Medicaid Eligibility Requirements

May 7th 2016

Medicaid health care coverage can provide the necessary medical services needed for individuals to maintain optimal health. Services and eligibility requirements vary by state, but states must uphold federal standards within the Medicaid program.

General Requirements

Although Medicaid is primarily based on the income levels of applicants, disabled people or someone caring for a disabled person may qualify. Considerations such as age, pregnancy status, income and household size also factor into eligibility for Medicaid. People who are blind, afflicted with a permanent disability, pregnant, age 65 or older, or 18 and under generally qualify for Medicaid.

In most states, people who receive benefits under the Supplemental Security Income program automatically qualify for Medicaid. Qualified applicants must also satisfy state and federal requirements regarding documentation of U.S. citizenship, immigration status and residency.

Income Requirements

In order to qualify for Medicaid, residents must show proof of income that does not exceed the state's set percentage of the federal poverty level. For example, in 2013, the poverty level for a family of four was set at an annual income of $23,550. The federal poverty level is re-examined annually and adjusted based on geographic location and cost of living. Income standards may change based on alterations to state and federal laws or governmental programs. For instance, the Affordable Care Act of 2010 expanded Medicaid eligibility beginning in 2014 to set the minimum eligibility level at 133 percent of the federal poverty level. The legislation required all states to adopt the guidelines and income standards of the Affordable Care Act of 2010 effective Jan. 1, 2014.

Exceptions

As of 2015, all states have adopted a health care coverage plan for children whose parents or guardians do not qualify for Medicaid. The Children’s Health Insurance Program (CHIP) also covers pregnant women and parents in some states. The CHIP program provides general medical care, preventative and diagnostic services and dental care for eligible children in the program.

Medicaid or CHIP coverage may also start retroactively for eligible individuals and families. Some states allow retroactive coverage for up to three months prior to an accepted application. Once participants no longer qualify for health care services through Medicaid, coverage typically stops at the end of that month.

Conclusion

Medicaid is a government-funded program that provides low-cost or free health care coverage for millions of Americans. The state and federal governments jointly run the Medicaid programs, with varying levels of coverage and eligibility. In general, individuals and families deemed low-income by the state, in addition to pregnant women, the elderly and the disabled, may qualify for Medicaid.

Sources

Medicaid.gov "Eligibility" http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html
Healthcare.gov "Medicaid & CHIP coverage" https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
Longtermcare.gov "General Medicaid requirements" http://longtermcare.gov/medicare-medicaid-more/medicaid/medicaid-eligibility/general-medicaid-requirements/

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