Eligibility for Medicaid

Around 50 million people are currently enrolled in Medicaid. However, many people have eligibility for Medicaid but are not enrolled in the program. Whether they are deliberately choosing not to apply or simply unaware there are deserving people who have eligibility for Medicaid. Applying for Medicaid can help relieve financial pressure from recurring or sudden medical bills.

The federal government sets broad guidelines for Medicaid, but each state manages its own branch of Medicaid. Several groups of people are eligible to apply for Medicaid if requirements are met. Among eligible people are:

  • Children
  • Disabled
  • Elderly
  • Impoverished
  • Pregnant women
  • Teenagers

Eligibility requirements vary by state and by which group of people an applicant belongs to. Some states extend Medicaid eligibility to other groups of people that are not mandated by the federal government. Most states only broaden their eligibility requirements within the mandated groups of eligible people rather than adding new groups of eligible people. The federal government provides a list of optional groups of people that it considers in need beyond the mandated groups of people.

The federal government extends matching funds to each state to help pay for Medicaid. Matching funds means a dollar of federal money is contributed to Medicaid budgets for every dollar of state money that goes in. More money helps cover more people who are in need.

To apply for Medicaid, people must visit a state agency. States often name it the Department of Human Services or the Department of Social Services. Applicants must fill out an application and submit documents as proof of their need. Among the documents that may have to be submitted are:

  • Business records (for self-employed applicants)
  • Driver’s license
  • Pay stubs
  • Proof of residence
  • Social Security card

Applicants should be prepared to possibly be interviewed about any income or material assets they possess. Income is one of the primary determinations of whether an applicant will be approved for Medicaid. The Medicaid office may ask for more documents or information at their discretion. If an applicant does not feel comfortable going through the application and interview on their own, they can ask for a caseworker to assist them.

After receiving Medicaid, continuing document submissions must be made to prove eligibility. Depending upon the state, this may be necessary every 6 months to 1 year. Usually this is not as rigorous as the initial application.

As a politically sensitive topic, Medicaid eligibility may change on a yearly basis. Although 41 states made it easier to enroll or stay enrolled in Medicaid for 2010, co-pays and premiums have been increasing. Budgetary demands have made it more difficult for states to maintain all of Medicaid’s benefits. It is extremely unlikely that Medicaid will be entirely eliminated. However, Medicaid’s benefits and charges may fluctuate with the economy and government funding.

Under the new health insurance’s guidelines, eligibility rules will expand by 16 million people by 2014. This does not account for natural growth in the number of people eligible for Medicaid or the people who are not being reached. Whatever the reasons, a significant number of new people will be able to enroll in Medicaid over the next 5 to 10 years. Whether all of these people actually enroll may determine whether Medicaid’s benefits strengthen or contract.

Because of the number of people enrolled and involved in the Medicaid program, fraud is an ongoing problem. Eligibility fraud is committed when a person submits false documentation or otherwise gains enrollment into Medicaid under false pretenses. If someone is suspected of committing Medicaid fraud, contact the state attorney general’s office with any information. The Office of Inspector General’s National Fraud Hotline is another way to contact the federal government with suspected fraud allegations.

Whether medical bills are recurring or sudden, Medicaid can help. Many people have eligibility for Medicaid but are not enrolled. With medical bills being one of the leading causes of financial hardship, Medicaid can make a difference. Eligible people often may face a critical choice, like choosing between food and medical treatment between paychecks. Enrolling in Medicaid can help people eliminate these choices. People in any of the eligibility categories should visit with a Medicaid caseworker and check into whether they can apply for Medicaid.