May 23, 2011
Medicaid Eligibility
Medicaid eligibility is reserved for low-income citizens of the United States and for lawfully admitted immigrants. The five categories of people that Medicaid serves are:
- Children
- Pregnant women
- Adults with dependent children
- Disabled Americans
- People over age 65
Medicaid Eligibility for Children
Medicaid eligibility may apply to families whose income or resources are low or if the child is sick enough to require special care in a nursing home but could stay home if funding for at-home nursing care was available.
The child's status determines Medicaid eligibility, not the parents. That means if the parents are not U.S. citizens while the child is a citizen, the child may be able to continue being covered under Medicaid beyond the five-year limit, even if the parents cannot. In addition, if the child is not your dependent, his or her Medicaid eligibility is based on the adults who claim the child as a dependent for income tax purposes. Your own income and resources do not count toward the child's eligibility.
For teenagers living on their own, your state may allow you to apply on your own behalf or any adult may apply for you. Typically, the child must be age 19 or younger in order to be eligible for Medicaid, but some states cover children up to age 21.
Medicaid Eligibility for Pregnant Women and Infants
Whether you are single or married, you should apply for Medicaid if you think you are pregnant. If your child is born while you are on Medicaid, the child will automatically be covered.
Medicaid Eligibility for Adults who are Aged, Blind, or Disabled
You should apply for Medicaid if you are 65 years or older, blind, or disabled and have limited income and resources. This category includes the terminally ill who are in need of hospice care. Also, if one spouse is in a nursing home, the other spouse may qualify because Medicaid eligibility determination takes into account the high costs of nursing home care.
Other Medicaid Eligible Groups
There are other protected groups who may be able to keep Medicaid for a limited time if their situations change. For example, families can get an additional 6 to 12 months of Medicaid coverage after losing eligibility due to work earnings or 4 months of coverage after losing eligibility due to increased child or spousal support.
States may also create Medicaid-eligible groups based on the needs in that area. States can also be more liberal in their Medicaid eligibility requirements than the federal guidelines. They cannot, however, be more restrictive.
State Medicaid Requirements
The federal government partially funds the program and provides general guidelines for Medicaid eligibility requirements. However, it is the individual states that determine Medicaid eligibility for its residents. The state requirements can vary depending on your income and situation.
Even if you're not sure whether you qualify, you should apply for Medicaid in your state if you cannot afford health insurance and have limited income and resources. Medicaid eligibility determinations will be made by a qualified caseworker in your state. Approvals are based on information you provide including: personal status (whether you fit into one of the qualifying categories); your annual income; and your financial resources. Extenuating circumstances that impact your ability to afford health care may also be taken into account.
To find a link to your state's Medicaid eligibility website, visit list of State Medicaid websites on the Centers for Medicare & Medicaid Services website.
