MEDICAID: HOW TO QUALIFY AND APPLY FOR MEDICAID

How are you eligible for Medicaid? Learn how to qualify for and apply for Medicaid. Cm. requirements and when to apply for coverage.

One in five people in the U.S. receives free or low-cost health insurance through Medicaid, a joint federal-state program administered by individual states under federal regulations. Each state has different rules regarding who is eligible for Medicaid and how to apply.

You can apply for Medicaid at any time and must have documented proof of eligibility, including citizenship, residency, age, income and resources, and medical expenses or disability. Eligibility checks are conducted on a regular basis. If you qualify, you can have both Medicare and Medicaid.

• Free or low-cost health insurance: Medicaid provides free or low-cost health insurance to low-income U.S. residents, people with disabilities, some Medicare recipients, and others who do not have access to affordable health insurance.
• State regulations vary: Medicaid is a joint federal-state program, with each state having full responsibility for administering the program and having different rules regarding eligibility and applying for Medicaid. Find out if you qualify and the application algorithm by contacting your state's Medicaid program.
• No specific enrollment dates: You can apply for Medicaid at any time. You will need to provide proof of your eligibility at the time of application, as well as during the renewal/redetermination process, usually once a year, or if your financial situation changes or you move to another state.

Medicaid is a joint federal-state health care program that provides health insurance for low-income families, certain pregnant women and children, and individuals receiving Additional social income (Supplemental Security Income, SSI).

States, following federal regulations, administer Medicaid programs and have the ability to expand Medicaid coverage. For example, states can provide Medicaid coverage to people receiving home and community-based services, children in foster care, and adults with incomes below 133% of the federal poverty level (FPL). The FPL for 2021 is $12,880 for individuals and $17,420 for a family of two.

To be eligible for Medicaid, you must meet financial requirements and be:

• A resident of the state in which you receive Medicaid
• Either a U.S. citizen or a lawful permanent resident, in addition to financial requirements

Financial eligibility for Medicaid is generally based on Modified Adjusted Gross Income (MAGI), which takes into account the taxable income and tax return relationship. Some people who are blind, disabled, or 65 years of age or older may be financially eligible for Medicaid using the Social Security Administration (SSA) SSI income methodology.

For individuals who fall into certain groups, Medicaid does not require a determination of income. Instead, eligibility is based on enrollment in another program. For example:

• Breast and Cervical Cancer Treatment and Prevention Program
• Adopted children are generally automatically eligible for Medicaid if there is an adoption assistance agreement in place under the SSA Act
• Young people, former foster caregivers, regardless of income level

States can also establish a Medicare-In-Need program for individuals with significant medical needs whose income is too high to otherwise qualify for Medicaid. Such states give you the option to deduct your medical expenses from your income to qualify for Medicaid.

Some states have stricter Medicaid eligibility requirements than SSI. Such so-called 209(b) states should allow Spending the surplus to the same income eligibility levels for groups based on disability, blindness, or age (65 years and older).

Because each state has different rules regarding eligibility and application, you should contact your state's Medicaid program to see if you qualify. For starters, it's a good idea to know what the maximum income and resource limits are for your state.

One in five Americans has Medicaid insurance. The following do not meet the requirements:

• People with incomes that exceed the limit set by the state in which they live. These limits vary by state, but are stricter in states that have not chosen to expand Medicaid coverage under the Affordable Care Act (ACA).
• People who are not U.S. citizens or do not qualify for lawful permanent resident status.
• People who were previously eligible, but their status has changed; For example, they are no longer pregnant, their income has increased through work or gift/inheritance, or they have moved to the state with other requirements.
• People who fail to report a change of status in a timely manner (usually within 30 days) or fail to renew status during the redetermination period may lose benefits. Under federal law, you have 90 days to provide your state's Medicaid agency with all the information they need after losing your coverage.

Yes. This is known as Dual Eligibility (dual eligibility), with most of your medical expenses likely covered. Medicare is generally considered primary insurance (unless you also have group coverage from your employer), and Medicaid is the payer in exceptional cases.

Medicaid covers benefits only after paying for Medicare, group health plans from an employer, and Medicare Supplement (Medigap). Note: If you are eligible for Medicaid and your income/circumstances are unlikely to change, you will not need additional insurance.

Medicaid helps Medicare recipients pay Medicare premiums and share in costs. In addition, this program provides many of them with benefits not covered by Medicare, such as long-term care assistance, certain medications, or glasses.

If you, as a Medicare recipient, are eligible for Medicaid, you are automatically eligible for Extra Help, a Medicare program that helps pay for drug costs such as premiums, copays, and deductibles.

Some states and health plans offer Medicare-Medicaid plans for certain people who have both programs to make it easier to get the services they need.

As with anything related to Medicaid, contact your state agency for help.

If you're not sure if you're eligible for Medicaid but likely meet the financial requirements in your state, you should apply. You may be eligible based on your household income, family size, age, or disability.

Apply for Medicaid through the Health Insurance Marketplace or directly with your state's Medicaid agency. Many Medicaid members receive Medicaid benefits through private managed care plans contracted with the state. You'll get information about how to apply by going to your state's website or contacting your state's agency.

Be prepared to provide information about your Medicaid application as proof of your eligibility. You should expect a response within 45 days, or longer if you are disabled. If your application is denied, you will receive a denial notice and instructions on how to appeal the decision.

Keep a record of the documents (copies) you use to complete the application. You may need to provide them again or show updated versions when you're ready for renewal/override, depending on your state's Medicaid program. Be prepared to provide the following documents:

• Birth certificate or driver's license
• Proof of Citizenship
• Proof of Your Place of Residence
• Documentary evidence of all sources of income and assets or other resources
• Documentary evidence of medical expenses
• Proof of your disability, if applicable
• Insurance ID card, if applicable

Don't wait to apply. Unlike Medicare, there are no restrictions or open enrollment periods, so you can apply at any time. It's better to apply and get rejected than not to try at all. Renewals and overrides to ensure eligibility will be maintained at least once every 12 months. Some states may require more frequent redefinitions, but in any case, you need to report any changes to your status as soon as possible, within 30 days.

Once your Medicaid eligibility has been determined, your coverage will take effect on either the day you apply or the first day of the month you apply. Benefits can be covered retroactively for up to three months before you apply if you would have been eligible for it during that time period.

Coverage ends at the end of the month you no longer meet the eligibility requirements.

If you have questions or would like to check the status of your application, contact your state's Medicaid program directly. Create an account with the agency/organization that administers your state's program.