Government-Funded Programs

Medicaid is an individually state run program that is funded with federal tax funds. Medicaid’s primary focus is to provide medical coverage for low-income families and/or individuals.

To determine Medicaid eligibility, state Medicaid offices consider several factors such as 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. Your state determines their own rules for counting income and evaluating other factors.

These rules vary from state to state. There are special rules for those who live in nursing homes and for disabled children living at home.

Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not (however, there is a 5-year limit that applies to lawful permanent residents).

Eligibility for children is based on the child's status, not the parent's. Also, if someone else's child lives with you, the child may be eligible even if you are not because your income and resources will not count for the child.

In general, you should apply for Medicaid if your income is low and you match one of the descriptions of the Eligibility Groups.  

(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.)

When does Medicaid eligibility begin?

Coverage may start retroactive to any or all of the 3 months prior to application, if the individual would have been eligible during the retroactive period.

Coverage generally stops at the end of the month in which a person's circumstances change such as an increase of income that yields the applicant no longer eligible for Medicaid benefits.

Most States have additional "State-only" programs to provide medical assistance for specified poor persons who do not qualify for the Medicaid program.

No Federal funds are provided for State-only programs.

What and who doesn’t Medicaid cover?

It should be understood that Medicaid does not provide medical assistance to every poor individual or family.

Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups.

Low income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. As noted earlier, categorically needy persons who are eligible for Medicaid may or may not also receive cash assistance from the TANF program or from the SSI program.

Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses.

How do you find out more information about Medicaid?

You can go to the government’s website at www.medicare.gov