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STATE SUMMARIES
INTRODUCTION
• Categorical and Financial Eligibility
MANDATORY GROUPS
• Cash Assistance Group
• Dual Eligibles
OPTIONAL GROUPS
• Poverty Level Group
• State Supplementary Payment Group
• Medically Needy Group for Aged,
Blind, and Disabled
• Institutionalized Individuals Group
• Home and Community-Based
Services (HCBS) Waivers
Group
GLOSSARY OF
ELIGIBILITY TERMS
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Website Report
INTRODUCTION
Medicaid is an important source of health care coverage for the low-income aged, blind, and disabled populations in America. While federal law places certain requirements on state Medicaid programs to cover some aged, blind, and disabled individuals, a state retains many complex eligibility options which often work in concert to determine the greater public health insurance picture for its aged, blind, and disabled residents. This paper, in coordination with the state eligibility summaries and database, represents our attempt to explain the various Medicaid eligibility categories open to aged, blind, and disabled persons in each state, as well as the specific rules that the state applies to each category.
Categorical and Financial Eligibility
In general, to be eligible for Medicaid, a person must fit into a Medicaid eligibility category. For the purposes of this report, the relevant categorical requirement is that the person be aged 65 or older, blind, or disabled.
Once a person is determined to fit the Medicaid categorical requirement, his/her financial eligibility must be determined by a thorough examination of both income (anything a person receives that can be used to purchase food, clothing, or shelter1) and resources (anything a person owns that can be converted to cash to purchase food, clothing, or shelter2).
An eligibility worker uses a Medicaid-specific methodology involving exemptions and deductions (essentially things that don’t count toward the eligibility determination) to derive the applicant’s “countable” income. A similar process is used to determine the person’s countable resources. This process allows persons to have total income and/or resources higher than the relevant standards and still qualify for benefits.
A person’s countable income is then compared to the income standard—the maximum amount of income a person can have and still be eligible3 . If it is less than or equal to the standard, the person is considered income-eligible. A person’s resources go through the same process with a resource standard. If the person is both income-eligible and resource-eligible, he/she becomes qualified for the program benefits.
1 From http://www.hcfa.gov/medicaid/twwiia/elig101.htm
2 Ibid.
3 Ibid.
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