Medicaid Frequently Asked Questions: What People With Cancer Need to Know
If you have cancer, you may have questions about Medicaid and your options for coverage under Medicaid. Below, you'll find answers to common questions.
What is Medicaid?
Medicaid is a federal health insurance program. It provides health insurance coverage to individuals with a low or no income level. States that expanded Medicaid as part of the Affordable Care Act rquire a minimum income level of 138% of the federal poverty level. If you live in a state that has not expanded Medicaid, eligibility is based on having a very low income level, having low resources (assets), and meeting other criteria, such as receiving Social Security Income (SSI). To find out if your state has expanded Medicaid, refer to healthcare.gov.
What are the new work rules for Medicaid?
Starting January 2027, federal rules mandate that certain non-disabled Medicaid enrollees age 19 to 64 must complete at least 80 hours per month of work, education, job training, or community service to maintain coverage. Be aware of what your state is requiring so you will not be dropped and lose coverage.
How this will work:
Hours needed: Those enrolled must log 80 hours each month (or earn an equivalent monthly income threshold)
Approved activities: Includes paid employment, vocational training, half-time school enrollment, or structured volunteering.
Timeline: States must implement the mandate by January 1, 2027. Currently outreach and compliance checks have already started in some states.
Exemptions to the new Medicaid rules:
Children and pregnant women
Primary caregivers for young children or disabled family members
Individuals certified as medically frail or having a qualifying disability
Older adults above the designated age cap
Are there other benefits that work with Medicaid?
Yes, however you must refer to your state program.
What resources can preclude me from being approved for Medicaid?
Resources you may have in an investment, bank, or retirement account. These resources may vary depending on your income and resource level, while Medicaid expansion only requires that you have a low income.
How do I apply for Medicaid?
You can apply online at www.medicaid .gov or www.HealthCare.gov. Since Medicaid is a state program, you must go through your state. These links will take you to your state program.
Be aware of what Medicaid MUST and MAY cover and the associated limitations and costs in your particular state.
What MUST Medicaid cover?
In every state, Medicaid covers medical care that you receive in a hospital or outside of a hospital.
Doctors visits
Blood tests
X-rays
Scans
Pregnancy
Mental healthcare
Long-term care services
Routine costs when you participate in a clinical trial
Physician services
Transportation and medical care
Family planning services
Nurse Medlife services
Certified pediatric and family nurse practitioner services
Early and periodic screening, diagnostic, and treatment services
Nursing facility services
Tobacco cessation counseling for pregnant women
Federally qualified health center services
Rural health clinic services
Outpatient hospital services
Inpatient hospital services
What MAY Medicaid cover?
May means in most instances, but there may be times when it doesn’t cover all the cost. Refer to https://www.macpac.gov.
Prescription drugs
Physical therapy
Podiatry Service
Optometry
Dental (Adults)
Dentures
Prosthetics
Personal Care
Hospice
Eyeglasses
Chiropractic Services
Occupational therapy
Speech, hearing and language disorder services
Respiratory care services
Case Management
Other diagnostic Screening, preventative, and rehabilitative services
Clinic services
Private duty nursing
Inpatient mental disease services for age 65 years old or older
Intermediate care facility services for intellectual disabilities
State plan home and community based services
TB related services
Inpatient psychiatric services for people under age of 21
This is not an exhaustive list. Please refer to: https://www.macpac.gov for a complete list.
What are the costs of Medicaid?
It depends on the state in which you live and what Medicaid benefits you qualify for. States can charge more for prescription drugs. You may have to pay out-of-pocket costs for certain types of medical care. You may have to pay copayments for prescriptions. These copayments are different for generic versus brand-name drugs and will vary based on your Income. Copayments for mail order drugs and drugs sold in a pharmacy will also be different.
Can I appeal a claim denial of Medicaid eligibility?
Yes. You have the right to appeal. The details of how to appeal your claim depend on where you live and whether you have a fee-for-service Medicaid or a Medicaid managed care plan.
You must be aware of deadlines. There is generally 90 days of receiving the Notice of Action(NOA). If you file within 10 days, you may be able continue to receive benefits while your appeal is pending.
Can you select the plan you want for Medicaid?
The opportunity to select a plan differs from state to state. Refer to www.medicaid.gov
If I move, do I have to terminate my plan and re-enroll in my new state of residence?
Yes, because each state has its own Medicaid program and also different rules, coverage cannot be transferred from one state to another, and you cannot have Medicaid benefits in two states.
You need to plan ahead if you are planning to move. Your healthcare team can help transfer your care. And you don't want a gap in coverage.
You need to understand states' eligibility rules and see what their coverage levels are compared to your current state coverage.
Where can I learn about Medicaid and Medicaid appeals?
Contact your state Medicaid agency or go to: https://www.triagecancer.org
Can you get Medicaid and Medicare at the same time?
In some instances, it is possible to have dual coverage. If you qualify, your Medicaid and Medicare plan(s) will work together to provide coverage for your needs. In most cases, Medicare will be your primary plan and cover most Medicare-eligible healthcare services. Medicaid is the secondary plan and may cover medical costs that Medicare does not cover or partially covers.
How do you qualify for dual eligibility?
In order to qualify for dual plans, you must meet the requirements for both Medicaid and Medicare and then be enrolled on both programs. Refer to: www.ssa.gov for Medicare and cms.gov for specific state coverage.
What are the benefits of dual eligibility?
Dual eligibility can provide greater coverage for a host of needs.
Medicaid can provide long-term nursing home care and personal care that Medicare does not provide
Durable medical equipment, like walkers, canes, and wheelchairs
Doctor visits
Inpatient and outpatient hospital services
Mental health services
Prescription drugs
Preventative care
Dental services