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Eligibility For Medicaid


Determining Eligibility for Medicaid
Except in the case of pregnant women and children up to age 19 years, eligibility for Medicaid is based on categorical relatedness, income and assets.

Categorical relatedness means that an applicant must be a member of a family with a child who is deprived of support due to the absence, incapacity, or unemployment of a parent(s).  If the applicant has no children under the age of 18, the individual must be age 65 or over, blind or disabled.

The Second factor considered is an applicant's income and assets.  Income is any money a family or individual receives such as wages, pensions, retirement benefits or support payments.  Assets include money in the bank, property other than the homestead, and the cash or loan value of certain life insurance.

When applying for Medicaid, you will be asked about your income and assets you own.  DHHR staff will inform you of any documentation needed at the time of your application.

The eligibility of pregnant women and children up to the age of 19 for Medicaid is determined solely on income.  There is no asset test.  Pregnant women must provide a medical statement confirming pregnancy.

What is "Spenddown"?
Individuals and families who are INELIGIBLE for medical assistance (Medicaid) at the time of application because of income higher than the "protected level" may become eligible under the "spenddown" process.
The process of subtracting your medical bill from your family income in order to become eligible for Medicaid is call "spenddown".  The month of application, plus five months, equals a period of spenddown consideration.  You may use current payments OR the unpaid balance on "old" medical bills in order to meet spenddown and achieve eligibility at the earliest possible time.