Eligibility Criteria Chart

Eligibility for major coverage groups within Medicaid

The following guidelines provide general income criteria that are used in part to determine a person's eligibility for Medicaid programs and services. To become eligible, please visit your local county Department of Family and Children Services Office.

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Proof of Citizenship Requirements

Citizenship Identity Verification Requirements for Medicaid
Providing Documentation of Citizenship for Medicaid
Providing Documentation of Citizenship for Medicaid Poster

2012 Financial Limits - updated 02/29/12

Medicaid Eligibilty manuals on the DHR web site

SSI Recipients

Aged, blind or disabled individuals who receive Supplemental Security Income (SSI)

Income Limits

Resource Limits

Individual - $698 per month ($8,376 per year)
Couple - $1,048 per month ($12,576 per year)

Individual - $2,000
Couple - $3,000

Nursing Homes

Aged, blind or disabled individuals who live in nursing homes and have low income and limited assets.

Income Limits

Resource Limits

$2,094 per month ($25,128 per year)

Individual - $2,000
Couple - $3,000

Community Care

Aged, blind or disabled individuals who need regular nursing care and personal services but can stay at home with special community care services.

Income Limits

Resource Limits

$2,094 per month ($25,128 per year)

Individual - $2,000
Couple - $3,000

Qualified Medicare Beneficiaries (QMB)

Aged, blind or disabled individuals who have Medicare Part A (hospital) insurance, and have income less than 100 percent of the federal poverty level and limited resources. Medicaid will pay the Medicare premiums (A&B), coinsurance and deductibles only.

Income Limits

Resource Limits

Individual - $951 per month ($11,412 per year)
Couple - $1,281 per month ($15,372 per year)

Individual - $6,940
Couple - $10,410

Hospice

Terminally ill individuals who are not expected to live more than six months may be eligible for coverage. Recipients must agree to receive hospice services through a Medicaid participating hospice care provider.

Income Limits

Resource Limits

$2,094 per month ($25,128 per year)

Individual - $2,000
Couple - $3,000

Low-Income Medicaid (LIM)

Adults and children who meet the standards of the old AFDC (Aid to Families with Dependent Children) program.

Family Size	Income Limits
1	$235 per month ($2,820 per year)
2	$356 per month ($4,272 per year)
3	$424 per month ($5,088 per year)
4	$500 per month ($6,000 per year)

Right from the Start Medicaid for Pregnant Women and their Infants
(RSM Adults and Newborns)

Pregnant women and their infants with family income at or below 200% of the federal poverty level.

Family Size	Income Limits
1	$1,862 per month ($22,344 per year)
2	$2,522 per month ($30,264 per year)
3	$3,182 per month ($38,184 per year)
4	$3,842 per month ($46,104 per year)

Each additional person: $660 per month ($7,920 per year)

Right from the Start Medicaid (RSM Children) - 185 % FPL

Children under 1 whose family income is at or below 185% of the federal poverty level.

Family Size	Income Limits
1	$1723 per month ($20,676 per year)
2	$2,333 per month ($27,996 per year)
3	$2,994 per month ($35,928 per year)
4	$3,554 per month ($42,648 per year)

Each additional family member: $610 per month ($7,320 per year)

Right from the Start Medicaid (RSM Children) - 133% FPL

Children 1 to 5 whose family income is at or below 133% of the federal poverty level.

Family Size	Income Limits
1	$1,239 per month ($14,868 per year)
2	$1,678 per month ($20,136 per year)
3	$2,117 per month ($25,404 per year)
4	$2,555 per month ($30,660 per year)

Each additional family member; $439 per month ($5,268 per year)

Right from the Start Medicaid (RSM Children) - 100% FPL

Children 6 to 19 whose family income is at or below 100% of the federal poverty level.

Family Size	Income Limits
1	$931 per month ($11,172 per year)
2	$1,261 per month ($15,132 per year)
3	$1,591 per month ($19,092 per year)
4	$1,921 per month ($23,052 per year)

Each additional family member; $330 per month ($3,960 per year)

Medically Needy

Pregnant women, children, aged, blind, and disabled individuals whose family income exceeds the established income limit may be eligible under the Medically Needy program. The Medically Needy program allows a person to use incurred/unpaid medical bills to "spend down" the difference between their income and the income limit to become eligible.

Medically Needy Pregnant Women and Children

Income Limits

Resource Limits

Family Size
1	$208 per month
2	$317 per month
3	$375 per month
4	$442 per month

Family Size
1	$2,000
2	$4,000

(Add $100 per additional family member)

Aged, Blind and Disabled

Income Limits

Resource Limits

Individual: $317 per month
Couple: $375 per month

Individual: $2,000
Couple: $4,000

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Related Links

Eligibility Criteria Chart