The Medicaid Program provides medical benefits to groups of low income people some who may have no medical insurance or inadequate medical insurance. 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. States have some discretion in determining which groups their Medicaid programs will cover and the financial criteria for Medicaid eligibility. Click her to view links to state resources in your area.

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. 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 Things to Consider:

People with Medicaid, family members, and caregivers should visit the Center for Medicare & Medicaid Services , the Official U.S. Government Site for the latest information on Medicaid programs enrollment, benefits, and other helpful tools.

Applying for Medicaid

You should apply for Medicaid if:

• you have limited income and resources regardless of age
• you are aged (65 years old or older), blind, or disabled and have limited income and resources
• you are terminally ill and want to get hospice services
• you are aged, blind, or disabled; live in a nursing home; and have limited income and resources
• you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services
• you are eligible for Medicare and have limited income and resources
• you are a family with children under age 18 and have limited income and resources
• you think you are pregnant. You may be eligible if you are married or single. If you are on Medicaid when your child is born, both you and your child will be covered

Medicaid does not provide medical assistance for all people with limited incomes and resources. You must qualify for Medicaid. Low-income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses. This option allows them to "spend down" to Medicaid eligibility by incurring medical and/or remedial care expenses to offset their excess income, thereby reducing it to a level below the maximum allowed by that State's Medicaid plan.

Eligibility Guidlines

Generally, Medicaid eligibility guidelines are as follows:

• If you are single and have combined assets and income of less than $2000 per month, you may be eligible for Medicaid.


• Forthose who are married, and a spouse is applying for Medicaid, if the combined assets and income of the couple is $90,000, then the spouse may be eligible for Medicaid. The spouse not entering the nursing home is allowed to keep a car, the couple’s house, personal belongings, and prepaid funeral expenses, as well as up to roughly $90,000 in assets and $2,000 per month in income. These rules vary by state. You must consult an attorney or your state’s Medicaid office to verify the exactfigures.


• If you have given away large amounts of money anytime in the 3-year period prior to filing your claim for Medicaid, the claim will be denied. The program is designed to discourage individuals from transferring assets in an attempt to spend down and qualify for Medicaid.


• If a gift is found, a penalty period will be assessed equal in length to the amount of nursing home coverage the gift would have been able to pay for. If any amount of money has been put into a trust in the last 5 years, this contribution will also be considered when verifying Medicaid eligibility.

Eligible Groups

The following is a list of services Medicaid eligible groups may be entitled to:

• Inpatient hospital (excluding inpatient services in institutions for mental disease)
• Outpatient hospital including Federally Qualified Health Centers (FQHCs) and if permitted under state law, rural health clinic and other ambulatory services provided by a rural health clinic which are otherwise included under states’ plans
• Other laboratory and x-ray
• Certified pediatric and family nurse practitioners (when licensed to practice under state law)
• Nursing facility services for beneficiaries age 21 and older
• Early and periodic screening, diagnosis, and treatment (EPSDT) for children under age 21
• Family planning services and supplies
• Physicians’ services
• Medical and surgical services of a dentist
• Home health services for beneficiaries who are entitled to nursing facility services under the state’s Medicaid plan
• Intermittent or part-time nursing services provided by home health agency or by a registered nurse when there is no home health agency in the area
• Home health aides
• Medical supplies and appliances for use in the home
• Nurse mid-wife services
• Pregnancy related services and service for other conditions that might complicate pregnancy
• 60 days postpartum pregnancy related services

State Service Requirements

All States must provide at least the following services when the medically needy are included under their Medicaid plans:

• Prenatal and delivery services
• Postpartum pregnancy related services for beneficiaries under age 18 and who are entitled to institutional and ambulatory services as defined in a state’s plan
• Home health services to beneficiaries who are entitled to receive nursing facility services under the state’s Medicaid plan
• States provide community long term care services for individuals who are Medicaid eligible and qualify for institutional care. The amount paid is determined by each state, and covers room, board, nursing care and social activities.