What are the requirements for Medicaid? Knowing how to qualify for Medicaid insurance coverage can be really helpful for people who need assistance affording health care coverage. Since the program was created to help low-earning people, you will need to learn what are the income requirements to enroll in Medicaid as well as any additional qualifications. However, to qualify for Medicaid you need more than a low income. The United States government established specific Medicaid eligibility requirements including residency and citizenship criteria you will need to meet to get coverage. State Medicaid programs need to follow these mandatory rules, although some states have a reduced Medicaid benefits eligibility program called the “medically needy program.” To learn more about the Medicaid application rules and requirements, read the sections below.
Learn About Medicaid for Seniors
Some seniors who qualify for Medicaid benefits also meet the requirements for Medicare. If you meet both Medicare and Medicaid eligibility requirements, having both could significantly reduce the cost of your monthly premiums and your out-of-pocket costs. If you qualify, you can have coverage from either program or from both at the same time. This is only available to seniors who meet the age requirements and people with specific disorders or disabilities.
If you qualify for Medicaid and Medicare health insurance, then Medicaid will step in to cover services that your Medicare would not cover. That means that if you meet Medicaid benefits eligibility and you already have Medicare, you could get coverage for prescription drugs, dental care, and vision care even if you do not have Medicare Part C or Medicare Part D.
Download our free guide to learn more about getting medical insurance from Medicaid and Medicare for wider coverage.
Find Out About Senior Medicaid Benefits Requirements
The federal requirements for Medicaid that apply in all states include meeting residency and citizenship qualifications. You will not qualify for Medicaid unless you can prove your citizenship status. Medicaid health insurance services are only available to United States citizens or qualifying non-citizens like lawful, permanent residents. You will need to share certain documents during the Medicaid application process that show that you meet the citizenship requirement.
In addition to the citizenship and non-citizen Medicaid eligibility requirements, you have to be a resident of the state where you are applying for benefits. As part of the Medicaid application guidelines, you will also need to give proof of state residency. You will need to share the necessary documents that show that you meet the requirements for Medicaid with your application.
What are the income requirements for Medicaid?
The income requirements will depend on whether you get Supplement Security Income (SSI). Medicaid eligibility requirements for people who do not get SSI will be based on the MAGI system (modified adjusted gross income). The MAGI system includes earned and unearned income like alimony and child support payments, pensions and veteran benefits. During the application process, officials will take a look at your earnings and qualified deductions as well as the size of your household to decide if you meet the income requirements to get coverage. Households with more family members can have higher earnings than individual applicants and still qualify for coverage. The maximum amount that a household can earn and still qualify depends on the federal poverty level, which considers the number of family members the income must cover. If you do get SSI, then the income Medicaid eligibility requirements tend to be lower than the ones estimated by the MAGI system. This allows more seniors to access Medicaid.
To learn more about how to qualify for Medicaid coverage, download our guide.
Discover Senior Requirements for the Medically Needy Program
You should also consider the Medically Needy Program. This is a program that many states offer to seniors who have serious health issues but an income level that would not generally meet Medicaid benefits income requirements. he Medically Needy Program calculates the “spend down” amount by subtracting the state’s medically needy income level from the senior’s income level. Once the senior spends the “spend down” amount on medical expenses, that person meets Medicaid eligibility requirements and then can receive Medicaid health insurance from then on.
Keep in mind that this program is only offered in 36 states and the District of Columbia, so you may only be eligible for this program if you live in any of these states, meet Medicaid benefits eligibility requirements (apart from income) and meet the Medically Needy Program requirements.