What Are the Eligibility Criteria for Medicaid?


Quick Answer

The federal financial eligibility criteria for Medicaid qualification is income less than 133 percent of the federal poverty level, though certain states have elected to raise the minimum eligibility requirement to above 133 percent. The Affordable Care Act of 2010 set the federal standard for financial eligibility, effective in 2014. This standard greatly increased the number of individuals and families eligible for Medicaid.

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Full Answer

Non-financial criteria for Medicaid qualification includes federal and state residency requirements, immigration status and documentation of citizenship. In order for a state to participate in the Medicaid program, federal law requires the state to cover certain population groups, referred to as mandatory eligibility groups. Federal law allows the states the option to cover additional population groups, referred to as optional population groups.

As of 2011, 133 percent of the federal poverty level is $29,700 for a family of four. As of 2014, Medicaid currently provides health insurance to 60 million Americans, among them children, pregnant women, parents, seniors and the disabled.

Medicaid provides mandatory benefits such as inpatient hospital care, outpatient hospital services, physician services and nursing facility services. It also provides voluntary benefits, such as prescription drugs, dentures, and physical and occupational therapy. Federal law requires that states provide only the mandatory benefits in order to participate in Medicaid.

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