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Federal Medicaid Rules

Medicaid is a social welfare program designed to provide medical insurance coverage to those who do not have their own insurance through an employer or who cannot afford to pay insurance premiums. While Medicaid can help people shoulder the cost of doctor's visits, prescriptions and medical emergencies, there are certain eligibility requirements that must be met in order to qualify. Some of these regulations were put into place by the federal government, which initially established and helps states fund Medicaid.

  1. Income

    • Since Medicaid was initially established for individuals who could not afford health insurance, depending on the state in which you reside, you may be required to submit an income eligibility form. This form simply details your monthly debts and expenditures and is reviewed (at the state level) by a representative assigned to your case at the Department of Social Services. Low income families who may or may not be on welfare are encouraged to apply. The rules for the amount of income you can make and still be eligible vary, but are based on the poverty level in your state and on the number of people in your family.

    Age

    • Children aged 18 and under are usually eligible for Medicaid if they are a U.S. citizen or legal immigrant. Eligibility for children is not always dependent on the parent's income. In many situations, a parent may not be eligible for Medicaid, but the child is. Determining factors, aside from a limited household income, are whether or not the child receives on-going treatment or has a past history of significant illness. The elderly (i.e., persons aged 65 and over) may also qualify for Medicaid even if their incomes are higher than the poverty level or other state-specific minimums, based on their age.

    Special Circumstances

    • Individuals who are pregnant, disabled, blind or diagnosed with HIV are also eligible for Medicaid, even if they earn a higher income than standard eligibility limits allow. If an individual resides in a nursing home or is disabled and living at home, he may qualify for Medicaid coverage. People diagnosed with HIV have a few restrictions regarding eligibility, such as income requirements and disease progression.

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