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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.

Medicaid Eligibilty manuals on the DHS website

Proof of Citizenship Requirements

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

 2013 Financial Limits - Updated 04/12/13

SSI Recipients

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

Income Limits

Resource Limits

  • Individual - $710 per month ($8,520 per year)
  • Couple - $1,066 per month ($12,792 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

  • $2,130 per month ($25,560 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

  • $2,130 per month ($25,560 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 -$978 per month ($11,736 per year)
  • Couple - $1,313 per month ($15,756 per year)
  • Individual - $7,080
  • Couple - $10,620

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

  • $2,130 per month ($25,560 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

$1,916 per month ($22,992 per year)

2

$2,586 per month ($31,032 per year)

3

$3,256 per month ($39,072 per year)

4

$3,926 per month ($47,112 per year)

Each additional person:  $670 per month ($8,040 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

$1773 per month ($21,276 per year)

2

$2,393 per month ($28,716 per year)

3

$3,012 per month ($36,144 per year)

4

$3,632 per month ($43,584 per year)

Each additional family member:  $620 per month ($7,440 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; $446 per month ($5,352 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

$958 per month ($11,496 per year)

2

$1,293 per month ($15,516 per year)

3

$1,628 per month ($19,536 per year)

4

$1,963 per month ($23,556 per year)

Each additional family member; $335 per month ($4,020 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