Medicaid qualifications can be challenging to navigate. This program offers health insurance for children, pregnant women, seniors, and those with disabilities. The 2010 Affordable Care Act expanded Medicaid to provide coverage for more low-income individuals.
What Does Medicaid Eligibility Mean?
Federal law makes Medicaid coverage mandatory nationally for qualified individuals, but eligibility requirements vary by state:
Medicaid eligibility in New York
To be eligible for Medicaid in New York, a person must be a U.S. citizen, national, permanent resident, or legal alien, and a resident of the state. Also, they must need insurance assistance, meaning they don’t have insurance coverage through another carrier and fall within a low-income bracket. The state determines that bracket annually.
Medicaid covers the following individuals:
• Those who are pregnant or responsible for a child 18 years or younger
• The blind
• The disabled, or those who have someone disabled in the home
• Seniors 65 years or older
Medicaid eligibility in Connecticut
Connecticut refers to Medicaid as their HUSKY program, which includes a basic part A and then expanded parts B, C, and D:
• Part A covers low-income Connecticut residents, their minor children, and pregnant women.
• Part B covers uninsured children under 19 with a family at certain income levels. In some cases, a family co-pay might apply.
• Residents aged 65 and older, those with disabilities, and the blind might qualify for part C. Income restrictions vary under this program.
• Residents aged 19 to 65 with dependent children, who are not pregnant and not qualified for other HUSKY programs, might qualify for part D. This program typically covers the lowest-income residents in the state.
Connecticut residents can learn more about HUSKY coverage and other social services programs and apply for coverage through the Department of Social Services.
What Does It Mean to Spend Down for Medicaid?
If someone’s income or their aging parent’s income is too high to qualify for Medicaid, they might be able to “spend down” income or assets. This program allows them to pay medical bills and other costs. Then, their income after paying those expenses determines their Medicaid eligibility.
Suppose someone’s annual income is $5,000 too high to qualify for Medicaid. Spending down allows them to pay $5,000 of medical bills and other related costs. After that spending, their income would fall into Medicaid’s income eligibility brackets. Then, they may qualify for Medicaid coverage.
Both income requirements and spending down rules vary by state. For someone to apply for Medicaid after spending down, they must submit receipts or other proof. Also, remember that every state determines which expenses are eligible for spending down. These expenses typically include:
• Medical bills, including prescription costs
• Transportation costs for healthcare
• Fees for medical aids, including walkers, eyeglasses, and the like
• Making changes to the home to accommodate medical concerns, such as installing a wheelchair ramp
• Prepaid funeral and burial expenses
Paying for Long-Term Care Using Medicaid
Medicaid long-term care coverage helps reduce the financial burden of medical expenses that accrue over the course of an illness or disability. This covers a range of services designed to help individuals remain in their homes or transition to another setting. Services may include home health aides; adult daycare; and respite care for family members who provide daily care.
In some cases, individuals may need to pay a portion of the cost, known as “cost-sharing,” which can range from small co-payments to substantial out-of-pocket expenses.
When considering long-term care options with Medicaid, it’s important to research your particular state’s guidelines to understand what coverage is available based on your circumstances and have your questions answered.
If you need additional information about Medicaid eligibility and qualifications, please speak with a team member at Oasis Senior Advisors at 475.619.4123 or 914.356.1901