Medicaid frequently asked questions (FAQs)
Get answers to your questions about Medicaid
Looking for information about Medicaid? We're here to help. Find answers to common questions about Medicaid — from who is eligible to how to apply.
What is Medicaid?
Medicaid is a federal and state program that provides health care coverage to people who qualify. Each state runs its own Medicaid program, but the federal government has rules that all states must follow. The federal government also provides at least half of the funding for their Medicaid requirements.
Medicaid eligibility and enrollment
In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states, Medicaid covers all low-income adults below a certain income level.
The exact requirements to qualify for Medicaid depend on where you live. To find out if you're eligible for Medicaid in your state, visit the website for Medicaid in your state. Then check the eligibility requirements.
You'll find a link to the website for your state Medicaid agency on the "Plan Details" page for each health plan UnitedHealthcare Community Plan offers. To see plans available in your area, visit UHCCommunityPlan.com.
When you apply for Medicaid, you'll need to fill out an application form. Different states have different requirements for Medicaid. You'll likely need to have various documents, such as:
- Information about household members (name, date of birth and Social Security number)
- Proof of citizenship
- Rent or mortgage information
- Expenses (utilities, daycare, etc.)
- Vehicle information
- Bank statements
- Income (pay stubs)
- Proof of disability or medical records showing a lasting medical condition
- Recent medical bills
You'll need to apply through the state agency that manages the Medicaid program in your state. For questions, or to see what health plans UnitedHealthcare Community Plan offers in your area, visit UHCCommunityPlan.com.
Medicaid coverage and benefits
Each state manages its own Medicaid program, so what’s covered by Medicaid can change from state to state. But there are some services that every state must cover in their Medicaid program by federal law. These are called mandatory benefits. States can also choose to offer other benefits under Medicaid. These are called optional benefits.
Mandatory Medicaid benefits include:
- Inpatient hospital care
- Inpatient short-term skilled nursing or rehabilitation facility care
- Doctor services
- Outpatient hospital or clinic care
- Laboratory and X-ray services
- Short-term home health care (provided by a home health care agency)
- Ambulance service
- Prescription drugs for people not covered by Medicare
Optional benefits offered by some states may include:
- Eye exams and glasses
- Hearing tests and hearing aids
- Dental care
- Preventive screenings
- Physical therapy (beyond what is offered under Medicare)
- Non-emergency transportation to and from medical treatment
- Some prescription drugs not covered by Medicare
- Some nonprescription drugs, including certain vitamins
- Chiropractic care
In most cases, Medicaid is the payer of last resort. That means that Medicaid will pay after any other payer has paid its share of the services provided. For example, if you have Medicare or any type of private health care coverage, Medicaid will always be the secondary payer. Health care providers will bill the primary payer first, and Medicaid will pay what’s left over. That’s why Medicaid enrollees must say if they have other sources of coverage.
Medicaid is a health care program that's managed at the state level by each state government. However, state governments do not actually provide health insurance. State governments contract with private insurance companies like UnitedHealthcare to provide health coverage for beneficiaries of Medicaid and other government health care programs. Our government-sponsored health plans operate under the name UnitedHealthcare Community Plan.
In most cases, Medicaid pays the full cost for covered services, so people with Medicaid do not have to pay a monthly premium or any deductibles. But there are some exceptions and rules vary by state. In certain cases, if someone has Social Security benefits, a small amount may be taken from those benefits to help cover the cost of Medicaid coverage.
Medicaid and Medicare coverage and benefits
Yes. Some people qualify for both Medicare and Medicaid. These people qualify for Medicare due to age (by being age 65 or older) or because they have a disability. They also qualify for Medicaid because they meet the Medicaid requirements in their state. People who are eligible for both Medicare and Medicaid are "dual eligible."
Medicare and Medicaid are two separate programs that have different eligibility requirements.
To qualify for Medicare, you need to be:
- At least 65 years old, or you’re under 65 and qualify on the basis of disability or other special situations
- A U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row
To qualify for state Medicaid benefits, you need to be:
- Under age 65 and meet the requirements for low-income families, pregnant women and children, individuals receiving Supplemental Security Income (SSI), disability or other special situation
- At least 65 years old and you also:
- Receive Extra Help or assistance from your state
- Are blind or have a disability, but do not need long-term care
As part of the Affordable Care Act (ACA), most states chose to expand Medicaid coverage to include all low-income adults under age 65. Other states may choose to do so at any time. Many people are surprised to find out they qualify. That's why it's always good to check.
To see if you're eligible for Medicaid in your state, visit the website for Medicaid in your state. Then check the eligibility requirements.
More about health insurance and common terms
The Affordable Care Act (ACA) expands access to quality and affordable health coverage for millions of Americans. Signed into federal law by President Barak Obama in 2010, the ACA guarantees health coverage regardless of income level, work situation, or previous health conditions.
DDD stands for Division of Developmental Disabilities – a division of the Department of Economic Security (DES). DES works with families, community organizations, advocates and state and federal partners to realize our collective vision that every child, adult, and family will be safe and economically secure.
State-specific health plan for certain Medicaid recipients. This is a long-term-care health plan for physically disabled adults and children.
Supplemental Security Income (SSI) is a monthly cash benefit paid by the federal Social Security Administration (SSA) and state Department of Health and Services (DHS) to low-income elderly, blind, and disabled residents. SSI benefits are not the same as Social Security benefits.
CHIP, which stands for Children’s Health Insurance Program, provides low-cost insurance for children whose families do not meet the income eligibility requirements for Medicaid. CHIP may also provide coverage for pregnant women in some states, but does not cover adults caring for children who qualify for CHIP.
What if I'm already a Medicaid member and I have a question?
If you have questions or problems, call Member Services at 1-800-493-4647, TTY 711. We can help with:
- Any concerns you may have about your health care benefits or services
- Answers to questions about how to get services
- Health education information
- Errors on the UnitedHealthcare ID card
Please have the UnitedHealthcare ID card available when you call so we can help you sooner.