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Medicaid Eligibility, Criteria & Benefits

Medicaid is a state-run program available in all 50 states that provides health insurance to some low-income people. Both state and federal tax dollars fund Medicaid. The eligibility criteria vary slightly from state to state and the coverage available varies from state to state. Not all people with limited incomes qualify for Medicaid, but for those that do, Medicaid provides access to much needed health care services.

  1. Eligibility

    • In most states, children, the elderly and the disabled qualify for Medicaid if they meet certain income guidelines. In some states, pregnant women also qualify for Medicaid if they meet income guidelines. In some states, adults can qualify just by meeting income guidelines even if they are not elderly or disabled. You should contact the Medicaid office in your state to learn the state's specific eligibility criteria.

    Income Guidelines

    • You must meet specific income guidelines to qualify for Medicaid, and these guidelines vary from state to state. You must also have limited assets in order to qualify. For instance, in Ohio, a single person with more than $1,500 in the bank would probably not qualify even if his monthly income were very low. You should contact the Medicaid office in your state to learn the state's income guidelines.

    Applying

    • To apply for Medicaid, you must contact the Medicaid office in the state in which you live. The name of the agency varies from state to state. For instance, in Ohio, you apply at the Department of Job and Family Services. In Texas, you apply at the Texas Health and Human Services Commission. You must complete an application form and provide documentation of all income and assets. The state may request other documentation as well. For example, if you seek to qualify for Medicaid based on a disability, you must provide proof that you are, in fact, disabled.

    Coverage

    • Medicaid coverage varies somewhat from state to state. It usually covers inpatient hospital care and outpatient medical care like visits to doctors, X-rays and laboratory tests, nursing home care, home health care, and nurse-midwifery services. It covers prescription drugs. It covers inpatient and outpatient mental health care, although the exact coverage provided may vary. In all states, Medicaid covers dental care for children. In some states, it also covers dental care for adults. Not all doctors and other health care providers accept Medicaid so people with Medicaid sometimes have trouble accessing health care even when services are covered.

    Spend-Downs and Co-Pays

    • Depending on their income, some people with Medicaid have a spend-down amount. A spend-down is like a deductible you must meet each month before you receive your Medicaid card. You must pay for a certain amount of medical expenses yourself, and then, once you reach that amount, Medicaid will pay for anything above that amount. In some states, Medicaid recipients must pay a small co-pay for some services they receive.

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