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Medicaid: Who Is Eligible For Medicaid?


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To be eligible for Medicaid, you must:

  • Be a member of an eligible group. The identity of the groups differ from state to state. For our purposes, you must have a "disabling health condition" as defined by Social Security. To learn more, see: Disability For Purposes Of Social Security.
  • Fit legal status requirements. 
    • You must be an American citizena legal refugee or an immigrant in the United States more than five years. Some states fund benefits for some other aliens as well.Illegal aliens who are not otherwise eligible for Medicaid can qualify only for emergency care and, in some states, prenatal care and birth. For more information, see: offsite link.
    • Illegal aliens who are not otherwise eligible for Medicaid can qualify only for emergency care and, in some states, prenatal care and birth.
  • Be eligible financially. You must have both assets and income below a defined level.
    • The financial requirements vary from state to state. 
      • The financial requirements are basically the same as the requirements for Supplemental Security Income (SSI). However, many states apply a more liberal standard for exemptions and deductions for Medicaid than with respect to SSI.
      • To learn about  eligiblity requirements in your state, click here offsite link.  
    • Certain assets are not counted in determining whether eligibility tests are satisfied (a lived-in home of any value, one vehicle, household goods, $2,000 in other assets, up to $1,500 in separate burial funds).
    • Some income isn't counted in determining eligibility. For example, $20 monthly per family, $65 and half the rest of wages in most, but not all, states.
    • States are allowed to permit certain "Medically Needy" people with higher incomes to qualify if they incur enough medical expense. This is known as "Spending down" or "Medically Needy." Most, but not all, states allow spend downs.
    • States are also allowed to grant "waivers" to certain designated diagnostic classes of people with higher income in certain circumstances.
    • Within very complex limits, you can transfer income and/or assets to qualify for Medicaid. To learn how to plan to preserve assets while Medicaid pays for long term care, see: Medicaid: Planning For Long Term Care.

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