Who's Eligible for Medicaid Coverage of Medical Care?

4 answers | Last updated: Oct 26, 2016
A fellow caregiver asked...

Who's eligible for Medicaid coverage of medical care?

Expert Answers

If you're 65 or older or have a long-term disability, and you have low income and few assets (other than the home you live in), you may be eligible for Medicaid coverage of your medical care. Eligibility rules differ slightly from state to state.

Income: In all states, if your income falls below the eligibility standard for the federal Supplemental Security Income program, known as SSI, you're also eligible for Medicaid medical coverage. This amount is about $700 per month of what's called "counted" income.

But quite a bit of actual income is not counted in determining eligibility, so if your total income is up to about $1,500 per month, you might still qualify for Medicaid. When deciding eligibility, Medicaid also considers your spouse's income, if you live together. Also, if family or friends give you free housing or meals, or regularly pay your bills, Medicaid may consider this as income when deciding your eligibility.

Medicaid medical care coverage may be available to you even if your income is higher than the state's Medicaid eligibility level, if you have regular medical expenses that aren't paid by another program or by insurance. This eligibility category, recognized in many but not all states, is known as "medically needy."

Assets: To be eligible for Medicaid medical coverage, you're allowed $2,000 ($3,000 for a couple) in cash, savings, or other assets, plus a number of other assets that are exempt (not counted). These exempt assets include:

  • Your house, if you live in it.

  • Your automobile, sometimes limited to a certain fair-market resale value (usually around $5,000, but this varies from state to state).

  • Your personal property and normal household goods, sometimes limited to a certain fair-market resale value (this varies from state to state).

  • Your wedding and engagement rings.

  • Life insurance with a total face value (cash surrender) of no more than $1,500, and term life insurance with no cash surrender value.

  • Specially earmarked funeral and burial fund of up to $1,500, plus a burial space.

To get down to this eligibility level, you may give away or transfer to someone else, other than your spouse, any amount of your assets. Medicaid medical coverage eligibility doesn't have any of the rules or penalties regarding transfer of assets that apply to Medicaid nursing home coverage.

To find out what the Medicaid eligibility rules are in your state, contact a local office of your state's Medicaid program. To find a local Medicaid office, go to the federal government's Benefits.gov website and choose your state. This will take you to a page with contact information for your state's Medicaid program and information about local offices.

Community Answers

A fellow caregiver answered...

Explain Medicaid SpinDown

Donna davis answered...

I've been a care giver to a gentleman for many year's.Im his power of attorney and i bath shave clean his house take him to his doctor's i do it all and people are telling me i should check in on getting paid for the service i provide for him but i dont know who i would contact.Could you please help me.Thank you Donna Davis

Marley answered...

Hello Donna, I was in your position years back and the family of the woman they wanted me to look after while they were at work had set it up with Adult and childrens services. (they are listed in the phone book). Basically they will call or meet with you and then have you sign papers and that's about it. They will tell you what is needed if anything other than that. I was caring for this woman within a couple of days and they paid me for that. I was planning on doing it just to be helpful so that was a nice treat to learn that there are funds out there to help and very deserving because you are giving these we care for most of out time and energy. I hope this helps.. Marley