Medicaid is a DHHS administered program designed to pay medical bills for low-income persons.  Each state operates a Medicaid program with different rules and different covered services.  You may be eligible in one state and not in another, depending on program rules.

In NH individuals and families must meet income and resource requirements and certain eligibility categorical criteria such as minor children, disabled individuals or pregnant women.  Medicaid does not pay persons directly, but sends payments directly to health care providers. 

Medicare is not based on financial need, but is generally linked to receipt of Social Security benefits based on being age 65 or older or having a disability.  The federal government administers this program and as of January 1, 2006, provides prescription drug coverage for those who are enrolled in Medicare or who are eligible for both Medicare and Medicaid benefits.  Benefits are available throughout the country from Medicare participating providers.  Call 1-800-MEDICARE if you have questions regarding Medicare coverage.

Health insurance coverage under Medicaid for children is known as NH Healthy Kids  Gold.  If your income exceeds the limits for coverage under the Healthy Kids Gold program, your children may still qualify for low-cost health insurance through Healthy Kids Silver.  If you apply at a DHHS District Office, you will automatically be referred to Healthy Kids Silver if your income meets the guidelines for that program.  This program does have premiums you must pay.  You may also call the NH Child Health Insurance Program at 1-877-464-2447 for information about Healthy Kids  Silver and how to apply.   For more detailed eligibility information about Healthy Kids  visit  the Medical Assistance Eligibility section of the Division of Family Assistance web site or visit the NH Healthy Kids website for more information about benefits and enrollment.

You can apply for Medicaid at any of the twelve DHHS District Offices throughout NH. 

You will be asked to provide certain information at the time of your application.  The more quickly you provide this information, the more quickly a decision can be made. 

If you are applying under a disability category you will need to provide detailed medical information about your disability; it may take a minimum of 90 days to finalize a decision after the Disability Determination Unit initiates the case.  It may be necessary to obtain additional medical information by mail, and you may also be asked to attend a medical or psychiatric evaluation that the Disability Unit schedules for you.

Accessing care:

You or your family members will receive an identification card for either the Medicaid program or the Healthy Kids Gold program (based on category of eligibility).  You need to present this card every time you receive healthcare services and make sure that the healthcare provider will accept this coverage. 

If you also have health insurance (through employment, Medicare, etc.), you must always use that insurance before using your Medicaid benefits.  Present both your health insurance card and your Medicaid or Healthy Kids Gold card at the time the services are provided.

Covered services:

Medicaid is comprehensive coverage, including in-patient and out-patient hospital services, doctor visits, home health care, eye care, psychological services, certain dental procedures, etc.  A complete listing of benefits can be obtained from a DHHS District Office or by calling Medicaid Client Services.

Most Medicaid recipients are entitled to pharmacy benefits unless the recipient is enrolled in Medicare.  You need to present your Medicaid card at the pharmacy and you will be informed whether your medication is covered or if there are any special requirements, such as prior authorization from your healthcare provider.  You can then work with your doctor to make sure you get appropriate medications.  As a Medicaid recipient you may also call First Health Services at 1-866-664-4506 to ask about coverage, restrictions and prior authorization procedures.

If you receive Medicare:

If a recipient also receives Medicare, most of their prescription drugs will be covered by Medicare, but recipients must first select and enroll in a prescription plan. Click here for more information on Medicare prescription drug coverage.

Many services are limited to a certain number of occurrences within a NH state fiscal year (July 1-June 30), or by how frequently the service may be obtained.  Some items may require prior authorization, such as out-of-state hospitalization, durable medical equipment purchases, orthodontic treatment (braces) and private duty nursing.  You may call Medicaid Client Services to obtain specific information regarding limits and restrictions.

The Medicaid for Employed Adults with Disabilities (MEAD) program allows certain employed individuals with impairments who meet the Social Security severity requirements to be enrolled in the Medicaid program.  Some MEAD eligible individuals may be required to pay a premium based on their income.

Children found eligible under either of these programs are entitled to the same range of benefits as other children under the Healthy Kids Gold program.