Medicaid Eligibility Specialist Job Description

A Resume Example for a Candidate to become an Eligibility Specialist in Medicaid

A Medicaid eligibility specialist can determine if a person is eligible for Medicaid and other forms of government aid. As a Medicaid eligibility specialist, you have to review each application to make sure the financial statements and personal information are accurate. You interview the applicants and family members when necessary, and document all your findings that lead to approval or denial of the application.

To become a Medicaid eligibility specialist, you need a bachelor's degree in a related field. Some states require years of experience in the healthcare profession before they can become Medicaid eligibility specialists. You need to have a good knowledge of federal and state rules related to medical assistance programs and insurance, as well as excellent verbal and written communication skills, in addition to educational qualifications and training.

The MAGI Methodology for Determining Medicaid Income Eligibility

The basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults is called the MagI. The methodology considers tax filing relationships to determine financial eligibility for Medicaid. The Aid to Families with Dependent Children program ended in 1996, so the methodologies used to calculate Medicaid eligibility were replaced by the new MAGI process.

Income disregards that vary by state or by eligibility group are not allowed in the methodology. Individuals must meet certain eligibility criteria to be eligible for Medicaid. Medicaid beneficiaries are usually from the state in which they are receiving the program.

They must be either citizens of the United States or non-citizens. Some eligibility groups are limited by age or parenting status. When an individual, his or her spouse, or anyone acting on the individual's behalf establishes a trust using at least some of the individual's funds, that trust can be considered available to the individual for determining eligibility for Medicaid.

State Medicaid programs must recover the cost of certain benefits paid on behalf of the facilityee, including nursing services, home and community-based services, and related hospital and prescription drug services, from the estate of a Medicaid enrollee. State Medicaid programs can recover for other Medicaid benefits, except for Medicare cost-sharing benefits paid on behalf of Medicare Savings Program beneficiaries. Third party liability is when third parties have a legal obligation to pay for medical services provided to a Medicaid beneficiary.

Medicaid Coverage and Benefits

A person must make less than 133 percent of the federal poverty line to be eligible for Medicaid. It is important to clear up any confusion about the relationship between Medicaid and Medicare before understanding what services Medicaid covers. The creation of both was in response to the inability of older and low-income Americans to buy private health insurance.

Their goal was to allow the financial burdens of illnesses to be shared among people who are healthy and wealthy. The federal government and state governments fund Medicaid. Each state has the power to decide how Medicaid is implemented.

Medicaid benefits that states offer are mandatory for the federal government to reimburse. Medicaid recipients may be expected to pay a co-payment or part of the cost if the state chooses to offer optional benefits but at a limited cost. States can offer coverage for generic versions of medicines as a way of encouraging patients to choose cheaper alternatives over more expensive ones, for example.

Nevada Medicaid provides quality health services to low-income Nevadans who qualify. Nevada Medicaid does not pay for medical services. Payments are sent to health care providers when they provide services to Medicaid recipients.

Texas Health and Human Services administers Medicaid. It administers Medicaid programs. Medicaid coverage varies depending on where the person lives and what kind of health issues the person has.