- Using federal guidelines, each state determines eligibility for Medicaid benefits based upon specific qualifications as determined by the applicant's category. The individual states have the ability to include additional eligibility levels to accommodate their populations. Federal Poverty Guidelines provide the basis for income requirements. All sources of income are totaled to determine an applicant's financial status, including any money received from state or federal funds such as Supplemental Security Income, a needs-based program providing basic necessities like food, clothing and shelter to people with minimal or no income 65 years and older, blind or disabled according to SocialSecurity.gov.
- Medical benefits for pregnant women with young childrenYoung woman playing with the child image by Vasiliy Koval from Fotolia.com
According to "Medicaid At-a-Glance," a Medicaid information source published by the Department of Health and Human Services, applicants who are determined eligible for Medicaid benefits under this eligibility level include recipients of Aid to Families with Dependent Children. Also falling within the parameters of this category are pregnant women and children less than 6 years of age, provided their family income is not more than 133 percent of the federal poverty level. Family income levels no higher than 100 percent of the federal poverty level qualify children 6 to 19 years old for Medicaid assistance. People living in medical institutions are eligible for Medicaid under this eligibility category, provided their monthly income does not exceed 300 percent of the SSI income standard. Contact your state Medicaid office for additional information in reference to "Categorically Needy" eligibility. - Medicaid provides health benefits for the elderly and disabled.elderly lady image by pixelcarpenter from Fotolia.com
This eligibility category applies to persons with income and assets above established poverty levels who cannot afford medical coverage. According to "Medicaid At-a-Glance," Texas does not offer Medicaid assistance to the aged, blind or disabled who fall under this category. They do provide it for mandatory medically needy groups such as pregnant women and children below 18 years of age. At the individual states' discretion, optional Medicaid benefits in this category cover full-time students under age 19 up to age 21. However, each state can set its own age limit for children it accepts into this eligibility group.
With the exception of the state of Texas, other optional recipients of Medicaid benefits under this category include persons 65 years of age and older, persons meeting the qualifications of blindness as set by the individual states or the SSI program and the disabled who satisfy their state's or SSI's criteria for determining disability. Approximately 35 states allow Medicaid benefits for the Medically Needy. In "Medicaid At-a-Glance," the Department of Health and Human Services provides a list of these states. - Disabled persons returning to workman in wheelchair image by jimcox40 from Fotolia.com
Depending upon individual states' income level requirements, ranging from 100 percent above the federal poverty level to 135 percent below this level, Medicaid pays Medicare premiums and the 20 percent co-payment for eligible applicants within this category. It covers other Medicare expenses, such as Part A premiums (hospital expenses) for low-income disabled people who lose coverage due to work and offers training and placement services for disabled persons wishing to return to work. Qualified applicants belonging to this eligibility group also receive Medicaid benefits for Long Term Care.
In all states, provision of full Medicaid benefits under category extends to women with breast cancer or cervical cancer. Persons with tuberculosis receive partial benefits covering only treatment of this disease. "Medicaid At-a-Glance" lists 11 states offering Medicaid benefits for persons with TB. - Medical benefits for children without health insurancethree young friends image by AGphotographer from Fotolia.com
Some states include the State Children's Health Insurance Program as part of Medicaid. This program provides medical benefits for children (to age 19) of families with incomes up to 200 percent of the federal poverty level. It also offers benefits to children of families with incomes above the poverty level, but who are unable to afford medical coverage. Income eligibility and medical benefits allowed by states offering this coverage are discretionary, but do include, at no cost, immunizations for children and healthy baby care. Your family's income will determine the amount of co-payments (if any) for additional medical services. For information about the SCHIP program in your state, call 1-800-543-7669.
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