More than a million people were enrolled in Virginia’s Medicaid program last year, and more than half of those enrollees were children. That’s a lot of people getting Medicaid coverage. What is Medicaid, exactly? Who is covered by it? And why does any of that matter to people who have private health insurance? The “State of Health Care in the Rockbridge Area” team offers answers to those questions and more in this guide.
1. What is Medicaid?
Medicaid is a government-run program that offers free or low-cost health coverage to low-income individuals and families. Each state runs its own Medicaid program, but the programs are funded by both state and federal dollars. In exchange for funding, the federal government created minimum guidelines for Medicaid eligibility that the states must follow. States can offer coverage to people who make more money than the federal minimum income guidelines, and some, but not all, do. So Medicaid eligibility guidelines vary widely from state to state.
Medicaid is different from Medicare. Medicare is an insurance program that covers Americans 65 and older and that they pay into during their working lives in the form of payroll deductions. Medicare also covers some younger people with special conditions.
2. Who is eligible for Medicaid in Virginia?
Medicaid eligibility in Virginia is determined by several factors, including age, income and whether or not a person is disabled. But non-disabled adults who have no dependents and are younger than 64 generally don’t qualify at all.
The federal poverty guidelines are used to determine whether a person has a low enough income to qualify for Medicaid. Different peoples’ eligibilities are based on a percentage of this baseline poverty number. In 2012, the federal poverty guideline for an individual was $11,170 in annual income, according to the federal Department of Health and Human Services. For a family of four, the poverty guideline was $23,050.
According to a report from the Henry J. Kaiser Family Foundation, the eligibility income levels for Medicaid in Virginia in November 2012 (including a related public health coverage program for children) were:
- For children: Parental income of 200 percent of the federal poverty level.
- For working parents: 31 percent of the federal poverty level. Note: Only five states (Alabama, Arkansas, Indiana, Louisiana and Texas) have lower eligibility income levels than Virginia for working parents. The U.S. average is 63 percent of the federal poverty level for this eligibility group, according to the Kaiser Foundation data.
- For pregnant women: 133 percent of the federal poverty level.