Before I really knew about disability policy, I didn’t fully understand Medicaid. With research and time (and some more research), I’ve boiled my findings down to the five biggest “thoughts and truths” about Medicaid, of which everyone should be aware.

Thought: Medicaid is for the poor; Medicare is for senior citizens.
Truth: While taught in introductory classes that the difference between the two programs is that “We ‘aid’ the poor and ‘care’ for the old,” there’s quite a bit more to it than that. Medicaid pays for some services that private insurers do not provide, like long-term services and supports (LTSS). For people with disabilities, attendant care is a LTSS not covered by Humana, UnitedHealthcare or any other health insurance company. In order for most people to access these services, unless they pay out of pocket or have some long term care insurance, they must go through Medicaid. However, people also have to adhere to the strict guidelines for Medicaid. Originally designed to keep people who earn too much money out of the system, the guidelines force some people who need the system to live in poverty. Because of the asset and income limits associated with Medicaid, people are forced to live in poverty so that they can access the services they need that are not offered by private providers.

Thought: Medicaid is for poor people.
Truth: Medicaid is for a variety of populations, including, but not limited to, people at or below the federal poverty level (FPL), pregnant women and their children, and people with disabilities.

Thought: Nobody pays for Medicaid.
Truth: Medicaid is jointly funded by the federal government and the state. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP), for which Missouri’s is at 63.28 percent. Also, people can “buy in” (or spenddown their monthly income) to Medicaid if their income makes them ineligible and they are eligible in every other way.

Thought: People who use the system don’t pay in to the system.
Truth: Many people join MO HealthNet long after they began working and contributing to the system. Through taxes, people contribute to the well-being of the state’s Medicaid system, and many people pay into that funding stream throughout their lives. Yes, some people are born into the system without having contributed. Also, the Ticket to Work Health Assurance Program (TTWHAP) allows people with disabilities to work and access MO HealthNet by paying a premium like you would with an insurance company.

Thought: If I do not qualify for Medicaid today, I don’t need Medicaid.
Truth: A person can qualify for Medicaid whenever income, assets and need reach a certain level. A person can also qualify with a disability. While many hope to never need state services and supports, the truth is they are here for you, just in case you do.

Melissa Alper is the Policy Analyst at Paraquad. She can be reached at or on Twitter at @malperstl.

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