Health Insurance: Categorically Needy

What Is a Categorically Needy Medicaid Beneficiary?

Pharmacist handing customer prescription
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The term categorically needy is a distinction used for individuals who fall into a determined specific category, or criteria, of mandatory Medicaid eligibility established by the federal government. These categories apply each individual state’s Medicaid program.

Each individual state must provide Medicaid coverage to these categories of individuals in order to receive federal funding. Individual states may also provide additional Medicaid coverage to other individuals, if they choose to do so.

More detailed information on Medicaid eligibility is available from the Centers for Medicare and Medicaid Services; the federal government agency overseeing the Medicaid program.

Medicaid

Medicaid is an insurance program specifically designed for low income and needy individuals. Medicaid provides health coverage specifically for younger children, certain senior citizens, and individuals with disabilities.

Medicaid is funded directly by the Federal government in junction with all fifty individual states.

Who is Eligible?

The government requires each individual state to provide health insurance for certain selected groups of individuals placed in the federal Medicaid program. Individuals included in the mandated federal Medicaid program include: young children, women who are pregnant, parents with an extremely low income (in certain cases), elderly individuals, and individuals with certain disabilities.

Eligibility varies by income.

Medicaid Benefits

Each state is required to cover certain particular health benefits. Benefits that the states are required to cover by the federal government are known as mandatory benefits. Such mandatory benefits include:

·         Services of a physician, a nurse midwife, and nurse practitioner, if necessary.

·         Necessary laboratory or x-ray services

·         Outpatient and inpatient hospital services

·         Services, supplies, and information regarding family planning

·         Access to services within various community health centers and rural health clinics

·         Various other services and state options

State Options

Each individual state may provide additional coverage for other health-related services, depending on the case. Such additional services must be approved by the federal government. These additional services are also sometimes known as optional services. Such additional services may include:

·         Dental care

·         Drug prescriptions

·         Eye and Vision Care

·         Mental health services

·         Individual case management

·         Rehabilitation services like physical therapy

·         Hospice care, if necessary

More Information About Individual State’s Medicaid Programs

Each individual state offers different Medicaid-related services and programs. Thus, it is extremely important for you to understand what your particular state’s eligibility requirements and rules are.

By having a solid understanding of your state’s rules and regulations regarding eligibility, you will have a much better idea of what to expect if you are eligible, and the requirement to become eligible if you are not.

The National Association of State Medicaid Directors’ website has an interactive map that can connect you directly to the site of your state’s Medicaid office. Additionally, the website of the Kaiser Family Foundation has ample information regarding the benefits offered by each individual state.

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