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.
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
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:
poverty level. Based on 2009 Federal Poverty Guidelines, a family of two would need an
- Pregnant women and children under 6 with family income at or below 133% of the federal
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:
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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