The following information is taken from USA.gov/medicaid and MEDICAID.gov. Our team at Twentyeight is here to help you navigate the insurance process! Please reach out to contact@twentyeighthealth.com if we can answer any questions for you.
What is Medicaid?
Medicaid provides free or low-cost health coverage to millions of Americans, including low-income people, families and children, pregnant individuals, the elderly, and people with disabilities.
Medicaid is a different program than Medicare. Medicare provides health coverage if you are over the age of 65, or under the age of 65 with a disability, regardless of your income.
What is typically covered under Medicaid?
Each state is required to cover certain benefits, and can choose to cover other optional benefits. For example, hospital services, physician services, laboratory and x-ray services, and home health services are required to be covered. Physical therapy, occupational therapy, and certain prescription drugs (like birth control) may not always be covered by Medicaid.
Here at Twentyeight, we do accept Medicaid for birth control and it’s often fully covered. We provide more than 100+ different brands, so coverage can differ depending on the brand. You can read more here about preventative services that are offered without a copay under the Affordable Care Act (ACA). Please note that Medicaid coverage can change if you become pregnant.
How do I sign up for Medicaid?
There are two ways to sign up for Medicaid:
You can sign up for Medicaid anytime during the year.
What is a managed care plan?
States can reduce Medicaid program costs by creating contracts with managed care organizations, which can also improve the quality of care. If you have Medicaid coverage, many states will require you to switch to a managed care plan after 30 days.
Who is eligible for Medicaid?
Eligibility depends on age, income level, the number of people in your family, and if you are pregnant or have a disability. Some states cover everyone below a certain income level, but even if you are not eligible based on income, you may qualify for one of the other reasons listed above. In many states, if your income is higher than the eligibility level, you can still receive subsidized care if you have regular medical expenses that aren’t paid for by insurance.
You can see a helpful state-by-state eligibility guide by Policy Genius here. Please see below for details on each of the states that Twentyeight is active in!
Eligibility overview: Florida has Medicaid programs for needy parents/caretakers, children, aged or disabled residents, former foster care recipients and non-citizens with medical emergencies. It didn’t expand Medicaid to cover adults without kids or dependents.
Income requirements: Families making up to 100% of the Federal Povery Level (FPL) are eligible as are pregnant individuals making up to 135% of the FPL. There are programs available for elderly, disabled or blind residents making between 88% and 150% FPL.
How to apply for Florida Medicaid: You can apply online at Access Florida or by mailing or dropping off a paper application to your local resource center.
Other notable programs: Medically Needy, assistance for residents who can’t qualify for Medicaid, but have high medical bills; Working disabled program; Florida Discount Drug Card program (for residents who can’t qualify for Medicaid)
Eligibility overview: The baseline FPL limit for adults is 138%, thanks to Medicaid expansion; children and pregnant individuals are eligible at higher limits.
Income requirements: Adults age 19 to 64 have income limits of $16,643 to $57,022; coverage for children ranges from $25,447 to $87,185; pregnant individuals have no maximum income limits if single but have a cap of up to $109,085 for a family of 8.
How to apply for Maryland Medicaid: Residents of Maryland can apply online using Maryland Health Connection or the Enroll MHC app, or by calling 1-855-642-8572.
Other notable programs: MCHP Premium provides low-cost health insurance coverage for higher-income children up to age 19 between 200% FPL and 300% FPL; the Maryland Women's Infant and Children (WIC) Program provides food and health services to women and children.
Eligibility overview: New Jersey provides CHIP and Medicaid through its NJ FamilyCare program. The state expanded Medicaid to cover anyone earning up to 138% of the FPL.
Income requirements: Children 18 and under can qualify with household incomes up to 355% of the FPL ($7,278 a month for a family of four). Adults can qualify with incomes up to 138% of the FPL ($2,829 for a family of four or $1,387 a month for an individual.) Pregnant individuals qualify with incomes up to 205% of the FPL ($4,203 a month for a family of four). Elderly, blind or disabled people can qualify for Medicaid with income less than the FPL ($1,005 for an individual or $1,354 for a couple) and assets worth less than $4,000 for an individual and $6,000 for a couple.
How to apply for New Jersey Medicaid: You can apply for NJ FamilyCare online.
Eligibility overview: New York expanded Medicaid to cover all needy adults, as well as pregnant individuals, infants, parents and caretaker relatives.
Income requirements: New York offers coverage to anyone earning an income within 138% of the FPL. That amounts to an annual income of $16,643 for a household of one, $33,948 for a household of four, and $68,559 for a family of 10. For each person after the 10th, New York allows an additional $5,769 to be eligible for Medicaid coverage.
How to apply for New York Medicaid: You can call the official health plan marketplace, New York State of Health, at 1-855-355-5777, or the Medicaid Helpline at 1-800-541-2831. You can also apply online at the NY State of Health website, or with a Managed Care Organization, a licensed broker, or at a local social services department.
For individuals who are foster children, children under 19, beneficiaries of the FPBP (Family Planning Benefit Program), relatives of caregivers or parents, people undergoing fertility treatments and pregnant individuals, they will have to apply for the Medicaid program via the New York State Department of Health Marketplace.
Medication coverage?: Yes, New York Medicaid providers coverage for prescription medications. If there is a copay, it is usually small. The copay is dependent on the medication prescribed and your specific plan.
Other notable programs: Medicaid in New York may help cover the insurance premiums of people who have AIDS; the Family Planning Benefit Program for people seeking contraception, STD screening and counseling, and who aren’t already enrolled in Medicaid; Child Health Plus, a health insurance plan for kids.
Eligibility overview: Medicaid in North Carolina is available to people aged 65 or older (who can also apply for Medicare), people who are blind, disabled, or need long-term care, infants and children under age 21 and parents or caretakers. The state has not expanded Medicaid to cover all needy adults.
Income requirements: For the aged, blind or disabled, or caretakers of someone with those characteristics, your income must be within 100% of the FPL — $1,005 per month for a one-person household, $1,354 per month for a family of two. If you’re disabled but working, the FPL threshold rises to 150%. Medicaid for families with infants and children is available if you make $2,842 per month for a family of two where the children are no older than 5, going up to $5,037 per month for a five-person family. The monthly income limits for families with dependents aged 19 or 20 are $434 (family of one), $569 (family of two), $667 (family of three), and $744 (family of four). The monthly income limits for pregnant individuals range from $2,653 to $4,018.
How to apply for North Carolina Medicaid: You can apply online. You can also apply in person at your county Division of Social Services office or send them a paper application.
Other notable programs: Health Choice, which is for children whose families make too much to qualify for Medicaid, but can’t afford private health insurance.
Eligibility overview: Pennsylvania expanded Medicaid so that its program Medical Assistance (MA) is offered to low-income adults aged 19 to 64, adults aged 65 or older of any income, blind and disabled adults and families with children under 21. Use the State of Pennsylvania’s online tool to find out if you are eligible for health care coverage including CHIP, Medical Assistance, Medicaid for Former Foster Care Youth, Mental Health/Substance Abuse, and Health Insurance Marketplace.
Income requirements: For expansion adults (ages 19 to 64), the income limit is 133% of the FPL, or about $1,337 per month for an individual and $1,800 for a two-person family. For pregnant individuals and infants under age 1, family income limits must be within 215% of the FPL — $2,161 per month for an individual or $4,408 for a four-person family. For children ages 1 to 5, their family must make within 157% of the FPL, or $3,219 for a family of four.
How to apply for Pennsylvania Medicaid: Apply online with COMPASS, Pennsylvania’s portal to its MA system as well as other services.
Other notable programs: Substance abuse services, breast and cervical cancer screening, dental services and family planning services.
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