Qualifying for Medicaid

By Susan Landis-Steward , last updated June 22, 2011

Medicaid is a federally funded insurance program that provides health care to those on limited incomes, and it has strict eligibility guidelines for qualifying. Medicaid is a direct pay program, meaning that it pays directly to your health care providers. In some states, you may also be required to pay small co-payments to the doctor. Not every physician takes Medicaid, as they are allowed to opt-out of the program, so you may have to do some searching to find a doctor.

To be eligible for Medicaid, you must disclose your age, existing medical conditions such as blindness, disabilities, or pregnancies, and your income and financial resources. You must be a U.S. citizen or a legal immigrant.

Each state sets its own rules for eligibility, and there are special rules for groups such as people living in nursing homes or disabled children still living at home. You can check online.

If you are 65 or older, blind, or disabled, and have limited income and resources, you probably qualify. If you have a terminal disease requiring hospice care, you also may qualify. If you are in a nursing home, or could avoid a nursing home with in-home care, you should also apply. If you have been on welfare and are now leaving welfare, you may also be eligible. If you have a low income and children under 18, or if you have very high medical bills you cannot pay, you should see if you are eligible.

A child's eligibility is based on the child's status. So if you have a foster child, or another child who is not related to you, that child may qualify even if you do not. Children who have serious medical conditions that require nursing care may be eligible if they could remain in the home with proper care.

If you are unsure if you or a child qualifies, you should apply and allow the Medicaid caseworker to make the eligibility decision. In addition, most states have their own programs to provide low-income health care so you should apply for those as well. Many of these program provide care for people who do not qualify for Medicaid.

Some groups are automatically eligible for Medicaid according to federal guidelines. These include families who meet certain requirements of the Aid to Families with Dependent Children plan in effect in 1996, those who receive SSI benefits, infants born while their mothers are eligible, and children under age 6 or pregnant women whose families have an income below 133 percent of the federal poverty level. If you are adopting or fostering a child and receive adoption assistance or foster care payments, the child may be eligible. You may also receive Medicaid for a limited period of time if you formerly had SSI income but lost it because of earnings or higher Social Security benefits.

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