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Who is eligible for medicaid

Posted by admin on Tuesday, March 17, 2015 · Leave a Comment

Medicaid is a government-subsidized health care program for families with children and individuals with low income. Funds from both federal and state governments are used to run the program, and each state determines who is eligible. Some states have expanded coverage, and guidelines include calculation of income based on the Federal Poverty Level (FPL).

General Eligibility Guidelines

Under the current version of the Affordable Care Act of 2010, all U.S. citizens and legal residents with income up to 133 percent of the FPL qualify. This includes adults without dependent children.

The FPL is updated annually and includes percentages for the 48 contiguous states and different percentages for Alaska and Hawaii. According to the 2015 FPL, a household of two living in the state of Illinois, with annual income of $21,867 is at 133 percent of the FPL, while a household of four, with annual income of $32,253 is at 133 percent of the FPL.

However, states that have not expanded coverage can apply to the Center for Medicare and Medicaid Services for exemption from Affordable Care Act mandates and follow their own criteria. To date, 22 states have opted not to expand Medicaid .

Children and teens up to age 19 and their parents are eligible based on household income, and youth who were formerly in foster care are eligible until age 26. In most states, children whose parents have income up to 200 percent of the FPL ($48,500 for a family of four) will qualify.

Individuals with disabilities are also eligible. In most states, those receiving Supplemental Security Income (SSI) are automatically qualified for Medicaid. Ten states have additional criteria not used by the SSI program.

Applicants who are not receiving SSI, but claiming disability must prove they

are impaired and unable to work for at least one year. If they are then determined disabled, limited income and assets establish eligibility.

Pregnant women are covered through extended Medicaid at a high rate. Some states have programs that allow expectant mothers with incomes above the FPL to enroll. After delivery, women retain eligibility through the 60th day even if family income changes. Their newborns are automatically eligible.

Other Qualifying Factors

Determination of Medicaid eligibility is not solely based on income. Applicants must meet federal and state mandates on immigration status, residency, and documentation of U.S. citizenship.

Naturalized American citizens have the same rights as U.S. born ones. In 2009, states were allowed to provide Medicaid to pregnant women and children who are lawfully present in the United States, without a waiting period. However, if states do not choose this option, pregnant women and children must wait five years before qualifying.

Limited Medicaid for Undocumented Immigrants

Undocumented immigrants are not eligible for federal or non-emergency Medicaid coverage. Eligibility for Emergency Medicaid only is possible if the immigrants are low income. Citizen children of undocumented parents do qualify for Medicaid under current law.

Verification to Establish Eligibility

Family members who are applying for benefits who are applying for Medicaid must provide a Social Security number and their citizenship or immigration status. Documentation of a legal right to be present in the United States must be established for Medicaid eligibility. All information is verified through the Social Security Administration for citizens and through the Systematic Alien Verification for Entitlements (SAVE) database for non-U.S. citizens.

If status cannot be verified through SAVE, other proof of income can be accepted. It is sometimes necessary to obtain the SSN of a non applicant to verify household income and determine whether other members of the household qualify.

Category: Insurance

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