Project HEAL: Government Plans Overview

1. Medicaid

• What It Is: A joint federal–state program offering health coverage to low-income individuals and families. Eligibility and covered services vary significantly by state.
  
  

• Who Qualifies:
  
  

  • Pregnant individuals with low income
    
    

  • Children from low-income families
    
    

  • Children in foster care
    
    

  • People with disabilities
    
    

  • Seniors with low income
    
    

  • Parents or caregivers with low income
    
    

• Mandatory Benefits include:
  
  

  • Inpatient/outpatient hospital services
    
    

  • Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
    
    

  • Physician services, home health, nursing facility care
    
    

  • Family planning, lab and X-ray, rural health clinic access, transportation to medical care, tobacco cessation for pregnant women
    
    

• Optional Benefits (state-dependent):
  
  

  • Prescription drugs, physical/occupational therapy, rehabilitation
    
    

  • Mental health services (especially for those 65+ in institutions), dental, eyeglasses, prosthetics, hospice, case management, personal care, and more
    
    

2. Medicare

• What It Is: A federal health insurance program for:
  
  

  • Individuals aged 65 and older
    
    

  • Certain younger individuals with disabilities
    
    

  • People with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)
    
    

• Coverage Components:
  
  

  • Part A: Inpatient hospital care, skilled nursing, hospice, some home health care. Often premium-free if Medicare taxes were paid.
    
    

  • Part B: Doctor visits, outpatient care, preventive services, home health—requires a monthly premium.
    
    

  • Part C (Medicare Advantage): Private insurer plans that cover Parts A, B, and usually D, sometimes including vision, dental, and wellness services.
    
    

  • Part D: Prescription drug coverage via private insurers, with its own premium.
    
    

• Other Support:
  
  

  • Medigap: Supplemental private insurance to cover gaps in Original Medicare.
    
    

  • Medicare Savings Programs: Help reduce Medicare costs for eligible individuals.
    
    

3. TRICARE

• What It Is: Healthcare coverage for uniformed service members (active duty, Reserves, National Guard), retirees, survivors, certain former spouses, and their families—available worldwide. 

4. Enrollment & Eligibility

• For Medicaid, check state-specific eligibility and enroll via your state’s site or the federal portal.
  
  

• For Medicare, eligibility and enrollment details can be found through the Social Security Administration’s website.
  
  

Summary and Implications for Eating Disorder Coverage

• Medicaid: Coverage varies widely by state. Some mental health services may be optional and not all levels of eating disorder care (like residential or PHP/IOP) are typically covered.
  
  

• Medicare: Covers basic hospital and outpatient treatment through Parts A and B, but coverage for specialized eating disorder care (e.g., residential, nutrition therapy, PHP/IOP) may be very limited or require private supplemental plans.
  
  

• TRICARE: Offers coverage to military-affiliated populations, but specific eating disorder benefits may differ and require checking plan details.
  
  

• Enrollment: Each program has its own enrollment channels and timing—for Medicaid (state-based), Medicare (SSA), and TRICARE (through the military health system).

For more information, go to  Project HEAL's website.