Looking for more information on Medicaid and
Medicaid Plans?
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 medical services.
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.
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.
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