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WHO IS ELIGIBLE FOR MEDICAID?

CAN AN ADULT BE COVERED IN THIS PROGRAM?

In order for the adult caretaker to receive in the Family Medicaid program, first of all, their child must be Medicaid eligible. Eligibility for the adult is based on the child. If there is an eligible child, then the adult can possibly receive. But, the income guidelines for an adult to receive are much lower than for the child. Also, there is a resource evaluation that must be met for the adult to receive.


PROGRAM
INCOME LIMIT (FAMILY OF TWO)
GROUP COVERED
BENEFITS OF PROGRAM
RESERVE (for two)
DEDUCTIBLE?
Medicaid-Assistance to Families (MAF) Medically Needy
$317
Children Under 21. Parents can be covered if a Medicaid eligible child under 19 in the home.
Any needed medical care. No limit on prescriptions for children. 6 prescription limit for adults.
$3000
YES
Medicaid-Assistance to Families (MAF) Categorically Needy
$472
Children Under 21. Parents can be covered if a Medicaid eligible child under 19 in the home.
Any needed medical care. No limit on prescriptions for children. 6 prescription limit for adults.
$3000
NO

CAN A PREGNANT WOMAN RECEIVE MEDICAID WHO HAS NO OTHER CHILDREN IN THE HOME?

Yes. There is a Medicaid program titles Medicaid for Pregnant Women (MPW). This program is based solely on the income of the pregnant woman and the father of the unborn if in the home. There are no resource limits in this program and the income limit is shown below. These income limits, referred to as poverty level, are established by Congress each fiscal year. This coverage begins with approval of an application and continues for two months after the birth of the baby. When the baby is born and birth reported the baby gets Medicaid automatically for one year.


PROGRAM
INCOME LIMIT (FAMILY OF TWO)
GROUP COVERED
BENEFITS OF PROGRAM
RESERVE (for two)
DEDUCTIBLE?
Medicaid-Pregnant Woman (MPW)
$2,111 (mom & unborn) Parents' income does count for pregnant teen
Pregnant Women
All pregnancy related services. No limit prescriptions 21.   Limit 6 prescriptions 21.
NA
NO

CAN SOMEONE RECEIVE MEDICAID IF HE/SHE IS NOT A U.S. CITIZEN?

There are many factors to this question.

If he/she is an Illegal Alien, the person can not receive full Medicaid. They may be eligible for Emergency Medicaid Services. Emergency Medicaid is determined by DMA (Division of Medical Assistance).

If she is illegal and pregnant, she may be eligible for Presumptive Medicaid for the later part of the pregnancy. When an Illegal Alien delivers her child, she can then apply for Emergency Labor and Delivery Services. The baby would then be eligible for Automatic Newborn coverage for 1 year, since the child is a U.S. Citizen.

If they are Lawful Permanent Residents (LPR) admitted to the U.S. on or after August 1, 1996 they are not eligible for full Medicaid for 5 years from the date they are admitted to the U.S. as an LPR. Residency status is determined Immigration and Naturalization Services. This is a mandatory 5-year disqualification period. After the 5-year disqualification period has expired, LPR's are potentially eligible for full Medicaid just like U.S. citizens.

If they are LPR under a political designation (ex. Refugee) admitted on or after August 1, 1996, they can only receive full Medicaid for the first 60 months they have entered this country. Refugees admitted before August 1, 1996 have been exempted from this.


 

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