Medicaid

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What is Medicaid?

Medicaid is insurance coverage for people who are eligible due to income, age or disability. The federal government and states jointly fund Medicaid. States administer Medicaid within federal guidelines and set the rules that say who is eligible, what benefits are covered and how the provider is paid. States receive federal financial support, but also put up some state funds. South Carolina gets about $3 from Washington for every dollar we put up for Medicaid.

Medicaid in SC is called South Carolina Healthy Connections Medicaid. It provides health care coverage to low-income individuals, families and the disabled. Medicaid does this by paying health care providers for their services given to eligible people.

Who does Medicaid serve?

South Carolina’s Medicaid program covers more than 1 million South Carolinians each year. To qualify for Medicaid, a person must be either pregnant, totally and permanently disabled, under the age of 19, or a caretaker relative living with a child under age 18 and have a low income. Children and adults who are neither elderly or disabled make up more than 3/4 of people getting help from Medicaid.  More than 630,000 children receive Medicaid in our state.

Elderly and disabled individuals make up less than 1/4 of Medicaid enrollment. Services for the elderly and disabled mostly fill the gaps left by Medicare.

Who is eligible for Medicaid?

Eligibility is determined by family income. Children who live in a household under 208% of poverty ($42,473 for a family of three) can get Medicaid. The parents could also be eligible for Medicaid if their income is at 62% of poverty ($12,660 for a family of three).

Different types of Medicaid programs have different income limits for adults. For example, adults have different income limits that depend on the type of program. Those in need of long term care or nursing home services can get help if they are at or below 300% of poverty.

What services are covered?

There are certain services that Medicaid must cover. States can choose to cover more services. The federal law has not required states to provide these additional services under Medicaid, so they are technically optional.In South Carolina, some of the services covered by Medicaid are: inpatient and outpatient hospital services,12 doctor visits a year, periodic screenings, therapy, and ambulance transportation and prescription drugs (prescription drug benefits for adults are optional). Children get unlimited doctor visits and prescriptions. In addition, if a child is diagnosed with a medical condition, she has the right to treatment under the Medicaid EPSDT program.

What would happen if Medicaid funding were cut?

Medicaid is the foundation of our healthcare system.

Congress is looking at changing how Medicaid is funded, which would reduce what the federal government spends and cap the amount of money states would receive per person; it would no longer be based on a match. This will result in fewer services and/or people being served. It can also mean optional services like prescription drugs will be reduced or eliminated.

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