What Are the Medicaid Income Guidelines?

Medicaid acts as a federally subsidized health insurance program designed to provide needed health insurance coverage for individuals and families with limited financial resources. Income guidelines for Medicaid eligibility are based a number of factors, one of which is income level. Income requirements can vary based on the needs of the individual or family.

Poverty Guidelines

• Income level requirements for Medicaid use nationally set poverty guidelines as a criteria for program eligibility. According to the Institute for Research on Poverty, national poverty guidelines are set on a yearly basis and are the same throughout the United States regardless of regional cost of living factors. Yearly changes in the poverty guidelines are based on the consumer price index, which acts as a gauge for determining the nation's economic condition. And while income levels play a determining role for Medicaid eligibility, other conditions must be met before a person's or family's income level is considered. According to the U.S. Department of Health & Human Services, as of 2010, a one person household with a yearly income of $10,830 or less falls within the poverty guidelines, which also applies for a household or family of eight members with a yearly income of $37,010. These guidelines are further broken down for households with two to seven members.

Group Eligibility

• Group eligibility refers to the types of need categories that apply for Medicaid-eligible persons or families. Need categories indicate the types of circumstances or condition that cause a person or family to require assistance, according to Money Alert, a financial information reference site. These groups include pregnant women and children, individuals who receive Social Security income, teenagers living on their own, disabled individuals, senior citizens as well as other identified groups. A person or family may qualify for Medicaid health insurance provided they fall within one of the Medicaid-eligible groups and have an income at or below the national poverty guidelines.

Medical Need

• In some circumstances, medical need can go a long way towards determining Medicaid eligibility, particularly in cases when a person's or family's income exceeds the poverty guideline limit, according to the Money Alert site. Though Medicaid is a federally-subsidized program, it's administered at the state level, meaning different states can have different eligibility requirements. Even after being approved for health insurance coverage, some programs may require participants to pay a portion of their healthcare costs. As of 2010, 35 states within the U.S. have medically needy programs that can approve cases in which a person or family exceeds the income guideline requirement. According to the Centers for Medicare & Medicaid Eligibility, eligibility based on medical need applies in cases where a person suffers from a physical disability or for elderly individuals in need of long-term care.