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Seniors Guide on How to Qualify & Apply for Medicaid

What is Medicaid?

Medicaid is a jointly funded state and federal health insurance program for low-income people of all ages. For the approximately 7.2 million seniors who currently qualify, Medicaid benefits can include medical care, physician visits, non-medical support services such as in-home assistance, and nursing home care. Essentially, if a senior meets both financial and medical criteria, Medicaid will pay nearly all long-term care costs.

Applying for Medicaid can be confusing for a number of reasons, not the least of which is it isn’t always called Medicaid. Some states call it Medicaid, others have different names for it. Many senior services come under the umbrella of “Home and Community Based Services, (HCBS). These services can be provided under the regular state Medicaid program, or through Medicaid Waivers. 

How to Get Medicaid

Though there are some federal minimums and maximums, states have some flexibility in setting their financial eligibility rules for Medicaid. After considering both income and assets, your state will apply its formula to determine eligibility. The application process includes a five-year “look back” to determine any transfers of financial resources.

When you are applying for Medicaid, it is worth inquiring about spousal impoverishment protections. If it applies to your particular situation, it means one member of a couple can qualify for Medicaid assistance without depleting the assets of both.

Medicaid Income Limits

States use one of two formulas to determine Medicaid eligibility. There are “income cap” states, that set a hard limit at 3 times the Federal Benefit Rate (FBR). The FBR is the maximum dollar figure paid to individuals that receive Supplemental Security Income (SSI).

“Non-income cap” states allow applicants who have income over the limit to still qualify for Medicaid if they have high medical bills relative to their income.

Get Help Applying for Medicaid

There are several resources available to help navigate the applying for Medicaid including:

The Area Agency on Aging

The Medicare State Health Insurance Counseling and Assistance Programs (SHIP)

American Council on Aging
  • The American Council on Aging website can direct you to Medicaid planners trained to assist you in the application process.

If you think you may be eligible for Medicaid benefits, find a friend or family member who has gone through the process or get the help of an expert. Your health and wellbeing depends on it!

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