MEDICAID:
FREQUENTLY ASKED QUESTIONS
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WHO IS COVERED BY MEDICAID?
States vary depending on the options they elect.
“SSI states” cover everyone who qualifies for Supplemental Security Income (aged, blind and disabled) and have rules that are not more restrictive than the federal government rules for SSI.
“Section 209(b) states” have requirements that are more restrictive than the federal SSI rules. Connecticut, Hawaii, Illinois, Indiana, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma and Virginia are Section 209(b) states.
States can also, at their option, cover “categorically needy persons.” These people can qualify for assistance such as SSI, but are not receiving it (for example, because they live in an institution). States may use a higher income standard, up to three times the SSI benefit amount, for an individual living at home. If states do not also adopt the “medically needy standard” described below, they would be considered “Income Cap states,” meaning that because of income greater than the allowed amount, individuals are ineligible for Medicaid. Alabama, Alaska, Colorado, Delaware, Idaho, Mississippi, Nebraska, New Mexico, South Carolina, South Dakota and Wyoming are income cap states. Connecticut has an income cap for home care but under a waiver allows spend down for institutionalized care.
States may, at their option, cover “medically needy persons.” These people would qualify for Medicaid because of their asset levels, but have too much income to qualify categorically but not enough income to pay for their medical expenses. California, Georgia, Hawaii, Illinois, Kentucky, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, Washington, Washington, D.C., West Virginia and Wisconsin, all have “medically needy” programs. Connecticut under a waiver allows spend down for institutionalized care but has an income cap for home care.
Arizona, Arkansas, Florida, Iowa, Louisiana, Oklahoma and Oregon allow a “spend down” but do not permit nursing home costs to be included. Texas does not include the aged in its spend down program.
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WHY IS MEDICAID DIFFERENT IN EVERY STATE?
Medicaid is a joint federal and state program to provide medical assistance to eligible needy people. It is an entitlement program based on income and asset guidelines. The federal contribution is about one-half. Since the states pay the remaining costs, they have broad discretion about whom to cover and what benefits to provide. Although there is a single state agency in charge of the program in each state, in many states the program is administered by county and city governments.
WHAT IF I JUST MOVED INTO A STATE?
States must provide Medicaid for eligible residents and cannot place any requirements as to length of residency.
WHAT ARE THE INCOME AND RESOURCE LEVELS FOR MEDICAID?
Income cap states limit income to three times the SSI benefit level. No spend down is allowed and any excess will disqualify the person in these states. For resources many states use the federal SSI levels. The income standards are more complex and vary in each state.
ARE ADULT CHILDREN RESPONSIBLE FOR THE MEDICAL BILLS OF THEIR PARENTS?
Federal law does not permit states to use the income or resources of adult children in determining Medicaid eligibility and the state cannot collect reimbursement from the children.
IS A WELL SPOUSE LEGALLY RESPONSIBLE FOR MEDICAID EXPENSES OF THE SICK SPOUSE?
Federal law permits states to “deem” the income and resources of the well spouse to be available to the sick spouse. The extent of the “deeming” depends on whether the sick spouse is at home or institutionalized and also varies in how the states apply the deeming rules. In some states, the deeming rules do not apply, but Medicaid may be allowed to sue the well spouse for a contribution.