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Medicaid Updates and Cancer

Medicaid is a federal and state-run program that assists its patients with healthcare costs. Read how updates to the program in many states might make it easier to receive Medicaid coverage for your cancer.

Medicaid Updates: Could They Make Coverage More Accessible?

Medicaid is a federal and state-run program that assists its beneficiaries with healthcare costs. Currently, there are more than 65 million people covered by Medicaid. This group includes children, pregnant women, low-income adults, and disabled people.

The federal and state government manage the Medicaid program. Although there are a few requirements each state must abide by, states are allowed to customize parts of their Medicaid program. Eligibility requirements, costs, services, and other features can be adjusted as the state government sees fit.

Many people confuse Medicaid with Medicare. These two programs operate in entirely different ways. Medicare is for people 65 and older, and people under 65 with certain disabilities, while Medicaid can be for anyone of any age.


Eligibility requirements for Medicaid

As mentioned before, eligibility requirements can vary by state. Eligibility requirements can include income level, age, disability, and other factors. However, if your state has expanded its Medicaid program, there is only one eligibility requirement – income. States that have expanded their Medicaid program or plan on expanding as of 2019:

  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Dakota
  • Ohio
  • Oregon
  • Pennsylvania
  • Rhode Island
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Washington D.C.

If you live in one of these states, are under 65, and have income that is equal to or below 133% of the federal poverty level (FPL), you can qualify for Medicaid. However, if you don’t live in one of the states, you may have to meet additional requirements to qualify for Medicaid. The only accurate way to see if you qualify is to apply.

Benefits Covered By Medicaid

The federal government requires Medicaid programs in each state to cover certain medical services. There are several additional services each state can choose to include in their Medicaid programs. Services that are required to be covered by each Medicaid program are:

  • Certified Pediatric and Family Nurse Practitioner services
  • Early and Periodic Screening, Diagnostic, and Treatment Services
  • Family planning services
  • Federally qualified health center services
  • Freestanding Birth Center services
  • Home health services
  • In-patient hospital services
  • Laboratory and X-ray services
  • Nursing Facility Services
  • Nurse Midwife services
  • Out-patient hospital services
  • Physician services
  • Rural health clinic services
  • Tobacco cessation counseling for pregnant women
  • Transportation to medical care

Other services that aren’t required but may be covered include prescription drugs, therapy, hospice, dental, vision, and more.


How Medicaid Covers Cancer

Based on the list above, you can see that Medicaid covers many services needed to treat cancer, such as in-patient and out-patient hospital services, lab work, and more. Just like eligibility requirements and benefits, costs for services vary from state to state.

However, there are a few services that are federally exempt from out of pocket costs. Some examples of these are family planning services, pregnancy-related services, and emergency services.

Expenses some Medicaid beneficiaries may be responsible for are premiums, deductibles, co-pays, and co-insurance. These expenses are usually small. For example, according to the Kaiser Family Foundation, an out-patient hospital visit can cost as little as $1.

Another service covered by Medicaid in every state is breast cancer screenings. The Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program covers breast cancer screenings for female Medicaid beneficiaries who have been diagnosed with breast cancer. Some states may have additional requirements to join this program.

How Medicaid works with Medicare

Dual eligible people are people who qualify for both Medicaid and Medicare. If you are dual eligible, you have substantial coverage for cancer treatment. Medicare will pay first for Medicare-covered services, and Medicaid will pick up most or all of the remainder of the bill.

The downfall of this is you will have to see doctors who accept Medicare and Medicaid. Most dual eligibles are auto-enrolled in a Medicare Savings Program. Depending on the program you qualify for, your Medicare Part A and Part B premiums may be covered for you. You may also qualify for Extra Help with your Medicare Part D plan.

Medicaid programs vary by state and person

Remember, your Medicaid coverage may not be the same as your neighbor’s. Eligibility requirements, benefits, costs, and other features depend on your income, state, and more. If you have Medicaid and a disability, check into applying for Social Security Disability income. This extra income can also help cover medical costs.


Danielle is a Medicare insurance expert, TCU journalism graduate, and former magazine editor who writes regularly for many online publications, including Forbes, where she is a member of the Finance Council.


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