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Medicaid: Who Is Eligible For Medicaid?

Groups That Are Eligible For Medicaid

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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.


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