Choice for Children, a program for families whose total household incomes are too high for them to qualify for Medicaid, but too low for them to afford health-insurance premiums. Health Choice offers qualifying families free or reduced-price comprehensive healthcare for their children.

Nearly 60 million people receive Medicaid benefits at some point during the year, with children equaling about half of those enrolled, while roughly a quarter of enrollees are elderly or disabled.

Maybe because many enrollees are elderly, Medicaid is sometimes confused with Medicare, the federal health-insurance program that pays for hospital and medical care for elderly patients, and for certain disabled Americans. To complicate this picture a little more, about 9 million people in the United States are actually covered by both Medicaid and Medicare. Typically low-income seniors and younger people with disabilities, these “dual-eligibles” generally have more complex, and costly, healthcare needs.

The federal government provides at least half the funding for state Medicaid programs, but does require that states provide a minimum set of services in order to receive that money.

What Services Does Medicaid Offer?

North Carolina Medicaid adds some services to those mandatory benefits required by the federal government of all states, though in general, Medicaid covers the following:

  • Doctors, OB/GYNs, health departments, and rural health clinics
  • Laboratory and radiology
  • Hospitals, anesthesia, and ambulatory surgical centers
  • Outpatient specialized therapy
  • Prescriptions (except prescriptions for Medicare beneficiaries)
  • Vision and hearing
  • Children’s dental and orthodontia
  • Podiatry
  • Nursing-home care
  • Personal care and other home-health services
  • Medical equipment, such as wheelchairs
  • Orthotics and prosthetics
  • Mental and behavioral healthcare
  • Transition from facilities to home-based and community care
  • Most medically necessary services for children under age 21
  • Medicare premiums, copayments, and deductibles

What Services Does Health Choice for Children Offer?

North Carolina Health Choice, a health-insurance program for children of families who make too much to qualify for Medicaid but too little to afford private insurance, covers:

  • Case-management and care-coordination services
  • Dental services
  • Durable medical equipment and disposable medical supplies
  • Emergency services
  • Family-planning services
  • Hospice care
  • Home-health care
  • Immunizations (shots)
  • Laboratory and radiology services
  • Mental health services, both inpatient and outpatient
  • Physician and clinic services, both well-child and sick visits
  • Physical therapy
  • Occupational therapy
  • Therapy for individuals with speech, hearing, and language disorders
  • Prescription drugs
  • Substance-abuse services, both inpatient and outpatient
  • Surgical services