Medicaid is a health care program funded jointly by the federal government and state governments. It provides free or low-cost health care coverage for low-income individuals and people meeting certain eligibility requirements, such as individuals with disabilities. For people with cystic fibrosis, Medicaid helps with the affordability of the treatments, medications, and inpatient and outpatient care needed to live a healthy life.
Medicaid is administered by states according to federal requirements and overseen by the Centers for Medicare & Medicaid Services (CMS). Each state sets its own eligibility requirements, so income and resource limits will vary by state.
What Services Does Medicaid Cover?
Federal law requires states to cover certain groups of people, called mandatory eligibility groups, based on their household size, age, disabilities, and income. States are required to cover the following services for mandatory eligibility groups:
- Limited inpatient and outpatient hospital services
- Physician, midwife, and nurse practitioner services
- Nursing home services for people age 21 years and older
- Home health services for people who qualify for nursing home care
- Pregnancy-related services
- Family planning services and supplies
- Laboratory and X-ray services
- Federally qualified health center and rural health clinic services
- Emergency services for non-U.S. citizens
- Screening, diagnosis, and treatment services for individuals aged younger than 21 years
States can also receive federal funding to cover optional services, such as:
- Prescription medications
- Eyeglasses and eye exams
- Hearing aids
- Durable medical equipment
- Clinic services
- Nursing home services for people aged younger than 21 years
- Home and community-based services
- Targeted case management
- Hospice or respite care
- Dental, optometry, prosthetic, and tuberculosis services
- Rehabilitative services provided by a home health aide
Medicaid and CF
In most cases, individuals with cystic fibrosis who are on Medicaid can get their covered medications and services at no cost. However, some states may impose limits on the number of medications or brand-name medications that they will cover. In addition, your service provider must be contracted with Medicaid. Some states may contract their Medicaid plans out to private insurance companies that must follow Medicaid’s coverage standards. These plans are called Medicaid managed care organizations (MCOs). It is also important to make sure your service provider accepts that MCO.