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Requirements to Apply for Medicaid

Medicaid was created in 1965 as a federal health and long-term insurance program administered by individual states. Requirements may vary somewhat regarding eligibility for the program based upon income, disability and other public aid received. According to the Kaiser Commission, Medicaid eligibility includes meeting financial criteria and belonging to one of five "categorically eligible" groups: children, parents with dependent children, pregnant women, people with severe disabilities and the elderly.

  1. Children and Teenagers

    • In 2005, Medicaid covered 29.4 million children, according to the Kaiser Commission on Medicaid Facts. Children younger than six and pregnant women living at or below 133 percent of the federal poverty level are Medicaid eligible, according to the federal Centers for Medicare and Medicaid Services. As of 2010, the federal poverty level is $22,050 for a family of four. All children up to age 19 are also eligible if the family is at or below the federal poverty level. Children younger than 21 who aren't eligible for Aid to Families with Dependent Children (AFDC) despite meeting income requirements also are Medicaid eligible. Moreover, a state may allow a teenager living on his own to apply. Adopted and foster children also are eligible under Title IV-E of the Social Security Act as are those receiving state supplementary payments. Disabled children living at home, and nursing home residents with limited resources and income are also Medicaid eligible.

    Pregnant Women

    • Pregnant women with income at or below 133 percent of the federal poverty level are Medicaid eligible. They retain their eligibility for 60 days after the end of the month in which the pregnancy ended, regardless of change in income. They are eligible, whether married or single. If the mother is on Medicaid when the child is born, both will be covered.

    People with Severe Disabilities

    • Medicaid covered 8.3 million disabled people in 2005, according to the Kaiser Commission. This includes blind or disabled adults with income below the federal poverty level but too high for mandatory coverage.Medicaid also covers those individuals who are institutionalized or receiving home care or community-based care in lieu of an institution. Those receiving federal Supplemental Security Income payments are also eligible for Medicaid.

    The Elderly

    • Medicaid covered 6.1 million seniors in 2005, according to the Kaiser Commission. Those 65 and older with limited income and resources are eligible for Medicaid coverage. The federal Centers for Medicare and Medicaid Services also advises individuals who need nursing home care but can stay at home with community care to apply for Medicaid coverage.

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