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Medicaid Disability Requirements

Medicaid is a health insurance plans for certain people with limited incomes. Medicaid is paid for by both the federal government as well as states. Although states are not required to participate in Medicaid, as of 2010, all 50 states offer the program. The specifics of the program are determined by states but the Centers for Medicare and Medicaid Services (CMS) provides the basic requirements for the program.

  1. Mandatory Eligibility Groups

    • Since Medicaid is a state-run program, eligibility is determined by individual states. However, CMS has certain mandatory eligibility criteria that all states must fulfill to receive federal funding. Certain limited-income families with children as described in the Social Security Act must be covered under Medicaid. Similarly, individuals receiving Supplemental Security Income (SSI) and infants born to Medicaid-eligible mothers must be covered by Medicaid. Children under six years and pregnant women from families that have total family income below 133 percent of the current federal poverty level must also be covered.

    Optional Eligibility Groups

    • States have the option to extend Medicaid to other groups as well. This includes extending coverage to infants and pregnant women whose family income is above 133 percent but below 185 percent of the federal poverty level. Other optional groups include disabled adults, institutionalized individuals with limited income, persons infected with tuberculosis and certain low-income women who have been diagnosed with breast or cervical cancer.

    Medically Needy Group

    • While Medicaid is mostly for low-income individuals and families, states have the option to extend the coverage to certain medically needy people who have higher incomes. These individuals must pay a certain amount of premium to Medicaid to offset their higher incomes.

    Spousal Impoverishment

    • This is a special category of Medicaid-eligible groups and comes into effect if one member of the couple is admitted into a nursing home. Under this circumstance, the combined resources of the couple are added and if this is below the state's resource standard, than the individual residing in the nursing home becomes eligible for Medicaid.

    Income Requirements

    • Since Medicaid is a state-run program, states have different income and resource requirements, which are updated annually. The CMS site provides the updated income requirements of all states. If you need more information about your state-run program, you can find links to your specific state as well.

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