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Understanding the Qualifying Eligibility Criteria for Medicaid and How You Can Apply Today

Medicaid is one of the largest federal programs that provide affordable health insurance for those who qualify. Currently, this program provides health insurance for about 72.5 million Americans.

Since Medicaid is state operated, the qualification and eligibility may vary from state to state. In order to be eligible to receive the benefits of Medicaid assistance, a person or their family must be part of the eligible groups or meet any of the following criteria listed below.

Mandatory Eligible Groups:Image result for approved for medicaid illustration

  • Low-Income Families or Individuals
  • Qualified Pregnant woman and children without conventional health insurance
  • People receiving Social Security Benefits such as SSDI or SSI

Can I Apply for Medicaid?

Medicaid is a federally funded program but is administered at the state level. This is a type of health insurance for elderly, disabled and low-income families and services over 70 million Americans on a daily basis. If you are considering applying for Medicaid today then please read on for important information on your qualifying eligibility criteria for Medicaid.

Medicaid is Largely Income Based

If you earn a certain amount of money you may qualify to receive Medicaid. The income is based on where you fall within the federal poverty guidelines. It is also based on the number of people in your household. If you have four children and make $22,000 then you are likely to qualify for the program. The less you make the better your chances of getting accepted into the program. Again the income guidelines vary from state to state and the poverty level is different for Alaska and other nonconfidential states.

Image result for low income illustrationSometimes it is Not About Your Income

After the Affordable Care Act was established, many states in backlash declined to expand their Medicaid programs and qualifying eligibility criteria for Medicaid. This meant that many who were qualified, no longer meet the qualifying eligibility criteria for Medicaid. In states like Texas, if you don’t have children, then it is incredibly difficult to get Medicaid.

Medically Needy

Again one of the pitfalls of the ACA (Affordable Care Act) was the dissolution of high-risk pools in states such as Wisconsin, that allowed the medically needy to have health insurance as well as those with pre-existing conditions. Whilst the removal of denial of coverage due to pre-existing conditions was a blessing, the flipside was high out of pocket costs and deductibles. Medicaid has become a lifeline to the medically needy and the disabled because the services are free to low cost and provide those who need it with a superior level of care regardless of their socioeconomic or health status. If you are medically needy your income is not taken into account so why not consider applying for Medicaid today.

What Could Disqualify Me From Applying for Medicaid Today?

Understanding the criteria for Medicaid is very simple. If you make too much money, are childless and over 19, not pregnant, not on Medicare or an immigrant, chances are you don’t qualify. But the only way to know for sure is to apply for Medicaid online or in person for a full determination and explanation of your rights to appeal.

Understanding the Criteria for Medicaid

When attempting an understanding of the criteria for Medicaid, it is important to note that the criteria for applying for Medicaid differ from state to state. If you are disabled, medically needy, low income or over 65 and need additional help with your medical care then you may qualify for your states Medicaid program. If you are denied for some reason, then you do always have the right to appeal.

Financial Eligibility Criteria

To be eligible for coverage due to your finances, a person must meet one of the qualifying criteria listed below in order to receive free or reduced insurance rates under Medicaid. MAGI or modified adjusted gross income is typically the formula used to determine the financial eligibility of a person. This formula is a way of determining the financial situations of people due to the adjustments made according to family size, and demographics. For example, those at age 65 and older or individuals with disabilities who are receiving social security benefits, have slightly more constrictive criteria to receive the benefits; however, they may still be eligible under the SSI methodologies.

  • Have Total household income at or below the state-minimum income required for assistance, which can be found at https://www.healthcare.gov/lower-costs/
  • Have a Child under the age of 18 without access to health insurance through a parent or guardian.
  • Must be a U.S. Citizen.
  • Must be a resident of the state in which they are applying for benefits.
  • Meet the state-defined Criteria for medically needy.

Certain states have options for people with severe medical conditions that require constant attention but normally would not qualify for Medicaid Assistance based solely on income. This type of assistance is currently offered in only thirty-six states plus the District of Columbia. Anyone who has excessive medical bills due to a health condition can use this as a spend-down amount, which means that amount will not be counted towards their income.

Spousal Impoverishment

Anyone who qualifies for Medicaid coverage for long-term care services will also qualify for spousal impoverishment. This protects the spouse of the person receiving long-term care services from living in poverty due to insurance costs of the spouse needing to be cared for in a long-term care facility.

Third Party Liability

Third party liability criteria refer to people who are legally bound to pay for part of or all of the medical costs of a beneficiary. If the beneficiary has another form of medical assistance such as Medicare, Medicaid will only pay for the portion not covered by the other form of assistance.

How do I apply for Medicaid?Image result for Medicaid

If you are ready to apply for Medicaid then visit benefits.gov and the site will navigate you to your state-based website for instructions. Most states will direct you to file an application at healthcare.gov depending upon your state. Some states did not join the federal marketplace so your right to Medicaid may differ. After you file an application at healthcare.gov you will receive a determination that will tell you one of five things.

  • You qualify for Medicaid
  • You don’t qualify for Medicaid
  • You may qualify for Medicaid, and this usually comes up if you live in what’s called an assessment state.
  • Your income dictates that you qualify for the Marketplace and a subsidy to help you pay your monthly premiums, also known as the advanced premium tax credit.
  • You qualify for nothing and receive an exemption certificate number to make sure that you are not penalized for lack of health insurance.

If you are successful in obtaining Medicaid, then you will receive cards in the mail and will be able to choose an insurance carrier. Medicaid is administered by most of the major insurance companies and insurance cards are provided to you as they would be to any other client. In conclusion, Medicaid is a wonderful and essential service provided to Americans who are in need. The criteria can differ from state to state but this should not discourage you when applying. If you need assistance when applying, there are several groups that can help you to file the application and if you wish to appeal any determination you should seek legal advice and ask the local Medicaid office for their eligibility guidelines.

Applying for Medicaid BenefitsRelated image

If you or someone you know meets the above criteria or if you want to obtain more information about the Medicaid program visit https://www.medicaid.gov/medicaid/eligibility/. You can also find easy to follow application instructions listed below.

Applying Online

You can apply online for a quick and easy approach to the application process, online applicants tend to also see a quicker response. To apply online follow the instructions below:

  • Go to www.medicaid.gov
  • Click on “Learn how to apply for coverage”
  • Then go to “Find out if you qualify and apply” on the right-hand side
  • Click the large blue button that says “Find out how” and follow the instructions

Paper Application

If you want to apply through a paper application you would simply visit your local Division of Social Services office or (DSS) and obtain a paper application for Medicaid. Fill out the application in its entirety and either mail it or drop it off at the local DSS office.

What You Should Keep In Mind

Some things to remember when applying for Medicaid is that you must have a valid driver’s license or Identification card, as well as an original form of your social security card and or birth certificate. You are also required to be a citizen of the United States, with legal documentation to verify. You will also only be permitted to apply for benefits within the state in which you reside, with documentation to verify that as well. To find out today if you qualify by visiting www.medicaid.gov/apply-for-coverage/index.html. If you have any questions or concerns while applying do not hesitate to contact someone from your local DSS office or simply stop in and ask for assistance.