When it comes to Medicaid, we’re hearing a lot of talking points and not all of them are totally accurate…
So we’re going to break down some of the most common misconceptions so caregivers can be informed and empowered when discussing this crucial program.
Misconception #1: “Medically complex and disabled kids automatically qualify for Medicaid.”
False.
Eligibility is managed by each individual state. Income, disability level, and medical necessity are just some of the factors each state can use to determine eligibility, and families often face lengthy application processes and strict eligibility criteria.
Misconception #2: “Medicaid is just for people with low income.”
Not true.
Children with medical complexities and disabilities may qualify for Medicaid regardless of family income, especially through programs like Home and Community-Based Services (HCBS) waivers. Again, access to these waivers is managed by each state.
Misconception #3: “Medicaid isn’t that important if you have private insurance.”
We wish…
Private insurance rarely covers specialized services that medically complex children need, including home nursing care, medical equipment, and therapies & medications. Without Medicaid, families would pay thousands of dollars out of pocket each month to cover these gaps.
Misconception #4: “Only fraudulent payouts are being targeted by budget cuts.”
Not quite…
The math isn’t mathing on this one. Fraud (especially by individual recipients) is extremely rare and is nowhere near the proposed total for cuts. In addition, as the population of medically complex children grows and lives longer, more supported lives, the budget for Medicaid will necessarily have to grow, not shrink, to support them.
Misconception #5: “It’s easy to get Medicaid.”
Not at all.
Families have to navigate tons of paperwork, denials, appeals, long waitlists, and then have to do it all again regularly to maintain coverage. In addition, Many families spend years fighting for coverage their child legally qualifies for.
Misconception #6: “You don’t have to pay for anything when you have Medicaid.”
If only…
Most families still have co-pays, out-of-pocket expenses, and travel costs. There are plenty of things that Medicaid doesn’t cover or the process to get coverage is so onerous that families simply don’t bother and choose to pay out of pocket for certain parts.
Misconception #7: “Medicaid is a luxury, not a necessity.”
Categorically untrue.
It’s the difference between life and death for many kids. Medicaid is often the only coverage available for much of the equipment, therapy, and in-home support needed for medically complex kids. The private insurance sector is not designed to support kids with intense medical needs.
Misconception #8: “No one wants to work, which is why they want Medicaid.”
Not at all.
For many families, Medicaid is the program that allows them to maintain their careers. Without it, parents are often forced to quit jobs to provide care. Medicaid isn’t “enabling” our families. It’s allowing us to survive.
Misconception #9: “Medicaid is just another type of insurance.”
Not really.
Medicaid offers comprehensive coverage beyond typical insurance, including home nursing, wheelchairs, ventilators, feeding supplies, therapies, long-term care, in-home support, specialized medical transportation, and more. No private insurance plan covers all of this. These services are often unavailable or unaffordable through private insurance alone.
Misconception #10: “We can’t do anything. No one cares. It’s not worth fighting for Medicaid.”
No. We can’t give up yet.
Our voice matters! Our voices are powerful in influencing policy and securing necessary resources. Plus, Medicaid funding and similar social supports are broadly popular across bipartisan constituencies. This does not have to be a losing issue for our families.
And remember:
