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Requirements for Medicaid for Adults

Medicaid helps poor Americans obtain health care, but it in no way provides health coverage for all adults. Adult applicants must meet certain income and asset requirements. Requirements for Medicaid vary depending on individual circumstances. Adults who have dependent children, disabled or have elderly dependents find it easier to qualify than other adults.

  1. SSI

    • Anyone who qualifies for the Supplemental Security Income (SSI) program is eligible for Medicaid. The premise for this coverage is that people who are eligible for SSI are covered by federal government guidelines, and states are not allowed to have stricter rules than the federal government.

    Medically Needy

    • Some states offer the medically needy program, which extends Medicaid eligibility to individuals whose income exceeds the eligibility income limit to receive Medicaid. They are able to use the "spend-down" method, which is using medical or remedial care expenses as means to reach the Medicaid income eligibility level. Some states also allow adults the option to obtain eligibility through the needy program by paying the state monthly premiums. The monthly premium is income minus unpaid expenses incurred for medical treatment. States that do not follow this type of program are defined as "income cap states." Income cap states include Alabama, Colorado, Delaware, South Carolina, Idaho, New Mexico, Wyoming and Mississippi.

    Breast and Cervical Cancer Disease

    • Under the Breast and Cervical Cancer Prevention and Treatment Act, signed in to law October 24, 2000, states have the option to offer medical assistance for low income and uninsured women. This program is for females diagnosed or screened at a Center for Disease Control (CDC) Breast and Cervical Cancer Early Detection Program and requires treatment due to pre-cancerous conditions, breast cancer or cervical cancer. The CDC program is available in all 50 states.

    Spouse Income

    • Your spouse's income and resources are calculated into the Medicaid eligibility requirements for a sick spouse. The level of determination depends on whether the patient is at home or is in an institution. States vary as to how they apply this determination.

    Personal Property Income Limits

    • Medicaid places a $2,000 limit resources limit for individual applicants and a $3,000 limit per couple. The applicant home and automobile value, up to $4,500 or the current market value of the automobile, is excluded from this asset equation.

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