Medicaid Eligibility Requirements

Medicaid is a health insurance plan provided by the government. In general, uninsured individuals with low incomes are eligible for Medicaid. However, specific Medicaid requirements vary from state to state. Payments of health-care costs for those who are uninsured are either made in full or in part. However, no money is issued directly to the patient. Medical providers are reimbursed for the services they provide to Medicaid recipients at a specified rate.

Income

• Medicaid coverage is available to U.S. citizens and immigrants who are legally admitted to the United States. The income of eligible Medicaid recipients must be below the poverty line, which is updated each year by the federal government. For example, children under age 6 and pregnant women with a family income that is at or below 133% of the federal poverty level are eligible for Medicaid. When determining if one's income meets the criteria for Medicaid, the number of members in the household is considered.

Disability

• Disabled and blind individuals with limited resources and income can apply for Medicaid. Individuals who reside in a nursing home or who are terminally ill and live in a hospice may also be eligible. Although individuals aged 65 and over may be covered under Medicare, this does not preclude them from receiving Medicaid as well if their income meets the criteria set forth by the state.

Age

• Individuals with a limited income who have one or more children that are 18 years of age or younger can apply for Medicaid. Although a parent may not be eligible for Medicaid, a child's eligibility does not depend on his or her parent's eligibility. However, newborns are provided coverage for at least the first year of life if they continue to reside with their mother and if their mother was receiving Medicaid before they were born. Coverage is provided by many states up to the age of 21.

Supplemental Security Insurance

• Supplemental Security Insurance (SSI) is a governmental program that provides benefits to individuals who have a limited income due to their inability to engage in substantial gainful activities. Individuals receiving SSI must meet certain criteria, which are similar to what is required for Medicaid. Specifically, disabled, blind and individuals over 65 may be eligible. Therefore, Medicaid recipients also receive SSI benefits in most states.

Residency

• Individuals who reside in a medical facility, such as a nursing home, can still receive Medicaid even if they still own their former residence. However, the county Department of Social Services notifies such individuals that a lien may be placed on the property. According to the Omnibus Budget Reconciliation Act (OBRA) of 1993, states are permitted to seek reimbursement for the cost of medical services covered by Medicaid upon the death of a Medicaid recipient. This process is referred to as estate recovery.