A Guide to Medicaid Eligibility & Enrollment. How to Complete a Medicaid Application Properly to Reduce Possible Approval Delays

Medicaid is a government-issued program that is available in all states. It provides medical insurance to people who cannot afford it or those considered low-income families. Medicaid provides benefits to those who are eligible through any means, whether it be income or health needs. The state in which you live is going to have their own criteria to decide the status of your Medicaid eligibility.

It is not easy to say whether you will qualify for Medicaid, however, it doesn’t hurt to try, especially if you are in need or have young children that need medical help. There are also many ways, if denied, that you can try to fight the verdict. The process of applying for and receiving Medicaid.

  • Government-issued program for healthcare
  • Criteria differ from state to state
  • A program provided to low-income families
  • For families with small children, long-term medical care, and a pregnant woman

Medicaid Enrollment Process

Medicaid enrollment is completed on your state’s government authorized website. The coverage is for both families and just children of those within the low-income bracket for that state or those who qualify for disability. Medicaid enrollment can also be processed through your state Medicaid agency. To find out more information about how to enroll in Medicaid you can contact your state with questions. Coverage includes long-term services, prescriptions, hospitalization, special health care services (such as autism), dental, and behavioral health.Each state will have a guide to aid you in what type of coverage you are able to get and what it will cover. The enrollment process, however, quite long in some states. The length of time to get approved can also take some time depending on your situation. For example, if you are pregnant the length of time is sometimes shorter than if you are not pregnant. However, if you are applying for your family and pregnancy is not in the equation, it can take longer.

Your Enrollment Options

  • Online, on your state’s website. Open up Google and type the following “Medicaid Enrollment” and hit enter.
  • Walk into the local Medicaid or family service center to fill out an application.

What Makes Someone Eligible?

There are several different criteria for eligibility. One of the biggest known criteria for receiving help through the state would be income. In many, if not all cases, this does go by your household gross income. Other big criteria for receiving benefits through your state would be a disability, for instance, blindness. Then there is age, those over the age of 65 will usually qualify for Medicaid or Medicare. Requirements for Medicaid can also include non-financial such as pregnancy or your parenting status. However, to receive benefits for these types you need to be a resident of the state, but also a citizen of the United States. Also, capable of receiving Medicaid are those who are medically needy. The guide to how this works is more complicated. You have (what is called) a spend down amount. This basically means that your medical needs exceed your yearly income and is the difference between a person’s medical needs and their income. Some requirements are as follows.

  • Low-income families
  • Families with children under the age of eighteen
  • A single parent
  • People with disabilities

As you are able to see, though the process might be lengthy in some states, there are many ways to help you with getting your medical needs taken care of. Any questions or concerns that you may have, you need to direct to a Medicaid state representative. They will be able to give answers to any questions that you may have that apply directly to your state. Even though the program does vary state to state, there are still many similarities in the program to make it universal across the country. You should be able to find the number to contact your state agency within the Local Government website.

Have a Higher Income Than Medicaid Limits Allow? You Have More Options Than You Think

Many individuals see the Medicaid income requirements listed for their state and are immediately deterred from even applying. The fact is, qualifying for Medicaid is not based upon your income alone. Income is but one of many considerations your state will take in determining your eligibility for Medicaid. Some additional programs are offered by certain states for those who are pregnant, disabled or have children to name a few. You will not know if you do qualify for one of these programs until you at least take the time to apply, and since there is no limited enrollment period, you can apply at any time to see if you still qualify despite your income.

Look into Trusts to Help You Qualify

One option for someone who has an income that disqualifies them from Medicaid would be a trust. A trust works by allowing individuals with assets and income greater than the limit set by Medicaid to allocate some of their income to enter into a trust. The trust then gives the recipient and their spouse, if applicable, a small monthly income allowance. If the recipient dies, the trust will be used to pay Medicaid back for healthcare costs. There are a number of these trusts out there for you. Miller Trusts, Supplemental Needs Trusts and Special Needs Trusts are a few examples. Since the rules for trusts vary from state-to-state, it is recommended that you consult an attorney if pursuing this option.

If You Are Disabled and Under the Age of 65, Consider a Medicaid Buy-In

For those individuals who have a disability and are under the age of 65 and working, you might find that you qualify for a Medicaid Buy-In program. Available in some states, this program allows you work full-time or part-time and still receive Medicaid benefits if you are over the income requirements for Medicaid. To qualify, you do have to be under the age of 65, working and have a disability as defined by the Social Security Administration. If you think you might qualify for this option, you will want to contact your Local Department of Social Services for more details.

Medicaid Spend down Programs for Those over 65

To qualify for this program, you will be required to be over the age of 65 or have a disability as defined by the Social Security Administration. A Medicaid Spend-Down program is designed for those individuals who might be over the income requirements for Medicaid but have high healthcare costs and are therefore deemed “medically needy”. So if you are someone who is paying enough in healthcare costs to make your income fall below the income limit for Medicaid, you might qualify for the Medicaid Spend-Down program. This program allows you to subtract your medical costs from your income, and in doing so, can make you eligible for Medicaid if the end figure is under the Medicaid income limits. There might be greater or fewer restrictions on this program depending on your state’s requirements, but in general, as an individual, you cannot have assets over $14,850 or as a couple over $21,750 to qualify.


Remember, income is just one factor in determining your eligibility for Medicaid. Each state has its own income requirements for Medicaid as well. Your individual life circumstances and your state’s requirements may create more opportunities for you to have access to Medicaid than you realize. Although you may not be certain that you will qualify for Medicaid, do not let your uncertainty deter you from applying. In addition, refer to the special programs above. If you believe that any of them might apply to you, be certain to contact your Local Department of Social Services for more information to help you in your application.

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