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Medicaid Financial Eligibility Pathways for the Elderly, Disabled

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Topics: Access/Barriers | Dual Eligibles | Medicaid | Medicare | Spending | State Data

This Kaiser Family Foundation (KFF) released a brief outlining the pathways to Medicaid enrollment and the financial restrictions on Medicaid eligibility for the elderly and disabled.  The brief provides an overview of eligibility for the elderly, blind, and disabled; the medically needy; and dual eligibles.  KFF also provides state-level data for each group.

From the report:

Individuals must meet financial qualifications for Medicaid coverage in addition to meeting categorical criteria. For the elderly and people with disabilities, these limits are often tied to the Supplemental Security Income (SSI) Program, which has certain categorical definitions for determining eligibility as well as an income standard of $674 per month for an individual and $1,011 per month for a couple in 2009. In determining the monthly income standard, states may disregard certain types or amounts of income – e.g., $20 in monthly income. Therefore if a $20 income disregard applies to a $674 standard, an individual can have $694 per month in actual income and still qualify. In 11 states, known as 209(b) states, Medicaid eligibility rules for people with disabilities and the elderly are slightly different from the federal SSI program. In 209(b) states, both the financial and non-financial eligibility criteria can be more restrictive than the federal standard, as long as they are no more restrictive than the rules they had in place in 1972. The states with 209(b) programs are: Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia.

Full report:  Medicaid Financial Eligibility Pathways for the Elderly, Disabled (PDF | 578.15 KB) exit disclaimer small icon

Kaiser Family Foundation. (2010). Medicaid financial eligibility: primary pathways for the elderly and people with disabilities.

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