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Eligibility For Medicaid

  

Medicaid provides health insurance to:

· Supplemental Security Income (SSI) beneficiaries

· Pregnant women

· Children under age 19

· Very low income families

· People who are aged/blind/disabled

· Medically needy (some examples of those who may be medically needy are described on the next page)

· Adults ages 19 to 64.

 

Medicaid eligibility is determined based on income and other factors, depending on your eligibility category. Eligibility is determined by Department of Health and Human Resources (DHHR) workers in county offices.

SSI Income beneficiaries are automatically eligible for Medicaid coverage and do not have to apply for benefits at the local DHHR office.


For pregnant women, children, and adults ages 19 to 64, eligibility is dependent on their Modified Adjusted Gross Income (MAGI) and household size.

Income not counted when determining MAGI includes:

· Scholarships, grants and awards for educational purposes

· Child support income

· Worker’s compensation benefits

· Veterans benefits

· Certain American Indian and Alaska Native income.

 Household size is based on who is claimed as a dependent on your federal tax return. This may include:

· You

· Your spouse

· Your dependent children (biological, adopted, or stepchildren)

· Other relatives and even non-relatives who qualify as dependents.

 The chart below provides general guidance for 2014 on whether you and/or your family may qualify for Medicaid based on MAGI. You need to check with your county DHHR office to determine if you meet the income guidelines.

Family Size

Adults ages 19 to 64 and/or Children age 6 to 19

Yearly income up to:

Pregnant Women and/or Children Under age 1

Yearly income up to:

Children ages 1 to 6

Yearly income up to:

1

$16,104

$18,444

$16,464

2

$21,707

$24,864.

$22,188

3

$27,310

$31,272

$27,912

4

$32,913

$37,692

$33,636

5

$38,515

$44,100

$39,360

6

$44,118

$50,520

$45,084

For other eligibility groups both income and assets are used to determine eligibility.

 

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