Medicaid is the national health program for individuals and families with low incomes and resources. The Centers for Medicare & Medicaid Services (CMS) is a federal agency that, along with Congress, establishes the main rules that Medicaid must operate within. CMS oversees the state-run Medicaid programs to insure they meet requirements in all areas of service and quality. Among the groups of people served by Medicaid are eligible low-income parents, children, seniors, and people with disabilities. Since each state runs its own program, the eligibility rules can vary significantly from state to state, although they all must follow the same basic framework set up by CMS. Visit the CMS website to find out if you or your family member is eligible for Medicaid coverage.
Medicaid does not pay benefits to individuals directly; Medicaid sends benefit payments to health care providers. Medicaid helps individuals who have no medical insurance or poor health insurance. In some states Medicaid beneficiaries are required to pay a small fee (co-payment) for medical services.
Dual eligibles are individuals who are eligible for both Medicare and Medicaid. These individuals will have prescriptions primarily covered by their Medicare Part D Prescription Drug Plan (PDP). Medicaid is the secondary payer and may pick up some or all of the cost of those medications not covered by the Medicare PDP.
For more information, you may want to access these resources on the CMS website:
Medicaid At-a-Glance 2005: A Medicaid Information Source
Contact information for your State's Medicaid Office
Your Pharmacy Alternatives pharmacist can provide further guidance about whether or not your medications will be covered by your Medicare PDP or by Medicaid.
Please contact us if you need further information.