Medicaid
Medicaid is a state-administered program which provides health insurance benefits to qualified individuals. These programs receive federal and state funding. Within broad national guidelines established by the federal government, each state is allowed to set its own eligibility, coverage, and payment guidelines.
There are many pathways to Medicaid eligibility. Individuals with low income and families who fit into an eligibility group determined by federal and state law may be eligible for Medicaid coverage. These groups include pregnant women, children, individuals over the age of 65, disabled individuals, Temporary Assistance to Needy Families (TANF) recipients and other special groups. Other individuals with low income may qualify for different types of Medicaid based on eligibility for Medicare. The table below lists the general eligibility criteria for some of the different types of Medicaid.
| Medicaid Pathway |
2012 Income Criteria (Individual/Couple) |
2012 Asset Criteria (Individual/Couple) |
Insurance Criteria |
| Traditional Medicaid (full benefits) | Vary by state and eligibility category | No criteria | |
| Qualified Medicare Beneficiary (QMB) | $11,412/$15,372 | $6,940/$10,410 | Entitled to Medicare Part A |
| Specified Low-Income Medicare Beneficiary (SLMB) | $13,644/$18,396 | $6,940/$10,410 | Entitled to Medicare Part A |
| Qualified Individual (QI) | $15,324/$20,676 | $6,940/$10,410 | Entitled to Medicare Part A |
| Qualified Disabled and Working Individual (QDWI) | $45,708/$61,548 | $4,000/$6,000 | Lost Medicare Part A benefits due to return to work, but eligible to enroll in and purchase Medicare Part A |
Source: Medicare.gov. Help with medical and drug costs. http://www.medicare.gov/navigation/medicare-basics/medical-and-drug-costs.aspx. Accessed February 3, 2012.
