Medicaid Eligibility: How to Find Out if You Are Eligible for Medicaid

There are many misconceptions about Medicaid, the most common being that Medicaid was designed to provide health care to only the poor. While income is a factor when a caseworker determines Medicaid eligibility, it is not the sole qualification. Applicants must also meet other eligibility requirements, including falling into specific groups, citizenship, assets and resources.

Income is usually the first thing to be considered when you apply for Medicaid. Income limits vary by state, but generally are at or near poverty level. In some states, individuals who have income over the limit, but are otherwise eligible for Medicaid may still be able to receive benefits. However, these individuals may be required to reach a deductible before Medicaid benefits begin or pay a co-payment when visiting the doctor.

In order to be eligible for Medicaid, individuals must fall into specific eligible groups. These groups include low-income families with children in the home; aged, blind or disabled individuals or those receiving SSI benefits; children under the age of six; pregnant women and infants born to Medicaid-eligible mothers; recipients of adoption or foster care assistance; some Medicare recipients; and special protected groups.

States also have the option of covering other specific groups at their discretion. Optional eligibility groups may include uninsured women with breast or cervical cancer, tuberculosis or HIV patients, the medically needy, institutionalized individuals, or recipients of state supplementary payments. Individuals that may be eligible as an optional group should refer to their state’s guidelines or speak to a Medicaid caseworker in their area for more information.

Assets and resources are also a factor in determining eligibility for Medicaid. These include automobiles, boats, bank accounts, certificates of deposits (CDs), cash, stocks or bonds, and retirement accounts. If an applicant has sold or transferred an item to another party recently, it’s a good idea to disclose that information on the application because there is a look back period. The length of time a caseworker will go back varies from state to state. If an applicant fails to advise their caseworker of recent transactions, it could be construed as an attempt to hide assets or resources in order to get Medicaid benefits.

It is important that applicants do not lie or attempt to hide income, assets or resources. This is considered fraud. If an applicant is caught attempting to defraud Medicaid, penalties may be assessed, including jail time, fines, repayment of Medicaid funds, or loss of Medicaid eligibility for a set period of time, which can be forever.