Will my Medicaid be dropped, too?

1 answer | Last updated: Oct 20, 2016
Dutchone asked...

I will be 64 in August. I am and have been raising my granddaughter, alone, since July of 2001, due to the death of her mother, my daughter. My granddaughter will be 18 on June 19, 2011. We are both on Medicaid now; will I lose mine when she turns 18? We have no other insurance and I live on Social Security. I get $833 a month and $378 a month for my granddaughter, which will end for her, when she turns 18. Thank you.

Expert Answers

During the time you and your granddaughter both received Medicaid medical coverage, the state Medicaid program determined your eligibility as a family with two people. Now that your granddaughter will be losing her Medicaid coverage because she turns 18, your state's Medicaid program will recalculate your eligibility based on its income limits for a single individual. Whether your income will allow you to remain eligible for Medicaid as a single person depends on the particular rules of the state you live in -- every state Medicaid program is slightly different and sets its own income eligibility standards and rules.

In most states, a single person with a total income of $833 per month (and without any substantial assets other than a home and car) would be close to the edge of Medicaid eligibility. However, even if your $833 per month is higher than the state's income eligibility level for a single individual, there are several ways you might qualify for Medicaid coverage anyway. The first is that not all of a person's income is counted by Medicaid when it determines eligibility. Certain amounts are deducted from actual total income, so that your "countable" income for eligibility purposes might be quite a bit less than your actual income. And if this countable income falls below the state's Medicaid income eligibility limit, you would be eligible for coverage.

Another way that you might be eligible for Medicaid coverage, even if your income is higher that your state's Medicaid income eligibility limits, is if you have regular medical bills. In some states, the Medicaid program subtracts from your income the amount of your regular medical bills, and if the total is lower than the state's income eligibility level, you are eligible for Medicaid coverage. This category of eligible individual, whose regular medical bills reduce income below the Medicaid limit, is called "medically needy." However, only some states offer Medicaid coverage to the medically needy.

Finally, even if your income is higher than your state's Medicaid income eligibility limit, you might still be eligible for Medicaid if your state has "share of cost" rules. Share of cost is like a deductible. It means that you would be eligible for Medicaid coverage in any month during which you pay medical bills out of your own pocket over a certain amount. Once you pay this "share of cost," Medicaid would cover the rest of your medical bills for that month.

The only way to find out whether you will still qualify for Medicaid coverage in your state is to contact your state Medicaid program directly. Since you're already receiving Medicaid coverage, you should contact the local Medicaid office that now handles your eligibility -- and the specific Medicaid eligibility officer you've dealt with before, if possible -- to find out what your status will be once your granddaughter is no longer eligible.