Looking for more information on Medicaid, Medicaid Services, and Medicaid Plans?

Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. Read more about your state Medicaid program.
 
Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may 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 your 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 available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law.

Medicaid does not pay money to you; instead, it sends payments 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 (co-payment) for some medicaid medical services.

Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not (however, there is a 5-year limit that applies to lawful permanent residents). Eligibility for children is based on the child's status, not the parent's. Also, if someone else's child lives with you, the child may be eligible even if you are not because your income and resources will not count for the child.

In general, you should apply for Medicaid if your income is low and you match one of the descriptions of the Eligibility Groups. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)

Medicaid Screening Tools
To help you see if you may be eligible for a variety of governmental programs, you may access the GovBenefits and BenefitsCheckUp websites.

When Medicaid Eligibility Starts
Coverage may start retroactive to any or all of the 3 months prior to application, if the individual would have been eligible during the retroactive period. Coverage generally stops at the end of the month in which a person's circumstances change. Most States have additional "State-only" programs to provide medical assistance for specified poor persons who do not qualify for the Medicaid program. No Federal funds are provided for State-only programs.

What is Not Covered in Medicaid
Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups. Low income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. As noted earlier, categorically needy persons who are eligible for Medicaid may or may not also receive cash assistance from the TANF program or from the SSI program. Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses.

Services for categorically needy eligibility groups:
Medicaid eligibility groups classified as categorically needy are entitled to the following services unless waived under section 1115 of the Medicaid law. Under the EPSDT program, states are required to provide all medically necessary services. This includes services that would otherwise be optional services.

 These service entitlements do not apply to the SCHIP programs.

■Inpatient hospital (excluding inpatient services in institutions formental disease).
■Outpatient hospital including Federally Qualified Health Centers (FQHCs) and if permitted under state law, rural health clinic and other ambulatory services provided by a rural health clinic which are otherwise included under states’ plans.
■Other laboratory and x-ray.
■Certified pediatric and family nurse practitioners (when licensed to practice under state law).
■Nursing facility services for beneficiaries age 21 and older.
■Early and periodic screening, diagnosis, and treatment (EPSDT) for children under age 21.*
■Family planning services and supplies.
■Physicians’ services.
■Medical and surgical services of a dentist.
■Home health services for beneficiaries who are entitled to nursing facility services under the state’s Medicaid plan.
■Intermittent or part-time nursing services provided by home
health agency or by a registered nurse when there is no home
health agency in the area.
■Home health aides.
■Medical supplies and appliances for use in the home.
■Nurse mid-wife services.
■Pregnancy related services and service for other conditions that might complicate pregnancy.
■60 days postpartum pregnancy related services.

*Under the EPSDT program, states are required to provide all medically necessary services. This includes services that would otherwise be optional services.