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.

Currently, there are a number of specific requirements and income eligibility levels vary by state.  But, in general, Medicaid covers children, pregnant women, parents of eligible children, people with disabilities that preclude work, and some elderly people. Note: Some people who are elderly or who have a disability qualify for both Medicaid and Medicare. 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.

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. 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. The cost of health care for people in Medicaid varies by state but is extremely limited for most.

Under the health reform law passed in 2010, the Patient Protection and Affordable Care Act (ACA), beginning in 2014, adults and children in families with incomes up to 133 percent of the poverty level (about $15,000 for an individual and $31,000 for a family of four in 2012 in most states) will be eligible for health insurance through the Medicaid program. On June 28, 2012, the U.S. Supreme Court declared the ACA constitutional. As part of that decision, the Supreme Court upheld the Medicaid expansion, however it also ruled that this expansion is optional. This means it is up to each state whether it will expand their Medicaid program eligibility to include nearly all adults and children with incomes up to 133 percent of the poverty level. At this time, it is not clear if every state will expand their Medicaid eligibility as envisioned in the ACA.

How to learn more and apply: The eligibility rules and benefits for Medicaid are different in each state. As a result of the ACA, Medicaid eligibility for some people will be determined in a different way beginning in 2014. Thus, if a person was previously determined ineligible for Medicaid, he/she may want to consider reapplying. 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 over the Internet, by telephone, or at locations in the community, such as community health centers. A link to your state's Medicaid website can be found at www.medicaiddirectors.org.

More information about Medicaid can also be found on the federal health care website at: http://www.healthcare.gov/using-insurance/low-cost-care/medicaid/index.html

This website also has information about free or low cost care options:
http://www.healthcare.gov/using-insurance/low-cost-care/index.html