Medicaid Qualification Rules

Medicaid provides health insurance to low-income individuals with limited resources. The state manages the program, but income and resource guidelines are set by federal statutes and change from year to year. Each state determines how income and resources are counted; there are several mandatory groups with different income requirements. If you would like to check eligibility before applying for Medicaid, access Benefits.gov. The site will perform a basic analysis and provide a list of Medicaid benefits you may be eligible to receive.

Citizenship

• You must be a U.S. citizen or legal immigrant. A five-year eligibility limit applies to legal permanent residents. Your income and resources must fall at or below the federal poverty line. States determine child eligibility by the child's status, not the parent. If you do not meet Medicaid eligibility guidelines, there may be a state-administered health program with less-stringent requirements.

Aged, Blind or Disabled

• Adults who are 65 years of age or older, blind or disabled with low-income and/or limited resources are eligible if they have a terminal illness and require hospice care. Low-income individuals in the aged, blind or disabled category are also eligible if they live in a nursing home and receive limited income. Some Medicare recipients are eligible if they are low-income and have limited resources.

Children

• Children under the age of 6 with a household income that falls at or below 133 percent of the poverty level are a mandatory eligible group. If the child was born after September 30, 1983, the state is required to extend the coverage to the age of 19 if the child falls within the income guidelines.

Pregnant Women

• Pregnant women with income at or below 133 percent of the U.S. poverty level are eligible for Medicaid whether they are married or single. A pregnant woman above 133 percent of the poverty level may still qualify if her income does not exceed 185 percent of the poverty level.

Resources

• Resources are any item or asset from which a person can obtain an immediate monetary benefit; for example, cash on hand, open bank accounts with a positive balance or any insurance policy the applicant can borrow against. Items not considered a resource include insurance policies the applicant cannot borrow against, such as a burial policy. In some cases, the applicant's home is exempt. Other non-resource items include clothing, furniture and vehicles used for employment, medical care or business operation.