Are You Eligible for Medicaid? A Brief Overview of the Income Criteria

Medicaid is a government health insurance program run jointly by the federal and state governments. It is the largest source of health coverage in the United States, with over 70 million people enrolled. The program is designed to help ensure those with lower income are able to get the health care they need. When trying to determine whether or not you are eligible for Medicaid, checking the income criteria is a great place to start.

It is important to note, however, that like most government programs, Medicaid income criteria can be quite complicated. There are many factors that need to be evaluated on a case by case basis. In addition, since Texas has not (yet, as of December 2016) adopted the expanded coverage options encouraged by the Federal government, determining eligibility can be even more complex. Getting a basic understanding of the income requirements is important, but seeking the consultation of an experienced Medicaid attorney is the best way to know for sure whether or not you qualify.

Determined by Poverty Levels

Since Medicaid is intended primarily for those with low incomes, eligibility is often based, at least in part, on income levels. In most cases, this will be based on a percentage of the federal poverty level. For example, an individual can make up to $11,880 to be considered living in poverty. Income criteria in Texas depend on the age of an individual, whether they have a disability, are a caretaker, are pregnant, and a number of other factors. Depending on the specifics of the situation, one can qualify when they are making anywhere from 133% to 201% of the federal poverty level.

Impact of Affordable Care Act

Since the Affordable Care Act (AKA, Obamacare) became law, financial eligibility for Medicaid has changed. Going forward, the modified adjusted gross income will be used to determine whether someone qualifies for this, or a number of other related programs. This system accounts for things like cost of living across different areas, and a number of other factors, to determine whether someone is below, at, or above the federal poverty line. Those who are 65 or older, however, will have financial eligibility using supplemental security income (SSI), which is slightly different than the modified adjusted gross income. Understanding how your income is calculated is very important when considering Medicaid applications.

Contact Us to Determine Eligibility

Understanding the income criteria, and other factors, that determine Medicaid eligibility is important. Due to the complexity of the laws surrounding Medicaid, however, the only sure way to know whether or not you qualify (and what you can do to qualify if you don’t already) is to talk to an experienced attorney. Contact Amsberry Law Firm to have your eligibility reviewed, and discuss all your options.

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Written by Amsberry Law Firm

Amsberry Law Firm

Mr. Amsberry is board-certified in labor and employment law by the Texas Board of Legal Specialization. He is a proven litigator who has argued before the United States 5th Circuit Court of Appeals and earned favorable outcomes in complex, precedent-setting employment and civil rights cases. He served as a reservist assistant judge advocate general in the U.S. Army and is a sought-after lecturer and speaker on a range of legal issues.

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