Washington State Medicaid Eligibility Requirements

Each state administers its own Medicaid program, which provides medical assistance for qualified individuals. Half of the money for the program comes from the state and the federal government contributes a matching amount. Washington administers two primary Medicaid programs: the medically needy and categorically needy programs. The medically needy program offers fewer benefits than the categorically needy program, but resources and income can be greater.

General Qualifications

• Applicants must be residents of Washington or selected counties in Idaho. Recipients must be U.S. citizens, legal aliens or qualified refugees. If eligible for Medicare or an employer-sponsored health plan, the individual must typically apply for coverage. All applicants must provide Social Security numbers. If applicable, recipients must cooperate in seeking support from the parent or parents of an eligible child unless good cause exists.

Categorically Needy Medicaid Program

• Certain groups are automatically eligible for coverage under the categorically needy program. These include recipients of Washington's Aid for Dependent Children -- also known as Temporary Assistance to Needy Families -- who are full-time students, women who are pregnant and who do not have additional children who are eligible, and families with an unemployed parent. Certain individuals can become AFDC recipients even if they do not receive a cash benefit. These include individuals whose cash payment would not exceed $10 and are therefore denied, those participating in a work supplementation program that causes AFDC ineligibility, individuals whose payments are withheld to repay prior overpayments and certain adoptive and foster parents. Those who are elderly, blind or disabled and who receive SSI benefits while awaiting a determination of disability may receive coverage along with their spouses.

Medically Needy Medicaid Program

• The medically needy program covers children and pregnant women whose income or resources were too great to qualify as categorically needy. An optional program covers those who would be eligible if they are terminally ill, opt for hospice care and would be eligible if they had chosen a medical institution. If Washington assumes financial responsibility for an individual, such as a foster or institutionalized child younger than 21, the child might receive coverage. Women with cervical or breast cancer can receive coverage for the condition.

Income Limits

• Washington bases income eligibility on the federal poverty level, which changes annually and is based on family size. However, certain deductions, such as child-care expenses, apply and special circumstances may also apply, so applicants who might not qualify on gross income alone may still be eligible. Only a caseworker can issue a final ruling on eligibility. Under the guidelines, however, women who are pregnant and children younger than 1 year can qualify with income limits less than 185 percent of the federal poverty level. For children who are at least 1 but not yet 6, the limit is 133 percent of the federal poverty level. For children over 6, the limit is equal to the federal poverty level. Medicare recipients who are eligible for Part A hospitalization benefits and who have incomes that do not exceed the federal poverty level may receive Medicare cost sharing if their resources are less than three times the amount established as the resource limit for SSI. Other low-income Medicare recipients may be eligible for payment of their Medicare premiums under Medicaid.