What Determines Medicaid eligibility

1. What Determines Medicaid Eligibility? Medicaid provides healthcare for individuals and families with a low income, but qualifying for it can be complex. In fact, several different factors determine whether you qualify. Medicaid is a federal program, but it is administered at the state level, meaning the rules can vary depending on your state. You should always check your state's specific guidelines to determine if you are eligible. In general, here is a breakdown of the primary factors that can impact Medicaid eligibility. 7 Factors That May Determine Your Medicaid Eligibility 1. Your Income Level One of the most significant factors in determining eligibility for Medicaid is household income. Each state sets limits based on the Federal Poverty Level (FPL). Generally, to qualify, your income must fall below a certain percentage of the FPL, which varies from state to state. 2. The Size of Your Household Medicaid eligibility is also based on the number of people in your household. A household with more members has higher income limits, allowing larger families to potentially qualify for Medicaid even if their total income is greater. When applying for Medicaid, it is important to include all the members of your household to ensure an accurate evaluation of your eligibility. 3. How Old You Are Certain age groups have specific Medicaid programs. Children under 19, pregnant women, and seniors over 65 may qualify for Medicaid, though the eligibility requirements and benefits can differ. 4. Your Disability Status People with disabilities may qualify for Medicaid, sometimes even if their income exceeds the standard limits. They may also be eligible for dual coverage from both Medicaid and Medicare.

2. 5. If You Are Pregnant Pregnancy can expand your Medicaid eligibility. Most states offer Medicaid for pregnant women, ensuring that both mother and baby receive appropriate medical care during pregnancy and after childbirth. Medicaid for pregnant women may cover a wide range of services, including prenatal care, delivery, and postpartum care. 6. Your Residency Status To qualify for Medicaid, applicants must be U.S. citizens or qualified non-citizens, such as lawful permanent residents. They usually must also be residents of the state where they are applying for and receiving Medicaid. 7. Your Medical Needs In some states, individuals with high medical expenses may qualify for Medicaid through a "medically needy" program. These programs are designed for individuals whose income is above Medicaid limits but who have significant medical costs that reduce their effective income. By "spending down" their income on medical expenses, individuals may qualify for Medicaid to help cover ongoing healthcare needs. Can I Go to an FQHC as a Medicaid Beneficiary? For those who qualify for Medicaid, Federally Qualified Health Centers offer a convenient, affordable way to access high-quality healthcare services! Each health center accepts Medicaid, meaning eligible patients can receive routine check-ups, screenings, dental care, and more without financial barriers. However, not everyone qualifies for Medicaid, and some individuals may be waiting for their eligibility to be processed. For those who fall into these categories, FQHCs provide care on a sliding fee scale, meaning patients without insurance or those awaiting Medicaid approval can still receive the medical attention they need. Whether you qualify for Medicaid or not, health centers are committed to ensuring everyone has access to necessary medical care. By offering multiple essential healthcare services, health centers allow you to see providers for various needs under one roof. From medical and dental to health education and preventative care, they serve as a safety net for those lacking access to high-quality care. Find a Health Center That Accepts Medicaid At the Oklahoma Primary Care Association (OKPCA), we aim to help connect individuals to affordable healthcare options. Whether you qualify for Medicaid, are ineligible, or are awaiting

3. a decision regarding your eligibility, we can guide you to local FQHCs that offer comprehensive care, regardless of your financial or insurance status. If you need support navigating the complex system of Medicaid or finding a health center near you, reach out to us! We are here to help you get the healthcare you deserve.