As I sat down to write this I struggled with where to start. For many of us, Medicaid will play a huge role in our lives. It will provide health insurance, make sure our kids get the services they need to live “independently”, and for some, take care of us into our old age.
This means there is no one size fits all explanation. Since going into everything it covers would require several books, what I’m going to cover here is an overview of how to qualify and the State’s Medicaid Waiver services. I will do more deep dives in the future, subscribe so you don’t miss them. And be sure to register for this month’s Zoom Q & A. As always the link is included at the end of this article.
Qualifying for Medicaid will look different based on the state you live in because it’s a joint program. It’s administered by both the Federal and State government. Every state uses the following factors: income, disability, family status, and household size. If your state has voted to expand Medicaid then you can qualify based on your income alone. In most states who have expanded Medicaid, the income limit is 133% of the Federal Poverty Level.
If you live in one of the (12) states who have not yet voted to expand Medicaid then you will need to check your state’s website to see what the income limits are. Not sure if your state has or hasn’t? The 12 states that have not expanded Medicaid are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.
It should be noted that if you have a disability and/or are over age 65 you may not need to meet the income limits set by the state. Instead, your eligibility will be based on rules. If you qualify for SSI you will be enrolled in Medicaid.
There are exceptions to this rule as well. Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Oklahoma, and Virginia all require their residents to apply for Medicaid separately. Their rules will be more restrictive than what is required to qualify for SSI. If you want more information look up 209(B) states.
If you make too much money to qualify for Medicaid you shouldn’t give up hope. Check to see if your state has a “Medically Needy” program that will allow for “Medicaid spenddown”. This means the state will allow you to reduce your countable income by subtracting medical expenses and cost-sharing. What’s cost-sharing? These are things like office co-pays, insurance deductibles, etc. When looking into Medicaid spenddown it’s also important to make note of how long you have to get your income within the limits. States can set their spenddown periods between 1 - 6 months.
What if you go to work, will you lose your Medicaid? Not necessarily, the Social Security Act took this into account. Here are the criteria you will need to meet, taken directly from Social Security’s website:
Have been eligible for an SSI cash payment for at least 1 month;
Still meet the disability requirement; and
Still meet all other non-disability SSI requirements; and
Need Medicaid benefits to continue to work; and
Have gross earnings that are insufficient to replace SSI, Medicaid, and publicly funded attendant care services.
Please note that the above criteria specifically spell out “and”. This means you need to meet ALL of them. “Publicly funded attendant care services” are the Medicaid Waiver supports you are receiving.
Keep reading with a 7-day free trial
Subscribe to Waypoints to keep reading this post and get 7 days of free access to the full post archives.