ABA Family Legal Guide

Health-Care Law

Health-Care Options

Medicare and Medicaid

Who is eligible for Medicaid?

States have some discretion in determining which groups their Medicaid programs will cover and the financial criteria for Medicaid eligibility. Here are some examples of the mandatory Medicaid eligibility groups:

• Low income families with children.
• Most supplemental security income (SSI) recipients.
• Infants born to Medicaid-eligible pregnant women. Medicaid eligibility must continue throughout the first year of life so long as the infant remains in the mother's household and she remains eligible, or would be eligible if she were still pregnant.
• Children under age six and pregnant women whose family income is at or below 133 percent of the federal poverty level.

  States also have the option to provide Medicaid coverage for other "categorically needy" groups. These optional groups share characteristics of the mandatory groups, but the eligibility criteria are defined somewhat more liberally. Examples of the optional groups that states may cover as categorically needy (and for which they will receive federal matching funds) under the Medicaid program are

• some low income children;
• certain aged, blind, or disabled adults who have incomes above those requiring mandatory coverage, but below the federal poverty level;
• institutionalized individuals with income and resources below specified limits;
• people who would be eligible if institutionalized but are receiving care under home- and community-based services waivers;
• recipients of state supplementary payments; and
• low-income, uninsured women screened and diagnosed through the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program and determined to be in need of treatment for breast or cervical cancer.