How to change Medicaid health plan

Created in 1965, Medicaid is a public program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, the elderly, and people with disabilities; it is jointly funded by the federal government and the states. If you’re thinking about changing your Medicaid health plan, keep reading.

In this regard, each state operates its own Medicaid program within federal guidelines. Because the federal guidelines are broad, states have great flexibility in designing and managing their programs. As a result, Medicaid eligibility and benefits can and often do vary widely from state to state. There is a different plan for each type of beneficiary, continue reading if you want to change your Medicaid plan.

Why is Medicaid important?

In 2015, Medicaid provided health coverage to 97 million low-income Americans. In one month, Medicaid served 33 million children, 27 million adults (mostly in low-income working families), 6 million seniors, and 10 million people with disabilities, according to estimates from the Office Congressional Budget.

Children account for more than two-fifths of those enrolled in Medicaid, but less than one-fifth of program spending. And just over a fifth of enrollees are elderly or disabled, but because they need more (and more expensive) health care services, they account for nearly half of spending.

Medicaid is sometimes confused with Medicare, the federally administered and funded health insurance program for people age 65 and older and some people with disabilities. Unlike Medicaid, Medicare is not limited to people with low income and resources. In fact, nearly 10 million low-income seniors and people with disabilities (so-called “dual eligibles”) are enrolled in both Medicare and Medicaid.

Who is eligible to enroll in Medicaid?

Medicaid is an “entitlement” program, which means that anyone who meets the eligibility requirements has the right to enroll. It also means that states must guarantee financial support for part of the cost of the programs. Therefore, to receive federal funding, states must cover certain “mandatory” populations:

  • Minors up to 18 years old of age in families with incomes below 138% of the federal poverty line ($25,975 for a family of three in 2013).
  • Pregnant women with income below 138% of the poverty line.
  • Parents whose income is within the state eligibility limit for cash assistance that was in place before the welfare reform.
  • Most elderly and people with disabilities who receive cash assistance through the Supplemental Security Income program.

States may also receive federal Medicaid funds to cover “optional” populations, including: Pregnant women, minors, and parents with incomes above the “mandatory” coverage income limits; the elderly and people with disabilities with incomes below the poverty line; “medically needy” individuals (those whose income is above the state’s normal Medicaid eligibility limit but who have high medical expenses, such as nursing home care, that reduce their disposable income below the eligibility limit); and, recently, in the framework of the health reform, almost poor non-disabled adults without children.

Keep reading: How to apply for Medicaid for children

Each state has its eligibility criteria

Since states have wide flexibility in determining which of these groups should be covered and at what income levels, Medicaid eligibility varies significantly from state to state.. While 31 states and the District of Columbia have expanded Medicaid coverage under health reform to parents and childless adults up to 138% of the poverty line, eligibility levels remain low in the rest. of the states. Generally, in a state that has not expanded coverage, Medicaid is limited to working parents with incomes up to 44% of the poverty line.

However, Not all low-income Americans are eligible for Medicaid.. Childless adults over the age of 21 who are not disabled, pregnant or elderly are generally not eligible for the program in the 19 states that have not expanded coverage, no matter how poor they are. Also, except for legal immigrant children and pregnant women in states that have chosen to cover them, legal immigrants cannot access Medicaid during their first five years in the country, even if they meet all of the program’s eligibility requirements.

What services does Medicaid cover?

Medicaid does not provide medical care directly. Instead, it pays hospitals, doctors, nursing homes, health care plans, and other health care providers for the services they provide to eligible patients. In fact, health care providers are not required to participate in Medicaid, and not all do..

About three-quarters of all Medicaid spending goes to pay for acute care services, hospital care, physician services, and prescription drugs; the rest is used to pay for nursing home services and other long-term care services and supports. In this regard, Medicaid covers more than 60% of all nursing home residents and 40% of the costs of long-term care services and supports.

Medicaid also reimburses certain hospitals for the uncompensated costs they incur when treating low-income, uninsured patients.. These payments, known as hospital disproportionate share payments, represent about 3% of spending on Medicaid services. (These figures are separate from administrative costs, which are roughly 5% of total Medicaid spending.)

Keep reading: What does Medicaid cover?

How is Medicaid evolving?

Medicaid is a countercyclical program, meaning its enrollment expands to meet increased needs during an economic downturn, when people lose their jobs and thus the health coverage they provide. Along these lines, during the last recession more than 10 million additional people signed up for Medicaid; more than half were children.

Federal rules require state Medicaid programs to cover certain “mandatory” services:

  • Basic medical services
  • Hospital inpatient and outpatient services;
  • Certified Professional Nurse Midwives
  • Laboratory and x-ray services;
  • Rural Health Clinic/Federally Qualified Health Center services;
  • family planning supplies;
  • Nursing services and home health care for adults age 21 and older;
  • Early and periodic screening, diagnosis, and treatment for children under 21 years of age.

States can (and all do) cover certain additional services as well. Some common examples include prescription drugs, dental care, personal care services for the elderly and people with disabilities. Although considered “optional” because states are not required to provide them, these services are essential to meeting the health needs of Medicaid recipients.

On the other hand, states have flexibility in determining the amount, duration, and scope of services they provide under Medicaid (although the services must be sufficient to meet program goals). For example, states must cover hospital and physician services, but may limit the number of hospital days or doctor visits they pay for. As a result of this flexibility, Medicaid benefit packages vary substantially from state to state.

I have signed up for Medicaid but I want to change my plan, how do I do it?

Basically, there are two ways to change your Medicaid health plan: online and by phone. Next, we will explain how to do it both ways.


  • Sign in to your account.
  • Choose your active program under “Existing Applications”.
  • Select “Report a Life Change” from the menu on the left.
  • Read the list of changes and click on “Report a life change”.
  • Select the type of change you want to report.
  • Browse the app to report your change. If your new eligibility results show that you qualify for a Special Enrollment Period, then you can search for plans and enroll in a different one.
  • Now, complete all the required steps in the online task list. Depending on your eligibility, you may have options to enter your tax credit amount or answer questions about enrollment preferences. Finish the “Final Review” task to complete your upgrade or new enrollment.

By phone

contact him sales call center and a representative will help you change your Medicaid plan. The contact number is 1-800-318-2596 (TTY: 1-855-889-4325) and they are available 24 hours a day, 7 days a week (except holidays).

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