Restructure Medicare & Medicaid: Examples of Medicaid’s
Mandatory Beneficiaries & Services
Examples of Mandatory Beneficiaries
e Children under age 6 with family annual income below $20,841
Children age 6 or older with family annual income below $15,670
Pregnant women with annual income below $12,382
Elderly and disabled with annual income between below $6,768 (for an individual)
(@)E) www.kpcb.com
Examples of Mandatory Services
Physician services Laboratory & x-ray services Inpatient hospital services Outpatient hospital services Rural health clinic services
Certified pediatric and family nurse practitioner services
Early & periodic screening, diagnostic, and treatment (EPSDT) services for individuals under 21
Note: Supplementary Security Income and Federal Poverty Levels are 2005 levels. Source: Kaiser Family Foundation, 2005.
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Restructure Medicare & Medicaid: Examples of Medicaid’s
Optional Beneficiaries & Services
Examples of Optional Beneficiaries
e Disabled and elderly with annual income between $7,082 (Supplementary Security Income, or SSI) and $9,310 (Federal Poverty Level, or FPL)
e Nursing home residents with annual income between $7,082 (SSI) and $21,000 (3x SSI)
e Pregnant women with annual income above $12,382 (>133% of FPL)
e Children under 6 with annual family income above $20,841
(@E) www.kpcb.com
Examples of Optional Services
Prescription drugs Dental services Rehabilitation and other therapies
Prosthetic devices, eyeglasses, durable medical equipment
Hospice services
Inpatient psychiatric hospital services for individuals under age 21
e Other specialist medical or remedial
care
Note: Supplementary Security Income and Federal Poverty Levels are 2005 levels. Source: Kaiser Family Foundation, 2005.
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