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Have a Higher Income than Medicaid Limits? You Have More Options than You Think!

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Medicaid is a government-sponsored program that is offered in all 50 states. Qualifications for Medicaid is based upon income and family size.

Due to the Affordable Care Act, a number of states expanded their qualifications to allow more people to receive coverage. Medicaid provides healthcare for low-income people, families, and children. Depending on where a person lives, some receive coverage for all adults below a specific income level.


Medicaid coverage is available in all states for persons below a specific income level. This is dependent upon family size, family structure, or disability status. In states that have expanded Medicaid coverage due to the Affordable Care Act, people can qualify for Medicaid based on income alone. Therefore, if a person’s income is below 13% of federal poverty, he/she will qualify. Each state has coverage options particularly for families with young children or women who are pregnant.


Once a person has been approved to receive Medicaid services, he/she will receive an enrollment card. To determine what type of coverage you receive, the best thing to do is contact member services to ensure your health services are covered. When you make an appointment with a healthcare provider, it is important to ensure that they accept Medicare services. If you do not, you may be required to pay for services out of pocket if they do not accept Medicaid. Check local Medicaid websites to find doctors that accept Medicaid to ensure your services will be covered.

Dental Coverage

Dental coverage is a required component of Medicaid. Those who are under 21 are eligible for bi-annual dental screenings and necessary treatments. It is necessary that people engage in regular screenings to determine the existence of serious conditions. These services must include treatment of infections, pain, teeth restoration, and general maintenance. If further treatment is necessary, the state is required to provide the services necessary to fix and prevent further problems even if the services are not a part of the Medicaid plan. For adults over the age of 21, each state may choose whether or not to provide dental services as part of the Medicaid plan. Most states provide emergency dental services for those adults covered under Medicaid, but only about half provide comprehensive dental care. Check with your current state to see what is and is not covered regarding dental services.

Emergency Services

During an emergency situation, go to the nearest hospital for treatment. The law requires that a hospital treat a patient in an emergency situation despite payment of services. Medicaid provides emergency ambulance services by provider’s licenses by the state. For Medicaid to cover ambulance transportation, the patient must be taken in a vehicle that has been inspected and licensed by the state. If non-emergency transportation is necessary, a doctor’s recommendation must first be given before Medicaid will cover the service.


The Children’s Health Insurance Program provides benefits to children through Medicaid and other programs. Children, who are eligible, are covered up through age 19 if the family’s income is too high to qualify for Medicaid. Each state sets its own terms for CHIP regarding income eligibility. 46 states will cover children up to or over 200% of the federal poverty level and 24 states will cover up to 250% of the poverty level. Dental services are available through a Medicaid expansion program under Chip and are required to prevent disease and promote proper oral health. Age-appropriate vaccines are also covered under CHIP and are a required component for those enrolled in the CHIP plan. Contact your state office to determine if your children are eligible for coverage under the CHIP plan.