You are here: Home Government ... Medicaid 101 Medicaid: Who Is ... Summary
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Summary

To be eligible for Medicaid, you must:

  • Be a member of an eligible group. The identity of the groups differ from state to state. For our purposes, you must have a "disabling health condition" as defined by Social Security. To learn more, see: Disability For Purposes Of Social Security.
  • Fit legal status requirements. 
    • You must be an American citizena legal refugee or an immigrant in the United States more than five years. Some states fund benefits for some other aliens as well.Illegal aliens who are not otherwise eligible for Medicaid can qualify only for emergency care and, in some states, prenatal care and birth. For more information, see: www.familiesusa.org/assets/pdfs/2g-NILC_State-Medical-Assistance-Programs.pdf offsite link.
    • Illegal aliens who are not otherwise eligible for Medicaid can qualify only for emergency care and, in some states, prenatal care and birth.
  • Be eligible financially. You must have both assets and income below a defined level.
    • The financial requirements vary from state to state. 
      • The financial requirements are basically the same as the requirements for Supplemental Security Income (SSI). However, many states apply a more liberal standard for exemptions and deductions for Medicaid than with respect to SSI.
      • To learn about  eligiblity requirements in your state, click here offsite link.  
    • Certain assets are not counted in determining whether eligibility tests are satisfied (a lived-in home of any value, one vehicle, household goods, $2,000 in other assets, up to $1,500 in separate burial funds).
    • Some income isn't counted in determining eligibility. For example, $20 monthly per family, $65 and half the rest of wages in most, but not all, states.
    • States are allowed to permit certain "Medically Needy" people with higher incomes to qualify if they incur enough medical expense. This is known as "Spending down" or "Medically Needy." Most, but not all, states allow spend downs.
    • States are also allowed to grant "waivers" to certain designated diagnostic classes of people with higher income in certain circumstances.
    • Within very complex limits, you can transfer income and/or assets to qualify for Medicaid. To learn how to plan to preserve assets while Medicaid pays for long term care, see: Medicaid: Planning For Long Term Care.

For more information, see:

To Learn More

Groups That Are Eligible For Medicaid

In general, the groups of people to whom Medicaid must be extended are:

Children of Low Income Families.

Federal law requires coverage for all children of low income families (including single parent families) and all children born of a Medicaid eligible mother. Each state sets its own definition of "low income."

Pregnant Women.

People Who Are Blind.

People Who Are Age 65 And Older.

People age 65 and over who meet the financial requirements qualify for Medicaid, including people who are eligible for Supplemental Security Income ("SSI") monthly benefits.

People Who Are Disabled

The definition for disability is the same as the one used by Social Security for the income programs: Social Security Disability Income (SSDI) and Supplemental Security Income ("SSI").

There is agreement among many professionals, although denied by the agencies themselves, that people who apply for Medicaid because of disability do not have to meet quite the same strict standards for disability as people who apply for SSDI or SSI based on disability.

People Who Are Disabled Who Work Who Are Between Ages 16 and 65

Medicaid covers part and full-time working disabled individuals up to 250 percent of the Federal Poverty Level and non-exempt resources at or below $10,000 (home and care are exempt). 

Some women with breast or cervical cancer, or people with Tuberculosis

States have the option to extend Medicaid to:

  • Women with breast or cervical cancer who are uninsured who were screened through the National Breast and Cervical Cancer Early Detection Program run by the Centers For Disease Control And Prevention (CDC) and found to need treatment for breast or cervical cancer• but only during their treatment. To qualify for Medicaid coverage under the program, women must be under age 65, not eligible for Medicaid and without creditable health care coverage. Women with breast or cervical cancer can receive all plan services.
  • People with tuberculosis (TB) who are uninsured. TB patients only receive services related to the treatment of TB.

To find out which states have extended Medicaid to these groups of people, see:
http://www.cms.hhs.gov/MedicaidGenInfo/downloads/MedicaidAtAGlance2013.pdf offsite link

People Who Receive Supplemental Security Income ("SSI")

Generally, federal law requires that states provide Medicaid to all recipients of SSI benefits. In many states, enrollment in Medicaid is automatic upon approval for SSI benefits. In others, you have to apply separately for Medicaid.

Even if you are only looking for Medicaid coverage, it is suggested that you apply for both Medicaid and SSI at the same time. If you live in a state in which the two automatically go together so there is no separate Medicaid office in which to apply, consider reminding the SSI representative that you want to apply for Medicaid. In all other states, complete the two separate applications at the separate SSI and Medicaid offices.

An SSI award will generally assure approval for Medicaid. See Supplemental Security Income for information on SSI and how to apply.

Income Limits

The amount of an applicant's income is usually determined in a manner very similar to Supplemental Security Income (SSI). Medicaid programs look at:

  • Wages
  • Unearned income
  • Gifts
  • Items or services that substitute for money, such as free rent, direct bill payments or food provision.

The income of a spouse with whom you are living is added together with the income of the person in need of medical care. There are different rules for the situation in which a spouse needs long term custodial care such as in a nursing home. To learn more, see: Medicaid: Custodial Care.

In many states, people who are members of one of the eligible groups, but have an income or resources greater than permitted to qualify for Medicaid, are allowed to qualify for Medicaid by reducing their countable income ("spending down") with medical charges. People who take advantage of this system are known as "Medically Needy."

To learn the income limits in your state, see: http://covertheuninsured.org/stateguides/. offsite link

To Learn More

Permitted Resources

Assets which Medicaid considers to be resources ("countable assets") include:

  • Real property which the applicant owns.
  • Cash and bank accounts.
  • Stocks and bonds.

As a general matter, depending on the state, people can qualify for Medicaid without selling their home. All Medicaid programs exempt one home. There is a limitation on the amount of equity in the home (market value minus debt) for the home to be exempt.. The minimum limit over which your home is counted is $500,000. Maximum limit is $750,000.

Most programs also exempt one vehicle (to help you get to and from medical treatments.) Some states put limits on the value of the exempted vehicle.

Medicaid also usually does not count:

  • Burial plots
  • Burial funds kept separate (to a maximum amount). This generally also includes pre-paid funerals if not revocable or refundable.
  • Small life insurance policies or at least policies with small accumulated cash values
  • Wedding rings
  • Other items exempted by Social Security but with varying limits on the amount that will be exempt.

Medicaid does count the assets of your spouse if the two of you are living together. Medicaid also counts jointly held assets. The rules for jointly held assets differ depending on whether the joint owner is a spouse or not as follows

  • Husband and Wife:
    • Medicaid looks at assets of both the patient and the healthy spouse as long as husband and wife are the joint owners â€" no matter which spouse actually owns which part of the asset.
    • The manner in which title is registered has no bearing on Medicaid eligibility.
  • Not Husband and Wife:
    • If the joint owners are not husband and wife, the patient is only attributed with his share of ownership of the jointly held asset, except for bank accounts.
    • Bank accounts are 100% attributable to the patient unless either party can provide proof of what part was contributed by the patient and what part by the healthy joint owner.               

As noted above, there are legal means of decreasing countable assets to qualify for Medicaid. For instance, there are states that apply different rules about resources to the Medically Needy. Those states do not require spending down resources so much as proof that the bills are consistently large enough to erase the resources rapidly if used to pay them.

To learn the resource limits in your state, see: http://covertheuninsured.org/stateguides/ offsite link

Acceptable Immigration Status

People who are not U.S. citizens may be eligible for Medicaid as long as all other Medicaid requirements are met if you fit into one of the following categories:

  • Lawful permanent residents.
  • Refugees, Asylees, and Cuban and Haitian Entrants.
  • People paroled in the US for one year or more.
  • People permanently residing in the U.S. under "color of law" (an immigrant whose presence is known to the government and who is allowed to remain in the US with the knowledge and permission of the INS).
  • People granted Withholding of Deportation or Withholding of Removal.
  • Certain battered spouses and children.

Even if you are an immigrant and don't fit into one of the listed categories, you may be eligible for Emergency Medical Care to treat an Emergency Medical Condition. An Emergency Medical Condition is a medical condition with acute symptoms of such severity, including severe pain, that without immediate medical attention, the result may be one of the following:

  • Your health is in serious jeopardy
  • There is a threat of serious impairment to bodily functions
  • There is a threat of serious dysfunction of any body organ or part.

An alien must prove the existence of the Emergency Medical Condition with a doctor's note which:

  • Identifies the emergency medical condition
  • Specifies the need for medical treatment resulting from the condition. and
  • Provides a date on which the emergency is expected to end.