Medicaid policies for eligibility are complex and vary considerably, even among states of similar size and geographic proximity. Thus, a person who is eligible for Medicaid in one state may not be eligible in another state, and the services provided by one state may differ considerably in amount, duration, or scope as compared with services provided in a similar or neighboring state. In addition, state legislatures may change Medicaid eligibility requirements during the year.
Unlike Medicare, which is a nationwide entitlement program, the federal government man- dated national requirements for Medicaid and gave states the flexibility to develop eligibility rules and additional benefits if they assumed responsibility for the program's support.
Medicaid provides medical and health-related services to certain individuals and families with low incomes and limited resources (the "medically indigent"). It is jointly funded by the federal and state governments to assist states in providing adequate medical care to qualified individuals. Within broad federal guidelines, each state:
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establishes its own eligibility standards. determines the type, amount, duration, and scope of services. sets rates of payment for services. administers its own program.
Thus, Medicaid varies considerably from state to state, and each state has modified its pro- gram over time.
Medicaid does not provide medical assistance for all poor persons, and it is important to realize that low income is only one test for Medicaid eligibility; an individual's resources are also compared to limits established by each state in accordance with federal guidelines. To be eligible for federal funds, states are required to provide Medicaid coverage for certain individuals who receive federally assisted income-maintenance payments and for related groups that do not receive cash payments. In addition to their Medicaid programs, most states implement "state-only" programs to provide medical assistance for specified poor persons who do not qualify for Medicaid. (Federal funds are not provided for state-only programs.) The federal government provides matching funds to state Medicaid programs when certain healthcare services are provided to eligible individuals (e.g., children, disabled, seniors). Each state administers its own Medicaid program, and CMS monitors the programs and establishes requirements for the delivery, funding, and quality of services as well as eligibil- ity criteria.
Medicaid eligibility is limited to individuals who can be classified into three eligibility groups:
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Categorically needy Medically needy Special groups