Eligibility Criteria

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

Providing Documentation of Citizenship for Medicaid
Providing Documentation of Citizenship for Medicaid Poster

2008 Financial Limits

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 - $623 per month ($7,644 per year)
Couple - $956 per month ($11,472 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

$1,911 per month ($22,932 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

$1,911 per month ($22,932 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 - $871 per month ($10,452 per year)
Couple - $1161 per ($13,932 per year)

Individual - $4,000
Couple - $6,000

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

$1,911 per month ($22,932 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	$1,734 per month ($20,808 per year)
2	$2,334 per month ($28,008 per year)
3	$2,934 per month ($35,208 per year)
4	$3,534 per month ($42,408 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	$1,604 per month ($19,248 per year)
2	$2,159 per month ($25,908 per year)
3	$2,714 per month ($32,568 per year
4	$3,269 per month ($39,228 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	$1,153 per month ($13,836 per year)
2	$1,552 per month ($18,624 per year)
3	$1,951 per month ($23,412 per year)
4	$2,350 per month ($28,200 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	$867 per month ($10,404 per year)
2	$1,167 per month ($14,004 per year)
3	$1,467 per month ($17,604 per year)
4	$1,767 per month ($21,204 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.

Pregnant Women and Children

Income Limits

Resource Limits

Family Size
1	$208 per month ($2,496 per year)
2	$317 per month ($3,804 per year)
3	$375 per month ($4,500 per year)
4	$442 per month ($5,304 per year)

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 ($3,804 per year)
Couple: $375 per month ($4,500 per year)

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