Medicaid and the State Children’s Health Insurance Program

The United States is one of the main developed nations that do not have a Universal Healthcare system. In contrast it has a combination of different healthcare programs tailored for different groups depending on their employers, their income levels and also according to their age groups. These programs are not necessarily similar in their eligibility requirements and operations across all the states in the United States. Each state has its peculiar requirements and this will look at the California state’s Medicaid program eligibility requirements.

My state of residence is California. In the state of California, the website for health department is the California Department of Healthcare services. The Medicaid program in Carlifornia is Medi-Cal which is offered by the state of California and funded by finances from the state and the federal government. The people who are covered by Medi-Cal are quarter of the children, most of the people who are infected with HIV/AIDS and also there are some people who are not covered by Medicare and these are mainly those people in the low income bracket, the elderly citizens and also the people affected with disabilities. Eligibility for Medicaid (Kaiser Commission. 2005.)

Medical coverage of children is dependent on the federal government levels of poverty (FPL) and the age of the children. The eligible children are those less than 1 year old from households with income not more than 200% FPL, children between 1 to 5 year old with 133% FPL household income, children aged between 6 and 19 years from households with 100% FPL. (Kaiser commission. 2005.) For the children with no insurance and their family income is above that eligibility for Medi-Cal, but falling below 250%FPL, their qualification can still be through the State’s Children’s Health Insurance Program known as Healthy Families. For the adults, coverage of pregnant women is for those with income levels of up to 200% FPL with some consideration of work and resource specifications. Some low income citizens are also covered by the Family PACT, funded by Medicaid but for only family planning.( Kaiser commission. 2005.)

For the senior citizens and the disabled people, their qualification is based on meeting the specifications of the federal Supplemental Security Income (SSI), a program of giving cash assistance to the old and those who are disabled, and the household income considered is up to 100%FPL. Medicare also gives them prescribed drugs, settles their Medicare premiums, their deductibles and also pays for their long term care. There is also a group of beneficiaries of Medicare in the low income bracket who are assisted with Medi-Cal. These are the SLMBs or QMBs.

The other category of Medicaid eligibility is medical neediness. The people in this group are eligible for Medicaid but earn highly therefore qualifying for Medi-Cal as medically needy. This category enables those persons who spend less to be qualified for Medicaid with their household income not exceeding 83% FPL and for partners up to 97% FPL incase exorbitant medical expenditure deflate their earnings. The immigrants who are not registered and those whose immigration category is not satisfactory can also be eligible for restricted Medi-Cal coverage like the emergency one for prenatal and long term care.( California Department of Healthcare Services. 2007)

The California State’s Children’s Health Insurance Program is called Healthy Families. it is a reduced cost plan for private healthcare with complete assistance for the children without insurance and coming from the low income earning families.( Thompson M. 2007) This program was designed to provide accessibility to healthcare to children who are uninsured. The children covered by this program come from families whose earnings do not exceed 250% of the poverty line, which exceeds the specifications for Medicaid but falls short of the requirements for private insurance. (Benefits, Discounts and Health Insurance.)The services provided range from preventive services like immunizations, health screenings for children, outpatient services and prescriptions, comprehensive coverage, coverage for dental and sight issues.


Benefits, Discounts and Health Insurance. California’s Health Insurance Program for Children. Web.

California Department of Healthcare Services. 2007. Medical. Programs. Web.

California Health Advocates. 2009. Factsheet

Kaiser commission. 2005. Medic-aid facts. The California Medicaid Program At A Glance. Web.

Thompson M. 2007. Why California Needs the State Children’s Health Insurance Program (SCHIP) Reauthorized, Not Downsized. Web.

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