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Health Care Reform:

Health Insurance & Affordable Care Act

New to Medicaid? How It Works

Who Is Eligible for Medicaid? continued...

Your income is important when applying for Medicaid. States usually have a cut-off based on your income and assets. If you're below a certain level, you may qualify.

You might be eligible even if you earn more. Even if your income and assets are above the cut-off level, you might still get Medicaid if your medical bills are high. You may be able to subtract those expenses from your income. This is called the spend-down process. After you subtract costs like hospital care and doctor visits, your income will be lower and may make you eligible for Medicaid.

You may be able to start using Medicaid. The Affordable Care Act is helping states make Medicaid available to more people.

The idea is to open up Medicaid to people who have low incomes and can't afford insurance on their own but who made too much to qualify for Medicaid in the past.

However, states can decide whether they will expand Medicaid to include more people. Some have. Some haven't. See your state page to find out if your state is expanding Medicaid.

States that have decided to expand Medicaid must provide coverage to everyone with incomes below 138% of the federal poverty level. That's:

  • $15,654.10 or less a year if you're single
  • $32,252.50 or less a year for a family of four

If you live in Alaska or Hawaii, you can make more money and still qualify.

Whether you're a U.S. citizen can make a difference. Each state has rules about citizenship. For instance, some states won't let you get Medicaid if you're not a citizen. Other states allow all immigrant children and pregnant women to use Medicaid.

Applying to Medicaid

If you want to apply to Medicaid, you should also know that:

Once you're approved, you'll get a Medicaid card. This is your ID card. You'll need to show it to get any Medicaid benefit, such as a doctor's visit or a prescription.

At the beginning, your Medicaid coverage is retroactive. That means it covers your expenses for up to 3 months before you applied.


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