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Medicaid and WIC Rules for Babies

Temporary Assistance to Needy Families (TANF) provides federal block grants to states for social services programs such as the Medicaid program and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The Medicaid program provides access to health care for low-income households. Babies are eligible for health benefits if their households meet certain requirements stipulated by the program. WIC provides nutrition education, foods and counseling to eligible pregnant women and their babies.

  1. Medicaid Income Rules

    • The Medicaid program covers medical services for infants who live in low-income and very low-income households. Income rules and restrictions are determined by the TANF, which distributes funds to the Medicaid program. According to the Federal Poverty Line (FPL) income rule, all children under the age of six must have a family income that is at or below 133 percent of the federal poverty level on an annual or monthly basis. These levels are subject to change by year; for example, in 2007, the annual maximum income for a family of three was $22,836.10. In 2010, the annual maximum income was $24,352.30. If you are unsure about the income requirement for your baby, current income guidelines can be found at the Medicaid website. There are other options for families who do not meet the income criteria set by the FPL. These families fall under a "categorically needy" group allowing infants younger than one eligibility for coverage if their family income is no more than 185 percent of the FPL. Each state has its own rules for "categorically needy" coverage; check with your local Medicaid program to see if your baby is eligible.

    Medicaid Citizenship Rules

    • Medicaid requires that all applicants be U.S. citizens, or in limited cases a legal resident for five years. In the past a signed affidavit was enough to prove U.S. citizenship; however, since The Deficit Reduction Act of 2005 (DRA), applicants must provide documented proof of citizenship. The DRA stipulates that babies born to immigrant or illegal mothers will only be determined eligible for Medicaid once an application with proof of citizenship documentation is submitted and processed by state agencies. The law stipulates four levels of proof of citizenship. The primary level is a U.S. Passport,Certificate of Naturalization and Certificate of U.S. Citizenship. Birth certificates are acceptable as secondary evidence, while a hospital record is considered third-level evidence. If an applicant does not have any of these documents, a group of non-governmental documents including written affidavits will be required. According to the law, it is the state's responsibility to seek the highest level of documentation possible.

    WIC Income Rules

    • The WIC program requires that households applying for WIC must have incomes at or below 185 percent of the FPL. According to WIC's income chart, a family of three cannot make more than $33,874 in a year to be eligible for the program. The program counts all members of the household, including the fetus of a pregnant mother. Babies who are eligible for welfare programs like Medicaid will be automatically eligible for WIC under the income requirements.

    Nutritional Risk

    • In order for babies to be considered for the WIC program, the applicant must be found to be at nutritional risk. This risk is determined by an initial health screening at a WIC clinic by a physician, nurse or nutritionist. The practitioner will evaluate medically based and diet-based risks like low weight, iron-deficiency anemia and poor eating habits. Babies who are found to be eligible for the program will be given food assistance such as formula, milk, infant cereal, and vitamin supplements.

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