October 6, 2023

Who Qualifies for Medicaid and What Does it Cover?

In 1965, President Johnson signed a bill creating Medicaid and since then, there have been questions about what Medicaid covers, who qualifies for Medicaid and Medicaid income limits.

Expansion of Medicaid under the Affordable Care Act created higher income limits to include more participants. Exactly who qualifies depends on several factors, including disability status and the number of people in a family; additionally, income limits are raised significantly for those who are pregnant. “It’s called presumptive eligibility,” says Jen Groves, vice president of community health services with EveryStep. “There is an eligibility income threshold, but it's almost triple what it would be if you weren't pregnant, meaning you could make almost up to 3 or 4 times what you typically could make if you were a non-pregnant person.

Many Iowans are missing Medicaid benefits
Groves says too many Iowans are missing out on Medicaid benefits. “I think people view Medicaid as being for folks who are unemployed or don't have access to health insurance. They think of folks that are down on their luck or low-income. And that is a piece of Medicaid, but it covers so many other populations.”

Those covered populations include:

• Children.
• Adults with disabilities.
• Pregnant women.
• The elderly.
• Individuals receiving breast cancer or cervical cancer treatment, with regimens that aren't covered under their commercial insurance — Medicaid can cover parts of their care.
• Adults who are 19 to 64, single and have low income or whose employer doesn’t offer health insurance.

“They are all sorts of reasons why someone may be eligible, qualify and receive Medicaid services,” says Groves. As of June 2023, more than 849,000 Iowans were receiving Medicaid, whether full coverage or partial coverage. An example of partial coverage is someone with a disability who has commercial insurance and Medicaid is their secondary insurance covering copays for occupational or physical therapy.

Medicaid stigma is unfounded
In addition to questions and misunderstandings about who qualifies for Medicaid, there is stigma attached to the program. Health and science writer Christine Fallabel concluded, “In our ruggedly individualistic society that celebrates self-reliance, where social safety net programs are viewed harshly and health insurance is typically seen as a benefit given to those who are gainfully employed, enrolling in Medicaid may seem like a cop out.”

Groves agrees there is some stigma attached to the program, but says the statistics dispel the belief only unemployed people benefit from Medicaid. “In Iowa, 75% of the adults aged 19 to 64 who receive Medicaid are working.” Groves says 3 in 8 Iowa children receive Medicaid services. “In Iowa, Medicaid really is a children's health insurance program, which means immunizations, well child exams, vision screens and developmental screenings.” But that’s just the beginning. There are also “value added benefits”.

“That means things like free glasses, and free Boys and Girls Club membership,” says Groves. “So, if you've got a school-aged kiddo who is on Medicaid, they could attend and participate in Boys and Girls Club and Medicaid pays for that.” In addition, there are free car seats and monetary incentives for things like cervical cancer screenings, children’s immunizations, breast pumps and doula services.

Determining eligibility
Groves says the first step to determining Medicaid eligibility is visiting the EveryStep website to see if any of the services listed meet your needs, and then filling out the confidential, no-commitment Find Care form. EveryStep experts will contact you to answer your questions and help.

“I think many of us, probably most of us, either ourselves or our family members, our parents have all been in situations where we know there’s going to be mounting medical debt – that’s absolutely what Medicaid is meant for. Folks shouldn't have to choose between paying their rent and paying for a medical appointment. They shouldn't have to choose between buying formula and making sure a kiddo gets to a physical therapy appointment.”

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We all face hard times in life, but some people in our community are coping with more difficult circumstances and are struggling to meet their needs as the cost-of-living rises. Many families are piecing together services for their kids.

EveryStep pulls the threads between health and social service systems tight, so no one falls through the gaps, and no one is left to struggle on their own. You have the power to help those who are struggling in your community. Please consider making a gift to strengthen Iowa’s care and support network.