Medicaid Eligibility Requirements

Medicaid Eligibility Requirements

Poverty alone cannot ensure you that you are eligible for receiving Medicaid benefits. About 60% of poor Americans are not covered by Medicaid just because they do not qualify the criteria for eligibility to get Medicaid services. Therefore, it is essential to know what the different aspects of Medicaid eligibility are and who can apply for Medicaid benefits.

Medicaid is a federal and state government joint venture to provide medical insurance coverage to the people belonging to the low income and resources group.  Even though Medicaid is a federal and state government funded initiative, the rule regarding eligibility and the range of coverage differ considerably for each state. However, some common criteria are applicable in all cases. The most important factor in deciding the eligibility for Medicaid is income and resources. The income threshold may be different for the various states of the country. The calculation of one’s resources also has slight variations from state to state. Usually, the factors that are considered while assessing the resources are bank accounts, real estate property like land and house, and other assets and items which will make cash if sold. The State Medical Assistance office may help you to assess your eligibility for Medicaid plan. If you receive Supplemental Security Income from the Social Security Administration, you could be eligible for Medicaid depending on your state’s rule.

Other factors that affect the eligibility for Medicaid are age, residency, citizenship or legal status, pregnancy, and family size. Low-income families with children, children under 19 (in some states 21), pregnant women and the child born when the mother is on Medicaid, single parents, individuals with permanent disabilities, people over the age of 65, beneficiaries of Medicare program, people requiring long term care in permanent living facilities, and people receiving Social Security are eligible for Medicaid. Children are eligible for Medicaid even if the parents do not qualify. Children’s eligibility is calculated based on his/her residency status. Even someone else’s child living in your house can be eligible for Medicaid. In the case of pregnant women, marital status is not considered while assessing eligibility. Aged, blind, and disabled people should meet the categorical eligibility criteria; people aged 65 and above, and those who meet the definitions of blind and disabled set by the Social Security Administration qualify for Medicaid benefits.  Legal immigrants can apply for Medicaid if they pass the eligibility criteria. Advanced HIV patients are also eligible for Medicaid.

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