Medicaid Eligibility

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Page last updated: 05/26/04

There are three main categories of individual who can qualify for Medicaid:

1. Mandatory Needy - Some examples are Supplemental Security Income (SSI) recipients (in 30 states); children under age six; certain Medicare beneficiaries; and special protected groups who may keep Medicaid for a period of time. Examples are people who lose SSI payments due to earnings from work or increased Social Security benefit
   
2. Categorically Needy - These optional groups share characteristics of the mandatory groups, but the eligibility criteria are somewhat more liberally defined. Examples of the optional groups that States may cover as categorically needy are targeted low income children; certain aged, blind, or disabled adults who have incomes above those requiring mandatory coverage, but below the federal poverty level; institutionalized individuals with income and resources below specified limits; people who would be eligible if institutionalized but are receiving care under home and community-based waivers.
   
3. Medically Needy - An optional program that allows states to extend Medicaid eligibility to additional qualified people who may have too much income to qualify under the mandatory or optional categorically needy groups. This option allows individuals to "spend down" to Medicaid eligibility by incurring medical and/or remedial care expenses to offset their excess income, thereby reducing it to a level below the maximum allowed by that state's Medicaid plan.