Medicaid provides health coverage or nursing home coverage to certain categories of low-asset people, including children, pregnant women, parents of eligible children, people with disabilities and the elderly needing nursing home care. Having limited assets is one of the primary requirements for Medicaid eligibility, but poverty alone does not qualify an individual to receive Medicaid benefits unless he/she also falls into one of the defined eligibility categories.
The eligibility categories for receiving Medicaid are:
- Pregnant women and children under 6 with family income at or below 133% of the federal poverty level.
- Children ages 6 to 19 with a family income at or below the federal poverty level.
- Adults who take care of children under age 18.
- Individuals who receive Supplemental Security Income
- Teenagers up to age 21 who are living on their own
- People who are over 65, blind or disabled
Some individuals who do not meet the income requirements may still receive Medicaid benefits because they are medically needy. If you do not live in a state with a medically-needy program and you do not meet the income requirements, you may not qualify for Medicaid.
In general, you must be a U.S. citizen to qualify for Medicaid. Legal immigrants may be able to qualify in certain circumstances. Illegal immigrants who would otherwise qualify for Medicare may be able to receive Medicaid assistance in emergency situations only.
Medicaid coverage can be retroactively applied up to three months before the application was made as long as you were Medicaid eligible for coverage during that period. So, if you incurred medical bills before you applied for Medicaid, you may be able to have those bills covered as long as you make your Medicaid application within the specified timeframe.
Individuals receiving some state program benefits not related to health care may automatically be eligible for Medi-Cal. Those receiving Supplemental Security Income, which provides cash assistance for low-income, elderly and disabled citizens, are eligible to receive Medi-Cal, as are residents who get refugee assistance, who are in the Foster Care or Adoption Assistance Program, those receiving In-Home Supportive Services, and those participating in CalWORKS.