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Medicaid Eligibility Information

Medicaid is a program designed to offer certain low-income populations with quality health care. It is both federally and state funded, though states largely determine their own eligibility rules. However, there are some federal mandates that states must follow and some eligibility information that is common among most programs.

  1. Categories

    • While some states elect to offer more broad coverage, they are only required by federal law to offer coverage to children, pregnant women, adults with dependent children, the disabled and the elderly. The federal Medicaid statutes are more specific and separate these five categories into 25 different populations.

    Income

    • Medicaid was specifically designed to provide individuals with low-income health care, so income is an integral part of the eligibility criteria. Income eligibility levels are usually different in each category and are based on the federal poverty guidelines. In the state of New York, for example, pregnant women must be at or under 200 percent of the federal poverty level (which is $1,805 monthly if single or $2,428 monthly if married in 2010), while a single or married elderly person must be at or under 85 percent of 92 percent of the federal poverty limit, respectively ($761 and $1,117 monthly).

    Assets

    • Assets, or resources, are also taken into account in most states. Assets are things such as vehicles, savings accounts, bonds and other valuables. The Kaiser Family Foundation reports that these limits are typically about $1,000 for children, $2,000 for a single elderly person or disabled person and $3,000 for a married elderly person or disabled person. These numbers are not related to the federal poverty limits.

    Spend-Down

    • Those with incomes too high to normally qualify for Medicaid, but with extraordinarily high medical bills may still be able to qualify for Medicaid in some states through a program called Medicaid Spend-Down or Medically Needy Program. The applicant submits receipts and medical bills, and the total amounts of their medical costs are subtracted from his total income. What is left is considered usable income, and only usable income is used to determine Medicaid eligibility.

    Citizenship

    • All United States citizens are eligible to apply. Undocumented immigrants are only eligible for emergency Medicaid if they meet other requirements. Documented immigrants may be eligible for full Medicaid coverage if they arrived in the country before Aug. 22, 1996. If they arrived after this date, it is different from state to state whether or not they are eligible for coverage, but Kaiser Family Foundation reports that most states have elected to cover this population.

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