Medicaid Isn’t Only For the Poor

When most people hear about Medicaid, they assume that it is simply another public assistance program meant only to benefit the poor.  The truth is, Medicaid provides health coverage for more than just low-income families.  While each state has its own rules regarding eligibility for the program, there are categories of individuals, other than the low-income, that are generally eligible for Medicaid benefits.  Medicaid isn’t only for the poor.

What is the basic purpose of Medicaid?

Medicaid is a federally-created public health insurance program, meant to provide health care coverage to low-income individuals, including: children, parents, pregnant women, seniors and individuals with disabilities. As of 2014, Medicaid provided health care coverage for 80 million individuals, of which 5 million were seniors and 9 million were individuals with disabilities.  Children account for nearly 40% (31 million) of all recipients of Medicaid benefits.  So, clearly Medicaid covers more than just low-income individuals.

Who can receive Medicaid benefits?

In order for a state to receive federal funding, the state must provide Medicaid benefits to certain categories of individuals, determined by the government to be “mandatory” populations.  These categories include children (up to age 18) in a family with income below 133% of the federal poverty line.  In 2015, the income limit for a family of three is $26, 719.00. Pregnant women, whose income is also below 133 % of the poverty line, are also covered.  Most seniors and individuals with disabilities, who also receive benefits through SSI (Supplemental Security Income) program, are generally eligible for Medicaid.

Who are the “medically needed?”

There are also certain individuals whose income may exceed the income limits for Medicaid, but whose medical expenses are so substantial that their income is essentially reduced to below the eligibility limit.  These people, considered “medically needy,” may also be eligible for Medicaid under the new health care reform provisions.  In states that have a Medically Needy Program, individuals are allowed to use their medical expenses to reduce their countable income.

States have wide discretion with eligibility

The federal government allows states to have wide-ranging flexibility in deciding which groups of individuals, and at what income level, the state will cover for purposes of Medicaid.  For this reason, eligibility for Medicaid varies significantly from one state to the next.  There are other eligibility criteria that are used in determining Medicaid eligibility. For example, in order to be eligible for Medicaid, an individual must satisfy federal and state requirements regarding residency, immigration status, and documentation of U.S. Citizenship.

Who is not eligible for Medicaid

While Medicaid is not only for the poor, it does not cover all low-income individuals, either.  Adults, age 21 and older, who do not have children and who are not disabled, pregnant or elderly, are typically not eligible for Medicaid, regardless of how low their income may be.  Legal immigrants are not allowed to apply for Medicaid during the first five years they live in this country.  This is true, even if they initially meet all of the eligibility requirements.

If you have questions regarding Medicaid eligibility, or any other Medicaid planning needs, please contact Sexton, Bailey Attorneys, PA online or by calling us at (479) 443-0062.