Medicaid

Last Updated: October 20, 2020

Written by the Open Caregiving Team. Editorial review by Joyce O. Murphy RN, MSN.

What is Medicaid?

Medicaid is a federal and state jointly funded healthcare program. It offers coverage of health services for certain people with low-incomes. This may include families, pregnant women, senior citizens, and individuals with disabilities, regardless of their age.

How does Medicaid work?

Each state and the federal government jointly fund Medicaid. Doing so lets states customize their programs with a goal of having their Medicaid programs meet various federal guidelines.

This structure helps states to better address local health needs. It also means that Medicaid programs and eligibility requirements vary from one state to the next. You can find your state’s specific Medicaid website and what they call their Medicaid program as state programs often have unique names. Research your state’s state’s rules and benefits.

What does Medicaid cover?

Medicaid coverage varies by state but has some mandatory benefits that states are required to provide. There are optional benefits that states can elect to provide. Review the full list of mandatory and optional benefits.

Who is eligible for Medicaid in 2020?

Medicaid Eligibility Basics

To be eligible for Medicaid, you must be:

  • A US Citizen or a qualified non-citizen (lawful permanent resident or green card holder).
  • A resident of the state in which you are receiving Medicaid.

The Federal government mandates that every state cover specific groups of people through Medicaid. Learn more about mandatory eligibility groups. Besides the federally mandated groups, each state can cover other people that they have decided will benefit from the program. Each state’s eligibility criteria change each year. Be sure to check to see if you are covered, even if you haven’t been in the past.

Use the Medicaid eligibility checker to see if you qualify.

Medicaid Financial Eligibility

See if you may financially qualify for Medicaid using the Low Cost Marketplace Health Care, Qualifying Income Levels

Your Modified Adjusted Gross Income (MAGI) is the number that determines who is financially eligible for Medicaid. This applies to children, pregnant women, parents, and adults under 65 without blindness or disability.

How do I calculate my Modified Adjusted Gross Income (MAGI)?

To calculate your MAGI, you take your taxable income and add any of the below deductions that apply to you:

  • Student loan interest
  • One-half of self-employment tax
  • Qualified tuition expenses
  • Tuition and fees deduction
  • Passive loss or passive income
  • IRA contributions
  • Taxable social security payments
  • The exclusion for income from U.S. savings bonds
  • Foreign earned income exclusion
  • Foreign housing exclusion or deduction
  • The exclusion under 137 for adoption expenses
  • Rental losses
  • Any overall loss from a publicly traded partnership

These deductions do not apply for many individuals so their MAGI ends up being the same as their Adjusted Gross Income which you can find on your tax return. MAGI does not include Supplemental Security Income (SSI).

Once you have figured your MAGI, you can learn if you are eligible for Medicaid by checking how your MAGI compares to the 2020 Federal Poverty Level.

  • If you live in a state that expanded Medicaid and make less than 133% of the Federal Poverty Line (FPL), you most likely qualify for Medicaid.
  • If you live in a state that did not expand Medicaid and make less than 133% of the Federal Poverty Line (FPL), you may or may not qualify for Medicaid based on state rules.
  • If you are pregnant, over 65, disabled, or have a child and make less than double the FPL you most likely qualify for Medicaid.

For people with blindness, disability or who are over the age of 65, MAGI does not apply. Their eligibility is based on the Social Security Income requirements. In 2020, The Social Security income requirements to be considered “low-income” is income up to $783 per month for one individual or up to $1,175 per month for a couple. Review this comprehensive list of what counts as income.

When does Medicaid coverage start?

Medicaid coverage begins immediately following an approved application. It can be retroactively applied for the three months prior to approval for people who would have been eligible in those three months, had they applied.

When does my Medicaid coverage end?

Medicaid coverage usually stops on the last day of the month that a person no longer meets the eligibility requirements for Medicaid.

Where is Medicaid accepted?

You can find your state’s Medicaid provider directory on the American Academy of Pediatrics website.

Can someone enroll in Medicare and Medicaid at the same time?

It is possible to enroll in both Medicare and Medicaid. People who are eligible for both healthcare programs are called dual eligible. There are two types of dual eligibility:

  • Full Dual Eligible – which means you don’t have any out-of-pocket healthcare costs.
  • Partial Dual Eligible – which means Medicaid covers some of your Medicare out-of-pocket costs.

Medicare always pays before Medicaid for healthcare services provided by both plans. Learn more about dual eligibility categories in the CMS PDF guidelines.

What are Home and Community-Based Services (HCBS Waivers)?

Home and Community-Based Services are health and human services that are at home or within your local community. States can waive Medicaid requirements to implement HCBS programs for people in need who would otherwise not be covered by Medicaid. These programs are called waiver programs or HCBS waiver programs and can be found on your State’s Medicaid website.

Learn more about what programs and services may be available through HCBS waivers.

How do I contact my state’s Medicaid office?

You can find the contact information for your state’s medicaid office along with other important information on the Medicaid.gov contact page.

How do you apply for Medicaid?

Individuals can apply for Medicaid at any point in the year directly through their state’s Medicaid website or through the federal Health Insurance Marketplace. You will need to provide the following information through official documents when applying:

  • Proof of citizenship/age – birth certificate or driver’s license
  • Proof of income – pay stubs or tax returns
  • Proof of Assets – bank statements
  • Proof of Address – official document stating address
  • If proving disability – medical records

Once you apply, states have 45 days to process your application and 90 days if you are applying because of a disability. Find your state Medicaid website below:

Was this helpful?

Sign up for our newsletter to receive new caregiver stories, resources, and support each week.

Related Topics To Learn About

Medicare

Medicare is a government-funded health insurance program for Americans 65 years or older and for some people with long-term disabilities.

Social Security Administration (SSA)

Social Security Administration (SSA) offers 3 types of social security benefits including: Retirement Benefits, Disability Insurance (SSDI), Survivors Benefits.