Medicaid Eligibility

Medicaid eligibility is available to people with limited incomes. You must meet certain requirements in order to be eligible for Medicaid. Medicaid does not pay money to you; instead payments are paid directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (as a co-payment) for some medical services.

Many various groups of individuals are covered by Medicaid. Within these different groups certain requirements must be met to be eligible. These requirements include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant.

The rules for counting income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home. Medicaid is means-tested and does consider an applicant’s assets and whether assets were given away to qualify for Medicaid. There are many special rules that apply to those seeking to qualify for Medicaid to help pay for long-term care, whether in a nursing home or in the community. These rules address penalties for transferring assets for less than fair value, income and resource protections for the spouse, and estate recovery.

Every state Medicaid program must cover inpatient and outpatient hospital services, laboratory and x-ray services, physician services, nursing facility services (which is more extensive than Medicare’s skilled nursing facility coverage), and home health services. In addition to the required services, states can include many optional services in their programs. Every state program includes some prescription drug coverage.

Generally, you should apply for Medicaid if you or someone in your family needs health care and cannot afford it. Be sure to apply for Medicaid within the state you reside in, and engage a qualified caseworker in your state to evaluate your individual situation. Every state’s rules vary, so it would be beneficial to seek out an elder law attorney in your area who specializes in Medicaid before you attempt to transfer assets or apply without any legal guidance.

Information provided by: http://www.cms.hhs.gov

*See videos on Medicare on our Medicaid page here.