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Medicaid Eligibility

Medicaid is a health insurance program designed to help people who cannot afford medical care.  Though Medicaid is generally available to people with limited income, a person must also meet certain other requirements in order to be eligible for Medicaid.  These requirements include a person’s age, whether s/he is pregnant, disabled, blind, or aged,  his/her income and resources, and whether s/he is a U.S. citizen or a lawfully admitted immigrant.  The rules for determining a person’s income and resources vary from state to state.  There are also special rules for some categories of people like those living in nursing homes and for disabled children living at home.

The immigration status of an individual is an important factor in determining whether or not the individual qualifies for Medicaid.  In general, a person must be a U.S. citizen to qualify for Medicaid.   In addition, legal immigrants may be able to qualify under certain circumstances.  Illegal immigrants who would otherwise qualify for Medicare can receive Medicaid assistance in emergency situations only.

Although income is an important aspect in determining whether or not a person qualifies for Medicaid, having low income alone is not the sole requirement.  Indeed, there are many people who are poor and below the poverty level who do not meet Medicaid requirements because they do not fit within the designated eligibility groups.  The groups of people who are eligible for Medicaid assistance are:

  • Pregnant women and children under six with family income at or below 133% of the federal poverty level.
  • Children aged six 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.

In some cases, one member of the family may be eligible for Medicaid whereas others are not.  For example, a child in the family may be eligible for coverage if s/he is a U.S. citizen or a lawfully admitted immigrant, even if the parents are not.  Eligibility for children is based on the child’s status, not the parent’s.

Some states offer Medicaid to medically-needy individuals even if they do not meet the income requirements.  The following states have medically needy Medicaid programs:

  • Arkansas
  • California
  • Connecticut
  • 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

In general, a person should apply for Medicaid if his/her income is limited and the person falls within one of the eligibility groups.  A person who is not sure if s/he qualifies for Medicaid can have a qualified caseworker in the state evaluate the situation and give a report as to whether the person qualifies or not.

Inside Medicaid Eligibility