Living with Diabetes

Medicaid is a program providing medical care for certain individuals and families with low incomes and resources. This program became law in 1965 and is jointly funded by federal and state governments (including the District of Columbia and U.S. Territories). This funding allows states to provide medical care to people who meet certain eligibility criteria.

For additional information about Medicaid within health care reform, please visit http://www.healthcare.gov/foryou/generalinformation/medicaid or http://www.cuidadodesalud.gov/enes/foryou/generalinformation/medicaid for information in Spanish.

Who qualifies?

Medicaid covers many groups of people. Even within these groups, though, certain requirements must be met. Criteria for Medicaid eligibility may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources; and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary between states and groups. There are special rules for those who live in nursing homes and for disabled children living at home.

Generally, people with diabetes should apply for Medicaid if their income is low and they are one of the following:

• Pregnant
• 65 years old or older and eligible for Medicare, but have extremely low incomes and limited resources
• Blind
• Disabled
  

If a person with diabetes is not sure whether he/she qualifies for Medicaid, he/she should apply for Medicaid and have a qualified caseworker in his/her state evaluate the situation.

What does Medicaid cover?

Medicaid is a state-administered program. Each state sets its own guidelines subject to federal rules. Certain services must be covered by the states in order to receive federal funds, such as in- and outpatient hospital services, doctor visits, and long term care services such as nursing home care or community-based care, among others. Additional services are optional and are elected by states. For example, coverage of prescription drugs is an optional state benefit, however, every state and the District of Columbia provides prescription drug coverage to Medicaid enrollees.

How will my Medicaid coverage change in the future?

Some Medicaid recipients are also Medicare beneficiaries. These people are known as “dual eligibles” because they are eligible for both Medicare and Medicaid. If you are a dual eligible individual, your prescription drug coverage will change soon.

On January 1, 2006, the new Medicare Part D Prescription Drug Benefit will begin, and all dual eligibles will be required to switch to this program. This means that Medicaid will stop paying for prescription drugs for dual eligibles on January 1, 2006.  It is important that you be prepared for this upcoming change so that you do not have a gap in drug coverage.

Dual eligibles may enroll in the Medicare Part D Prescription Drug Benefit as early as November 15, 2005. Those who do not enroll in a program before May 15, 2006 will be automatically assigned to a Part D plan at random.

Prescription drug coverage will not change for people that only receive Medicaid benefits.

How do I apply for Medicaid?

To apply for Medicaid in your state, contact your local Medicaid office (look in the blue pages of your phone book for contact information, probably under "Medical Assistance"). Some states let you apply on the Internet, by telephone, or at locations in the community, such as community health centers. By contacting Medicaid directly, you can get state information.

Other Resources

The Centers for Medicare and Medicaid Services

The following Web sites provide screening tools to help you see if you may be eligible for a variety of governmental programs.

GovBenefits.gov

National Council of Aging's Benefits CheckUp