Medicaid is a federally funded, state-administered program. The U.S. government set up basic eligibility requirements for coverage that are followed by all state agencies. These requirements cover various groups of people and deal mainly with age and income levels. Rules for calculating income and resources vary by state, and can vary by group.
Children
Eligibility is determined on the child's status, not the parents'. Children who live with unrelated guardians will not have the income or resources of those guardians counted for the child. Minors can apply on their own if they live on their own. Adult children living with families of limited income can apply through the parent or guardian. Children requiring nursing home care or in-home care are eligible. Children whose families are at or below 133 percent of the federal poverty level are automatically allowed until age 6. Children born to parents already on Medicaid are automatically eligible; coverage continues through the first year after birth as long as the mother remains eligible.
Citizenship
Applicants must be a U.S. citizen or legally admitted immigrant. Children of lawfully admitted immigrants may be eligible, but there is a five-year limit for lawful permanent residents.
Disabilities
Persons 65 years or older who are blind, disabled, or have limited income are eligible. Terminally ill patients seeking hospice services or living in a nursing home are eligible. Persons needing nursing care but remaining in their homes while receiving special community care services are eligible.
Income Level
Persons who receive Supplemental Security Income (SSI) or who fall at or under 133 percent of the federal poverty level are eligible for Medicaid. Eligibility is provided for families with children as stated in the Social Security Act, Section 1931, as allowed by the requirements of the state's Aid to Families with Dependent Children (AFDC).
Mandatory Eligibility
Pregnant women eligible for Medicaid remain so to the end of the second full month after the child's birth. Eligibility testing standards cannot be higher than the AFDC program covering children or the SSI program covering expectant mothers. Applicants who also receive adoption assistance or foster care using Title IV-E of the Social Security Act cannot be denied Medicaid.
Optional Eligibility
Eligibility is extended to elderly, or disabled adults, when income is above mandatory coverage but below federal poverty guidelines. Minor children who fall within guidelines for Aid to Families with Dependent Children, but are not otherwise eligible for AFDC, can apply. Institutionalized persons with limited income are eligible. Patients infected with tuberculosis who are financially eligible for the program under the SSI levels can receive Medicaid for TB-related ambulatory and drug services.
Tags: federal poverty, limited income, Dependent Children, eligible Medicaid, Families with, Families with Dependent
