What Should You Know Before Applying for Medicaid?

What Should You Know Before Applying for Medicaid

You may qualify for Medicaid if your income falls below a certain level, and you meet certain other eligibility criteria. Medicaid is a federal program operated independently by each state. According to Medicaid.gov, approximately 72.5 million Americans have health insurance coverage through Medicaid. The program provides insurance for more people than any others, including the age-based Medicare program. Read on for some important things to know before applying for Medicaid.

Understanding What Federal Law Requires

Federal law requires each state to provide coverage to low-income families and individuals, people who receive Supplemental Security Income (SSI), pregnant women, and children who meet all eligibility requirements. These groups of people fall into mandatory eligibility groups. Governments of each state have the option to add additional groups or cover certain individuals. Common examples are children living in foster care not eligible for other healthcare programs and people who receive community-based services because of a disability.

2010 Medicaid Expansion

Congress passed the Affordable Care Act (ACA) 11 years ago that expanded access to Medicaid for millions more Americans who had not yet reached their 65th birthday. Under ACA, all children whose families earned a minimum of 133 percent of the federal poverty rate automatically qualify for Medicaid. Several states chose to extend the same eligibility requirements to adults. If you feel your annual income is low enough to qualify for Medicaid, your next step is to check the eligibility requirements in your state.

Main Eligibility Criteria for Medicaid

States use both financial criteria and non-financial criteria when deciding whether to approve a Medicaid application. Employees who process applications use the Modified Adjusted Gross Income (MAGI) model to determine the financial eligibility aspect. Several other federal healthcare programs use MAGI, including the Children’s Health Insurance Program (CHIP) and the health insurance marketplace operated by individual states.

MAGI considers the applicant’s taxable income, eligible deductions, and tax filing status. The formula replaces a previous program used to determine Medicaid eligibility associated with the now-defunct Aid to Families with Dependent Children (AFDC). MAGI does not require applicants to disclose assets or apply a resource test.

People who are blind, have other significant disabilities, or are over age 65 do not have MAGI applied to their Medicaid application. State governments typically use the formula for determining social security disability income (SSDI) eligibility for Medicaid applicants who fall into one of these three groups.

Non-Financial Qualifications for Medicaid

Federal and state governments also require Medicaid applicants to meet the following non-financial criteria:

  • Be a permanent resident of the state where they applied for Medicaid.
  • Be born in the United States or a naturalized citizen, although certain lawful permanent residents also qualify.
  • Meet age, parenting, and pregnancy status qualifications imposed by individual states.

Contact the Elder Disability Law Firm of Beasley & Ferber

Applying for Medicaid can be frustrating and confusing, especially when eligibility requirements can vary significantly between states. Beasley & Ferber invites you to request a consultation with our elder disability law firm today to receive guidance as you go through the process.