Who's Eligible for Medicaid Coverage of Medical Care?

A fellow caregiver asked...

Who's eligible for Medicaid coverage of medical care?

Expert Answer

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.