Medicaid Eligibility

There is more to Medicaid eligibility than simply having a low income. Medicaid requirements are based on certain Medicaid guidelines. We take a look at what it takes to become Medicaid eligible.

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Medicaid provides medical assistances for certain types of low-income individuals. Medicaid pays medical bills with funds from federal, state, and local taxes. Patients with Medicaid may sometimes be responsible for making a small co-payment for services, but they don’t often have to pay anything for services.

Medicaid assistance is often confused with Medicare, but the two are different programs. Medicare is a type of health insurance for individuals over 65 and those under 65 with certain disabilities. The eligibility requirements for Medicaid and Medicare are different.

Having a low income is not the sole requirement for receiving Medicaid assistance. There are many people who are poor, with incomes below the poverty level, who do not meet Medicaid requirements because they do not fit within the designated eligibility groups.

Generally these groups of people can receive Medicaid assistance:

  • Pregnant women and children under 6 with family income at or below 133% of the federal poverty level. Based on 2009 Federal Poverty Guidelines, a family of two would need an income less than $19, 378 to qualify for Medicaid assistance.
  • Children ages 6 to 19 qualify with a family income at or below the federal poverty level.
  • Adults who take care of children under age 18.
  • Individuals who receive Supplemental Security Income
  • Teenagers up to age 21 who are living on their own
  • People who are over 65, blind or disabled

Some individuals who do not meet the income requirements may still receive Medicaid benefits because they are medically-needy. The following states have medically needy Medicaid programs:

  • Arkansas
  • California
  • Connecticut
  • the District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Montana
  • Nebraska
  • New Hampshire
  • New Jersey
  • New York
  • North Carolina
  • North Dakota
  • Pennsylvania
  • Puerto Rico
  • Rhode Island
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin

If you do not live in a state with a medically-needy program and you do not meet the income requirements, you may not qualify for Medicaid.

In general, you must be a U.S. citizen to qualify for Medicaid. Legal immigrants may be able to qualify in certain circumstances. Illegal immigrants who would otherwise qualify for Medicare may be able to receive Medicaid assistance in emergency situations only.

Medicaid coverage can be retroactively applied up to 3 months before the application was made as long as you were Medicaid eligible for coverage during that period. So, if you incurred medical bills before you applied for Medicaid, you may be able to have those bills covered as long as you make your Medicaid application within the specified time frame.

Since Medicaid eligibility varies by state, it’s difficult to list all the groups and categories of people who qualify for Medicaid assistance. To find out if you qualify for Medicaid, you should contact your state’s Medicaid office for specific details about eligibility in your state.

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