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!

The information on this page is meant to provide a general overview of the law. The laws in your state and/or city may deviate significantly from those described here. If you have specific questions related to your situation you should speak with a local attorney.

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