Medicaid Eligibility: 4 Important Things to Know

Medicaid provides health care coverage for over 72.5 million Americans, including children, seniors, and pregnant women. It is the largest single-source healthcare system in the United States. However, only certain individuals will qualify for Medicaid. Those who receive supplemental security income and low-income families will often qualify for Medicaid, but they must usually still go through an application process.

Financial Eligibility for Medicaid

The government will consider your family’s modified adjusted gross income (MAGI) to determine whether you qualify for Medicaid. MAGI considers both taxable income and your filing status to determine whether Medicaid is an option for you. There are no asset or resource tests, and the process has become more stabilized since the late 1990s.

Some individuals are exempt from the MAGI rules, including those who are 65 or older or who have a disability. There are special rules for children and pregnant women as well. Generally, those who qualify for SSI will also qualify for Medicaid.

Non-financial Eligibility

Individuals must also be eligible from a non-financial aspect as well. For example, Medicaid recipients must be a resident of the state in which they receive aid. They must also either be a citizen of the United States or be a qualifying non-resident. Occasionally, there are limitations for eligibility based on age, pregnancy, or parenting status.

Those Who Are Medically Needy in Florida

Florida is one of several states that has a “medically needy” program for those who do not qualify for “full” Medicaid. Those in Florida who have a certain level of medical expenses each month may be eligible for Medicaid even though they otherwise would not meet the income or other eligibility tests.

As part of this program, you would pay a portion of the medical bills, and then the “share of cost” program would cover the remaining amount. The actual amount of the cost shared varies based on the household size and the relative income for the family. There are additional options for those in Florida who do not qualify for Medicaid but who still need help paying for prescriptions, including the Florida Discount Drug Card Program and FlordiaRXCard.com.

Effective Date of Coverage

When you qualify for Medicaid, your coverage is effective as of the date of the application, or the first date of the month of the application. Benefits can be retroactive for up to three months before the month of the application, assuming the applicant would have been eligible at that time. Coverage stops when you are no longer eligible.

The Legacy Planning Law Group can help deal with the application process and determine whether you would be eligible for Medicaid in Florida. Call today for more information.

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Written by Legacy Planning Law Group

Legacy Planning Law Group is dedicated to working with individuals and families to help protect the assets they have built throughout their life, and make everything simpler for families who have lost a loved one. We help thoughtful people achieve the peace of mind that comes with planning their personal legacy and passing on family harmony.