Medicaid Eligibility

Eligibility depends on your state, household size, income and sometimes assets. Many states expanded Medicaid to cover more adults with low incomes, while others use stricter limits. People who are older, blind or disabled may qualify through separate categories with asset tests. Some people qualify for both Medicare and Medicaid, which can greatly reduce out-of-pocket costs. Because rules change, check with your state Medicaid agency or a benefits counselor rather than assuming you do not qualify. Applying is free, and a hospital financial counselor can often help you fill out the forms or check your likely eligibility first.

Some states offer medically needy or spend-down programs, which allow people whose income is slightly too high to qualify after their medical expenses reach a certain level. Many states also allow retroactive coverage for medical bills incurred in the months before you applied, if you would have been eligible then. This can help with large hospital bills from the time of diagnosis. Ask about these options when you apply and gather bills and financial records to support your application. Ask the caseworker how far back coverage can reach in your state and which bills to include.

Medicaid programs with asset tests count savings and certain property. Compensation from an asbestos claim can affect eligibility, and Medicaid may seek repayment for care it covered if a claim is related to the same illness. Planning tools such as special needs trusts may help protect eligibility in some cases, but they must follow strict rules. Talk with an elder law or benefits attorney before moving money or accepting a settlement, since mistakes can lead to penalties or loss of coverage.

1. 1

   Contact your state Medicaid agency or visit its website to review current eligibility rules.

2. 2

   Gather income, asset and medical bill records before starting your application.

3. 3

   Ask whether retroactive coverage or a spend-down program applies to your situation.

4. 4

   Speak with an elder law or benefits attorney before accepting any claim payment.