What does the Medicaid program cover?
The Medicaid program is a joint federal and state program that provides low-cost medical coverage for eligible individuals. The goal is to improve the health of people who may lack medical care for themselves and their children. While the federal government mandates coverage for certain categories of individuals, each state can set its own requirements.
Who is eligible for Medicaid?
Medicaid provides low-cost health coverage for eligible individuals in various groups. People who meet the eligibility criteria have the right to enroll in the Medicaid program. Although Medicaid primarily focuses on low-income groups, many states operate expanded Medicaid programs to cover all individuals without a specific income threshold.
Financial eligibility criteria
The financial eligibility requirements for Medicaid are divided into two categories: income and owned assets. Under the Affordable Care Act (ACA), Medicaid eligibility is calculated based on your household’s modified adjusted gross income (MAGI). MAGI is the total amount from multiple income sources, including adjusted gross income, non-taxable foreign income, non-taxable Social Security benefits, and tax-exempt interest.
Non-financial eligibility criteria
Non-financial requirements also determine your eligibility for Medicaid. Some general requirements you must meet to qualify for Medicaid include citizenship or residency status, residency in the state that offers the Medicaid program, age, and a Social Security number. You must also meet some medical requirements to qualify for specific Medicaid service categories.
Expanded Medicaid eligibility in states
As of August 2021, 38 states (plus the District of Columbia) have expanded their Medicaid programs to cover all low-income adults whose household income falls below a certain threshold. If your state has expanded Medicaid, you are eligible for coverage based solely on your income. Generally, your household income should not exceed 138% of the federal poverty level.
How to spend to meet Medicaid requirements
If your income or assets exceed the Medicaid income limit in your state, your state may operate a spend-down program that allows you to qualify for coverage by spending the income that exceeds the program limits. You can spend by incurring medical care and corrective treatment expenses that you do not have health insurance coverage for.
Appealing a coverage denial
If you meet all the requirements and are deemed financially eligible, you will begin to receive appropriate services from the Medicaid program. If you do not meet all the eligibility requirements, you will receive a notice of your right to appeal. States must provide an opportunity for individuals who believe they are eligible to appeal the denial of coverage, whether due to an error or failure to take prompt action.
Frequently Asked Questions (FAQs)
How often is Medicaid eligibility determined? Medicaid eligibility is determined once every 12 months. Benefits may be lost during the renewal process if required paperwork is not submitted. How can I check my Medicaid eligibility? You can check your Medicaid eligibility in two ways: by visiting your state’s Medicaid website or by calling your state’s Medicaid office. Through the health insurance marketplace. You will learn about the programs you and your family qualify for.
Source: https://www.thebalancemoney.com/how-to-qualify-for-medicaid-5202068
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