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What are the eligibility requirements for Medicaid?

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Quick Answer

In order to qualify for Medicaid, a person or family generally must meet state guidelines for income as a percent of the federal poverty level - which, for a family of four, was $24,250 in 2015. There are also federal and state requirements for residency and citizenship status.

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Full Answer

The qualification level varies by state, and partially depends on whether the state participates in expanded Medicaid or not. If the state does participate, then the qualification is at least 133 percent of the federal poverty level and below. In other words, a family of four with a modified adjusted gross income of $32,252.50 in 2015 would qualify in states with expanded Medicaid.

The requirements also vary depending on who is in need of coverage. There is usually a higher income limit for children than there is for adults. For example, in California in 2015 adults who need assistance must meet the 133 percent federal poverty level threshold. However, the families of children who need assistance qualify up to 261 percent of the federal poverty level ($63,292.50).

The documentation requirements by state can also vary. States such as New York require proof of expenses and proof of any current or prior health insurance. Other states simply require proof of income. Most states also require those in need to show proof of residency within the state as well as U.S. citizenship. However, those requirements may be waived for pregnant women.

The requirements for Medicaid eligibility are divided into two categories: general requirements and financial requirements. General requirements include gender, age and disability status, as LongTermCare.gov explains. For women, pregnancy status is also a factor. Children and their parents or caretakers can also qualify for Medicaid plans. An applicant’s disability should be in line with the definition from the Social Security Administration.

Financial eligibility requirements are determined by the income level group and medical needs of applicants, according to LongTermCare.gov. Different states determine income levels differently, but generally, regular benefit payments such as salaries, wages, pensions, veteran's benefits and dividends from bonds and stocks determine income levels. Others include interest from bank accounts, returns from certificates of deposit, disability payments and social security retirement payments.

Things such as food stamp nutrition assistance, federal government housing assistance and home energy assistance are not included as relevant income. Most states provide coverage for the special income level group, states LongTermCare.gov. To be eligible under this group, an applicant must be 65 years and above, blind or disabled. He must also be in a care institution such as nursing home for 30 consecutive days or more.

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