How to Qualify for Medicaid

Medicaid exists to help people afford medical costs and provides aid to men, women, and children of all ages. Medicaid is a federal program which is made available in and administered by every state. To enroll in the program, you will need to meet certain criteria such as income level, family size, or disability status. Many requirements will vary depending on the state you are a resident of.[1] Learn more about Medicaid to see if it might be the right choice for you or your family.

Method 1
Method 1 of 2:

Qualifying for Medicaid

  1. Image titled Qualify for Medicaid Step 1
    1
    Learn if you are eligible for Medicaid. There are some requirements that you should meet before you apply for Medicaid. These qualifications will vary from state to state; however, there are some commonalities that you can expect. Review the following list of qualifications to get an overview of what might be required of you.[2]
    • Be at a certain income level. For example, a family of 4 can earn no more than $29,700 annually by federal requirements.
    • The size of your family will determine required income level minimums. Larger families will have higher requirements for income.
    • Either be disabled yourself or be the beneficiary of someone who is disabled. You may also be required to submit medical proof of any disabilities.
    • State specific requirements. Some states have higher allowances for their minimum income requirements.
    • Other criteria may be required such as residency, immigration status, as well as providing documents proving your U.S. citizenship.
  2. Image titled Qualify for Medicaid Step 2
    2
    Be aware that some non-citizens may still be eligible. Even if you are not a citizen of the United States of America, you may still qualify to receive Medicaid. Review the following points to see if you fit in this category of non-citizens who may still receive Medicaid:[3]
    • If you have claimed asylum or are a refugee.
    • If you are a lawful permanent resident or hold a green card.
    • If you were a victim of human trafficking.
    • If you are a veteran or currently active member of the military.
    • If you are entering from Cuba or Haiti.
    • If you were under parole for more than 1 year.
    • If you are a non-citizen woman or child who was a victim of battery.
    Advertisement
  3. Image titled Qualify for Medicaid Step 3
    3
    Check your income level. If you live below or near the federal poverty level, you may be eligible for Medicaid. Each state will have their own requirements for income level. Compare your income to these federal and state income levels to learn if you are eligible for Medicare.[4]
    • As of 2011, the Federal poverty level for a family of four is $29,700 annually.
    • The Affordable Care Act of 2010 allows income levels to be 133% of the federal poverty level.
    • Income level requirements will vary from state to state. For example, income levels in New York can be 149% of the federal poverty level while Maryland allows up to 317%.[5]
    • A detailed list of state income requirements can be found at "www.medicaid.gov"
    • Income levels are usually judged in consideration with the size of your family.
    • Not all states have expanded their coverage under the Affordable Care Act. 19 states are currently not expanding coverage including Alabama, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Carolina, South Carolina, Oklahoma, South Dakota, Texas, Virginia, and Wisconsin.[6] [7]
  4. Image titled Qualify for Medicaid Step 4
    4
    Learn about additional eligibility groups. If you don't find yourself fitting into one of the main groups served by Medicaid, you may want to see if you fit into the three additional eligible groups. Keep in mind that it is up to the state to cover these optional groups. Review the following list to learn more about these groups:
    • Those deemed “medically needy” may be considered eligible for Medicaid. People in this group are generally above the federal poverty level, but are allowed to pay a portion of medical bills while Medicaid covers what their payment did not.
    • Women who were found to have breast or cervical cancer may be eligible for Medicaid if they were otherwise found ineligible.
    • People who have tuberculosis, but were otherwise ineligible, may be covered by Medicaid.
  5. Image titled Qualify for Medicaid Step 5
    5
    Apply. If you believe that you may qualify for Medicaid then you should apply. There are a few methods that you can use to apply; however, they will all involve you applying at a state level.
    • You can check to see if you are qualified on-line at healthcare.gov
    • Each state will have its own methods of application.
    6. Advertisement
Method 2
Method 2 of 2:

Learning More About Medicaid

  1. Image titled Qualify for Medicaid Step 6
    1
    Learn what and who Medicaid is intended for. There are multiple functions to the Medicaid program and different reasons that you might need to apply. Review the following functions of the Medicaid program to learn if it is a good fit for you:[8]
    • Medicaid can help if you are unable to pay large medical bills.
    • If you are enrolled in Medicare, you may already be qualified for Medicaid.
    • There may be financial circumstances that qualify you for Medicaid, such as being below the federal poverty line.
    • If you receive supplemental security income (SSI), you may automatically be eligible for Medicaid.
    • Medicaid aims to provide medical aide to pregnant women, children, seniors, people with disabilities, and non-disabled individuals.[9]
  2. Image titled Qualify for Medicaid Step 7
    2
    Understand your state Medicaid requirements. Although Medicaid is a federally funded program, it is implemented on a state level. Some states will even have their own programs that they run. You will have to learn about your own state and their requirements for enrollment in Medicaid.[10]
    • You can find information about your state requirements “at this website”
    • States will select on an individual level who is accepted into the Medicaid program.
    • States can also choose to expand their coverage to groups beyond the federally mandated groups.
    • There are some federally mandated aspects to Medicaid. These involve which groups of people are required to be covered by Medicaid.
  3. Image titled Qualify for Medicaid Step 8
    3
    Be aware of retroactive eligibility. Medicaid may apply retroactively up to three months before you applied. If you apply and are accepted, and were also eligible three months ago, any medical bills incurred during those last three months may be covered.[11]
    • Coverage under Medicaid will end when you are no longer considered eligible.
    4. Advertisement

You Might Also Like

Cancel Medi‐Cal
How to
Cancel Medi‐Cal
Check Your Medicaid Status
How to
Check Your Medicaid Status
Replace a Medicaid Card
How to
Replace a Medicaid Card
Join Silver Sneakers
How to
Join Silver Sneakers
Contact Medicare
How to
Contact Medicare
Switch Medicare from One State to Another
How to
Switch Medicare from One State to Another
Advertisement

References

  1. ↑ https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
  2. ↑ https://www.healthcare.gov/medicaid-chip/eligibility/
  3. ↑ https://www.medicaid.gov/sites/default/files/2020-01/overview-of-eligibility-for-non-citizens-in-medicaid-and-chip.pdf
  4. ↑ https://www.medicaid.gov/medicaid/eligibility/index.html
  5. ↑ https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-eligibility-levels/index.html
  6. ↑ http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/
  7. ↑ https://www.advisory.com/daily-briefing/resources/primers/medicaidmap
  8. ↑ http://www.health.ny.gov/health_care/medicaid/#definition
  9. ↑ https://www.medicaid.gov/medicaid/eligibility/index.html
  1. ↑ https://www.medicaid.gov/medicaid/by-state/by-state.html
  2. ↑ https://www.medicaid.gov/medicaid/eligibility/index.html

About This Article

Clinton M. Sandvick, JD, PhD
Co-authored by:
Clinton M. Sandvick, JD, PhD
Doctor of Law, University of Wisconsin-Madison
This article was co-authored by Clinton M. Sandvick, JD, PhD. Clinton M. Sandvick worked as a civil litigator in California for over 7 years. He received his JD from the University of Wisconsin-Madison in 1998 and his PhD in American History from the University of Oregon in 2013. This article has been viewed 54,414 times.
68 votes - 60%
Co-authors: 10
Updated: January 31, 2023
Views: 54,414
Categories: Medicare and Medicaid (United States)
Article SummaryX

The specific qualification requirements for Medicaid vary from state to state, so the best way to make sure you qualify is to check your state's Medicaid website. However, there are certain national qualification requirements. For example, a family of 4 can earn no more than 20,700 dollars annually by federal requirements. You can also qualify if you’re disabled or the beneficiary of someone who is disabled. You may have to provide evidence of your disability, as well as proof of your US citizenship. If you’re not a US citizen, you may be able to claim Medicaid if you meet other criteria, such as being an asylum seeker, refugee, veteran or active member of the military. For more tips from our Legal co-author, including how to apply for retroactive medical bills under Medicaid, read on!

Did this summary help you?
Advertisement