Whom does Medicaid cover?
States vary depending on the options they have elected. SSI states cover everyone who qualifies for the Supplemental Security income program (aged, blind and disabled). These states cannot have rules that are more restrictive than the federal government rules for SSI. Section 209(b) states adopt requirements that are more restrictive than the federal SSI rules. These states are CT, HA, IL, IN, MN, MO, NE, NH, NC, ND, OH, OK, UT, and VA. States may also optionally cover categorically needy persons. These persons qualify for assistance such as SSI, but are not receiving it (for example, because they live in an institution). States may use a higher income standard, up to three times the SSI benefit amount for an individual living at home. If states do not also adopt the medically needy standard described below, they would be considered Income Cap states. Income cap states are AL, AK, CO, DE, ID, MS, NE, NM, SC SD, and WY. CT under a waiver allows spend down for institutionalized care and has an income cap for home care. States may optionally cover medically needy persons. These are persons who would qualify for Medicaid categorically, but are over income. These individuals can spend down to the Medicaid level by deducting incurred medical expenses. The following states have medically needy programs: CA, CT, GA, HA, IL, KY ME, MD, MA, NH, NJ, NY, NC, ND, PA, RI, SC, TN, VT, VA, WA, WV, and WI (also, DC). CT under a waiver allows spend down for institutionalized care and has an income cap for home care. Some states allow a spend down but do not permit nursing home costs to be included. These are AZ, AR, FL, IA, LA, OK and OR (TX does not include the aged in the spend down program). Unfortunately this creates a hopeless web of rules in the different states and you must seek out advice in your state on how to deal with its rules!
Other Medicaid FAQs
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Why is Medicaid different in every state?
Medicaid is a joint federalstate program. It provides medical assistance to eligible needy persons. Unlike Medicare it is an entitlement program based on income … more -
Is there a citizenship requirement for Medicaid?
Participants must be citizens or a qualified alien. These categories of aliens were set in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. -
Can I be barred from Medicaid if I just moved into a state?
States must provide Medicaid for eligible residents. States cannot place length of stay residency requirements. -
What are the income and resource levels for Medicaid?
Income cap states limit income to three times the SSI benefit level. In 1997 the benefit level is $484 per month and the income cap is $1,452. No spend down is allowed … more -
Will Medicaid pay for my Medicare premiums and deductibles?
Medicaid pays the deductibles, coinsurance and premiums for Medicare Part A and B for lowincome persons. These individuals are called Qualified Medicare … more -
Can Medicaid place a lien on property or recover against an estate?
Aside from the resource rules described above, there are many exemptions, the biggest one being a homestead. However, Medicaid may impose a lien on a recipient`s … more -
Are adult children responsible for the medical bills of their parents?
In determining Medicaid eligibility of an adult, federal law does not permit states to use the income or resources of nonspouses. States cannot collect … more -
Are well spouses legally responsible for Medicaid expenses of a sick spouse?
Federal Medicaid law permits states to deem the income and resources of the well spouse as available to the sick spouse. The extent of this deeming depends on whether … more
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