Medicaid is a federally regulated, state-run health care program in the United States that provides coverage to over 72 million men, women, and children who cannot afford private health care or Medicare. Medicaid was established in 1965 and is now the largest health care provider for people of low income and with limited resources in the country.
Individual states are responsible for determining what Medicaid services the state provides, what the qualifications for eligibility are, and how health care providers in the state system are paid for their services. While every state has different criteria for eligibility, federal regulations require that all of the states include mandatory groups such as low-income families, children and pregnant women who meet federal requirements, and people who get Supplemental Security Income (SSI).
If you are 65 or older or have a disability and live on a limited income, even if you are getting Medicare benefits, you may be eligible for health care coverage or assistance from Medicaid. Here is information about who is eligible for Medicare services alone, or Medicare and Medicaid together.
What are the eligibility requirements for Medicaid?
Together with the mandatory groups mentioned above required to be included in Medicaid, each state has the option to provide coverage to other groups also. These include the following individuals or groups of people if they meet the financial requirements as well:
• Those who receive home based or community based services
• Children in foster care who would are not eligible for Medicaid otherwise
• Women who are pregnant
• Parents of children younger than 18
• Teens who live on their own
• Those who are blind or have other qualifying disabilities
• Low income people who have no disability or dependent children but still meet state requirements
• Those who are 65 years of age or older
In addition, to qualify for Medicaid services, you must be a resident of the state where you receive Medicaid, and you must be a U.S. citizen or a lawful permanent resident.
Medicaid regulations specify that a person must be medically needy and meet their state of residence’s income requirements to be eligible for coverage. These income levels are based on the Federal Poverty Level and are different for every state. The CMS office in your area has a list of the income requirements for your state, but here is a look at what the income qualifications look like for some states:
As of 2020, a single person over 65 years old qualifies for Medicaid with a monthly income that is no greater than the pretax amount of $2,349.00. In the same state, a family of four qualifies with a monthly income less than $4,759.00 before taxes.
When it comes to determining income limits for married couples when one spouse is applying for nursing home, assisted living, or in-home care coverage through Medicaid, the income of the couples is considered separately. The income of the non-applicant spouse is not included in determining the eligibility of the applicant spouse. For example, in 2020 if the applicant’s income is no more than $2,349.00 per month before taxes, he or she is eligible. If both spouses apply for coverage, the combined income should be no more than $4,698.00 per month.
Although the asset limit for Medicaid coverage varies from state to state, in most states an individual who is 65 or older may have up to $2,000.00 in countable assets. The home of an applicant is exempt if the value is not more than $595,000.00 in most states. This amount doubles when both spouses are applicants.
Who is eligible for both Medicare benefits and Medicaid services?
If you meet both the federal qualifications for Medicare and state qualifications for Medicaid, you can become a dual-eligible. If this is true, your Medicare benefits pay for your health care costs first and then Medicaid pays for those that are not covered by Medicare, as the second payer. Long-term nursing care and home health care are services that are covered in this manner.
Depending on your eligibility, you may qualify for either full benefits or partial benefits as a dual-eligible. As a full beneficiary, you are covered by Medicaid for all health care services it provides. With partial benefit status, you do not get Medicaid coverage for services, but Medicaid pays for Medicare premiums and coinsurances.
If you would like more information about whether you qualify for Medicaid, you can ask a representative at a Medicaid office in your area.