How To Learn About Medicaid Eligibility: Medicaid Requirements

Learn What's Needed to Qualify for Medicaid

Doctors with elderly patients

Each year, thousands of people who have no other way of paying for their medical expenses rely on Medicaid to pay for all or some of their medical bills. If you fall into an extremely low-income category or are disabled, you may be eligible to receive assistance. This article will help you learn more about requirements. 

Payments are made directly to the service provider and not to the individual receiving the treatment.

Even though this is a federal assistance program, it is administered by the state you live in. Each state has some degree of ability to determine who will receive assistance and qualify in their state.

It is important to note that the specific details of eligibility vary from year to year and the most current information is available from the office in your state.

Regardless of which state you live in, this program is available only to citizens of the United States or to qualified aliens. A qualified immigrant must have been:

  • Lawfully admitted for permanent residence under the Immigration and Nationality Act (INA).
  • Admitted as a refugee under Section 207 of the INA.
  • Granted asylum under Section 208 of the INA.
  • A Cuban and Haitian entrant, as defined in Section 501(e) of the Refugee Education Assistance Act of 1980.
  • Granted parole for at least one year under Section 212(d)(5) of the INA.
  • An immigrant whose deportation is being withheld under either Section 243(h) of the INA as in effect prior to April 1, 1997 or under Section 241(b)(3) of the INA, as amended.
  • Granted conditional entry under Section 203(a)(7) of the INA in effect before April 1, 1980.
  • A battered alien, who meets the conditions set forth in Section 431(c) of PRWORA (with current amendments and additions).
  • A victim of a severe form of trafficking, in accordance with Section 107(b)(1) of the Trafficking Victims Protection Act of 2000, Public Law 106-386.

Also, some immigrants may not receive assistance for five years from the date that they enter the United States as a qualified alien. Refer to the website for details about whether or not you qualify.

Generally speaking, you must fall into the mandatory eligibility group, the optional eligibility group, or be considered medically needy. A general overview of each group is given below, but the specific eligibility requirements for these groups may vary from state to state.

  1. Mandatory Eligibility Group. Generally speaking, many of these individuals receive federal income assistance or fall into a protected group category. In order to receive Federal funds, the states must provide coverage for these individuals. This group includes, but is not limited to:
    • Low income families with children who meet the state's Aid to Families with Dependent Children (AFDC) requirement.
    • Supplemental Security Income (SSI) recipients (or the aged, blind, and disabled).
    • Babies born to eligible pregnant women.
    • Children under age 6 and pregnant women with family income at or below a specified percentage of the Federal poverty level.
    • Recipients of adoption assistance and foster care.
    • Some Medicare recipients.
    • Other protected groups.
  2. Optional Eligibility Group. This group is defined by the state and may have needs similar to the Mandatory Eligibility group, but the criteria may be less stringent.
  3. Medically Needy. The Medically Needy option allows states to provide assistance to individuals who do not qualify under the above groups. Under this option, a person may be allowed to offset their excess income with medical and remedial care expenses to reduce the income to a level below the highest level allowed for that state's medical plan.

For those who need it, this program provides critical care that they would not otherwise be able to receive. If you feel that you may meet the eligibility requirements, it is well worth investigating.  While you can start with your local office, it may be a good idea to pursue online health care policy classes as well so you can be sure you're getting the full amount of benefits you deserve.


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