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Eligibility Guidelines for Medicaid

Medicaid is state and federally funded health care coverage for low-income families and certain other individuals. Unlike Medicare, which is one federal program, each state has its own Medicaid requirements for applying. There are specific guidelines set by the government that each program must follow. If you meet the eligibility guidelines, contact your local social services department to locate the Medicaid office near you. You will need basic personal information and financial information for all household members.

  1. Citizenship and Residency

    • You must be a United States citizen or qualified alien to receive Medicaid coverage. Citizenship must be proved for eligibility. Some states provide coverage to non-citizens who encounter a medical emergency. Submit your Social Security number, birth certificate, government-issued identification card or passport. You must reside in the state where you are applying for Medicaid.

    Eligibility Group

    • Medicaid is offered to children, parents or guardians of children, pregnant women, elderly and disabled or blind. The age requirements will vary. In some states, the age limit for children is 19, while in other states the child must be under 18. Disabled individuals must be declared disabled through the Social Security Administration. Medicaid for low-income individuals who are age 65 or older or disabled is often referred to as SSI-related Medicaid. Long-term nursing home care is available to seniors who meet the income requirements.

    Income

    • Income guidelines are based on household size and determined by the state. In Texas, for example, if you are applying for an infant, your income cannot exceed 185 percent of the federal poverty level. If you are applying for a child age 1 through 5, the income must be no more than 135 percent of the poverty level. Non-working parents are limited to 13 percent, while working parents cannot exceed 27 percent. Some states offer Medicaid to those who exceed the income requirements, but are classified as "medically needy." To be medically needy, you must have a high amount of medical bills. You may be placed on Medicaid with a deductible or share of cost.

    Assets

    • Each state has a certain amount of countable resources a household cannot exceed. In some states, including Virgina, there is no resource limit for children, pregnant women and infants. Individual seniors are limited to $2,000 in resources, while couples are allowed $3,000. In Florida, low-income families are allowed $2,000 in resources. Your home, primary vehicle and personal possessions are exempt. Cash, bank accounts, stocks and additional vehicles or property is counted.

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