How to Get Medicaided

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Robin Mead

If you got turned down for Medicaid, or thought you would be turned down so didn’t bother applying, don’t give up hope just yet.

There are many different Medicaid programs in every state. If you get turned down for one, you can try a different one. See the list below for twenty different ways people can apply for Medicaid. That’s right…. twenty!

WHAT’S MEDICAID?

Medicaid is a health insurance program run by your state. If the word “Medicaid” doesn’t look familiar to you, it may be because your state uses a different name.

For example: In California, it is called “Medi-cal.” In Pennsylvania, it is called “Medical Assistance.” In Massachusetts, it is called “MassHealth.” And in some places it is totally random. Like some Wisconsin Medicaid programs are called “BadgerCare”

WHAT’S THE DIFFERENCE BETWEEN MEDICAID AND MEDICARE?

Good question. The answer is here: What’s the Difference Between Medicare and Medicaid?

WHAT DOES MEDICAID OFFER

  • Medical care (doctors, hospitals, medical tests, etc)
  • Vision (some states)
  • Dental (some states)
  • Transport to doctors (most areas)
  • Pays all deductibles and most co-pays
  • If you have Medicare, some Medicaid programs pay the premiums
  • Medicaid waiver programs can also provide home aides, home modifications, assistive technology, and other services

DON’T GIVE UP ON MEDICAID

Many people (wrongly) think that they can’t get Medicaid. And many people (wrongly) are told that they can’t get Medicaid. And many people (wrongly) are told this by people who work at Medicaid! Why Is Someone Telling Me I Can’t Get Medicaid? Twenty different ways to apply:

“I DON’T BELIEVE I CAN GET MEDICAID”

Maybe it will help to see a sample of how many different Medicaid programs one state can have. Here’s a few examples of different Medicaid programs and income limits from a sample state. Income Limits for a Single Person:

  • Medicaid Spend Down: $590/month
  • Aged Blind Disabled Medicaid: $780/month
  • Medicare Savings Program/QMB: $1,060/month
  • Medicaid Premium Assistance Program: $1,300/month
  • Medicaid for Families: $2,000/month (1 parent + 1 child)
  • Medicaid Waiver/Long Term Care: $2,300/month
  • Medicaid Buy In: $4,600/month

Option #1 – MAGI Medicaid

Learn more About MAGI Medicaid

Who qualifies:

  • Anyone who is NOT on Medicare and NOT receiving Social Security disability
  • Only available in a state that expanded Medicaid
  • Available in 31 states

Finances:

  • Income limits vary by state.
  • There are no asset limits. Money in bank and things you own don’t count.

Option #2 – Aged, Blind, Disabled Medicaid

Learn more About Aged Blind Disabled Medicaid

Who qualifies:

  • Anyone who is disabled or
  • Anyone who is elderly
  • Tip: You do NOT have to be approved for Social Security.
  • Available in all states.

Finances:

  • Income limit: Income limits are generally $800 – $1,200 per month, depending on the state. Higher if married.
  • Asset Limits: There are also asset and resource limits.

Option #3 – Medicaid Buy In Programs

Learn more about Medicaid Buy In Programs

Who qualifies:

  • Working people with disabilities.
  • Many people with disabilities are not able to work a regular job, but still qualify for this program if they are doing any kind of self-employment at home (babysitting, pet sitting, tutoring, elder companion, helping neighbors, making art, etc.)
  • Some states require ten hours per week. Other states have no minimum
  • Available in 45 states.

Financial Criteria:

  • Income limits are often high (like up to $80,000 year!).
  • Many states do not count spousal income.
  • Some states do not count disability income.
  • May or may not have resource and asset limits.

Option #4 – Medicaid Waivers

Medicaid waivers provide health insurance, plus salary for home aides, plus other services. Learn more about Applying for Medicaid Waivers.

Who qualifies:

  • People who cannot care for themselves and need assistance.
  • Designed to help people stay out of nursing homes or institutions.
  • Available in all states.

Financial Criteria:

  • Financial criteria varies by state. Also has a resource limit.
  • Ignore if you see figures for married couples. Most states do not count spouse’s income if your spouse is not also needing aides.
  • Ignore if you see charts with medicaid income limits. This is a different form of medicaid with different rules.
  • Monthly limits are typically $800-$2,200, depending on the state.
  • If you are over the limits: How to Apply When You Have Too Much Money
  • Stories from readers: How I Got Approved for a Medicaid Waiver

Option #5 – Medicaid Spend Down, Medically Needy or Share-of-Cost Programs

  • May be useful in an emergency that is sudden and expensive (i.e. car accident)
  • In many states, this program is not good for ongoing care and will leave you impoverished.
  • If you are told you have a spend down or share of cost for your ongoing Medicaid, do not accept this.
  • Do your own research. Find a different Medicaid program you can apply for.
  • Also see: How to Avoid Share of Cost (for California, but applies to some other states as well)

Option #6 – Apply for SSI

SSDI comes with Medicare. SSI comes with Medicaid. If you are approved for SSI, in most cases, you will also qualify for Medicaid.

Option #7 – Adult Disabled Children

This is a special benefit for people who first became disabled before the age of 22 (doesn’t matter what age you are now)

  • Some people lose SSI when they switch to disabled adult child benefits
  • There is a special rule that can help you keep your Medicaid in this situation. Learn more: Disabled Adult Child Benefits

Option #8 – Medicaid for Parents and Pregnancy

  • “I’m a pregnant now” – Most states have medicaid programs for pregnant women. If you were turned down for Medicaid in the past, but now you are pregnant…. go try again!
  • “I’m a parent now” – Most states have medicaid programs for parents. If you were turned down for Medicaid in the past, but now you have kids…. go try again!

Option #9 Medicaid for People on Medicare

Learn more about How to Escape Medicare Fees

  • Medicaid offers several programs that pay for Medicare co-pays and/or premiums. May be called QMB or SLMB or something else in your state.
  • There are several other programs that can also help with Medicare expenses.

Option #10 – Medicaid for Kids

  • “I have kids and I’m poor” – All states have programs that offer medicaid to low income children. Go apply.
  • “I have kids, but I’m not poor” – If you make too much money, try applying for just your kids. They may qualify without you. Some states have much higher income limits for kids. For example, in some states, a single mom with three kids can make over $75,000 per year and the children are eligible for Medicaid.

#Option 11 – Medicaid for Disabled Children

If your child has disabilities or chronic health conditions, check out Medicaid Waivers for children. These programs provide health insurance plus many other services and programs to help your child. Also see these Facebook Groups for Medicaid Waivers

Who qualifies:

  • Medicaid waivers exist for children with developmental disabilities in every state.
  • Some states also have programs for physically disabilities, medically fragile, and other types of health conditions.
  • Most programs are for children with severe conditions.

Financial criteria:

  • In most states they will not count ANY of the parents income or assets.
  • Most states will only count money that belongs directly to the child

Option #12 Medicaid Waivers for Mental Illness

If you have been diagnosed with Serious Mental Illness, you may be eligible for medicaid through a mental health medicaid waiver program. You will get other cool services too!

  • These programs are now available in Connecticut, California, Ohio, Virginia, Colorado, Indiana, and several other states. You can also look up the names of different waiver programs in your state.
  • It’s a good idea to ask about or research exactly what kind of mental health history treatment you need to qualify. There may be very specific criteria and it will be a waste of time to apply without looking into the criteria first.

Option #13 Moving

“I was in Idaho. I moved forty five minutes away to Oregon. I moved just over the boarder, my house is five miles from the border, and I got Medicaid. It was completely worth it.” – Heather

  • Medicaid rules are wildly different by state. Some people find it worth it to move to a state where they will be able to get the services they need.
  • Some of our readers report moving to California, particularly families with disabled children. Minnesota, Colorado and New York also have good programs for certain situations.
  • For people without disabilities, any state that expanded medicaid can be better than one that didn’t.

Option #14 – Medicaid Planning

  • Some people qualify for Medicaid by consulting with a Medicaid planner or hiring a Medicaid estate planning lawyer. Commonly used by people who have inheritance, lawsuit settlements, higher income levels or other assets.
  • Here is an Overview of medicaid planners

Option #15 – Open a Special Needs Trust

If you have too much resources (bank accounts, savings, cars, valuables, etc).

  • This is a special type of trust for people with disabilities. If your money or resources are in certain types of trusts, they will not count for Medicaid.
  • This can cost a few thousand dollars. However, many people find it worth it, as it can protect assets and help you get care for the rest of your life. You may wish to consult with a medicaid planner or hire a special needs planning lawyer.

Option #16 – Open a Pooled Income Trust

If you have too much income (salary, disability check, retirement income, etc)

  • People with too much income sometimes open something called a “pooled trust” or “miller trust.” Some of your income will go into the pooled trust each month, and then the trust can pay your rent or other expenses. This income will not count for medicaid.
  • Learn more about pooled income trusts in This Fact Sheet (this link is from new york, but gives very helpful information that may apply in other states.) Some states do not allow pooled trusts.

Option #17 – Ignore Other People You Live With 

When you apply for Medicaid it asks you to list everyone in your “household.”

This does not mean what you think it means. In most cases, it does not mean housemates, brothers, sisters, friends, adult children, or parents of adult children. Check what “household” actually means for the Medicaid program you are applying for.

Option #18 – Don’t Be a Dependent 

Some forms of Medicaid consider a “household” to be anyone declared as a dependent. If someone has declared you as a dependent, and this is disqualifying you, make sure to look into this.

Tip: The rules usually state that they consider who is expected to be declared as a dependent on next year’s taxes. So if you were a dependent last year, it may not be too late to apply on your own.

Option #19-24 Medicaid for Special Populations

🌷 Applying for disability: If you are currently applying for disability, please check out: How to Get Medicaid While Applying for Disability

🌷If you are not eligible for disability – If someone has told you that you cannot apply for disability, look here for ways to Qualify for Disability After You Were Told You Don’t Qualify for Disability

🌷 Special Populations – Some states have even more Medicaid programs for special populations (foster care, widows, refugees, etc.) As an example, check out this long list of Medicaid programs in California.

🌷 Developmental Disabilities – Most states have special medicaid waiver programs for people with developmental disabilities and for people with Autism. The waiting lists can be many years long, but the programs and services are excellent.

🌷 Married – If your spouse’s income is disqualifying you: “My spouse makes too much money”

🌷 Relatives Caring for Children – Some states will allow you into a Medicaid program for parents if you are a relative who cares for a child.

🌷 Specific Conditions – Some states run special Medicaid Waiver programs for people with certain conditions. For example: HIV/AIDS, Traumatic Brain Injuries, Autism, Cystic Fibrosis, Developmental Disabilities, and other conditions. The programs may provide many different helpful programs and services. You can also look up the names of different waiver programs.


“SOMETHING WENT WRONG”

If you applied for one of the programs above and got turned down, don’t give up hope. There may be a solution. “I applied for Medicaid and something went wrong” . Read this page if one of these things happened:

  • “Someone I live with makes too much money.”
  • “My parents have too much money”
  • “I have a too much income.”
  • “I was approved but the Spend Down is really expensive”
  • “I have too much savings or I might get an inheritance”
  • “Child support is making my child not eligible”
  • “I think I should qualify, but I got turned down”
  • “Medicaid said I’m not disabled or not medically eligible”

Reader’s Story

Pansy was repeatedly denied Medicaid. She did not give up, and Medicaid covered her $40,000 hospital bill: How Pansy Got Medicaid By Being Smart, Scrappy & Persistent


THE END

If all else fails, you can give up on Medicaid and instead try some other ways to find affordable medical care: How to Get to the Doctor When You Can’t Get to the Doctor

Updated August 2018. Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working.

20 thoughts on “How to Get Medicaided”

  1. I have been denied SSI and am in the process of appealing. despite that I was able to qualify for IHSS (in home supportive services) in California. my doctor filled out the form saying I’m eligible for help and that was sufficient. So don’t give up!

    also there are several agencies locally that help with advocacy and legal representation for low income people filing for and appealing SSI. if you can’t afford a lawyer you might find something similar in your nearest city. don’t give up. keep persisting.

    it’s what we all have to do, despite almost overwhelming odds, even beyond what most people can even imagine. but we can. so keep going, and keep asking for help!

    this is an amazing guide for any of you living in poverty, or disabled without family help

    Like

  2. Should my parents leave their money and real estate to me in a pooled special needs trust? I have never heard of this but we are trying to figure out how they can leave their assets to me in a way that will support me for the rest of my life. I am disabled but have yet to qualify for disability. I also have large educational debts.

    Like

    1. The site I just linked to has a directory of special needs trust lawyers.

      Many of our readers have been successful in getting disability discharges on student loans. Hope it goes well for you.

      Like

  3. Please add “Pickle Amendment” for Medicaid qualifications issues (Google it). Otherwise, great work and great page. (Pooled) Special Needs Trust is the best solution for most assets/income problems and should be highlighted on this page.

    Btw, artwork on this blog is outstanding. Love it.

    Like

  4. I am on SSDI. I also receive widow’s benefits. Two separate deposits into my checking account from SS. My Medicare is paid by the state. I recently found out that I also qualify for medical assistance. I live in PA. My question..does the lump sum I received from SSDI count as resource for MA? I am thinking I should not qualify. Also, I have supplemental insurance. Should I cancel that since I am receiving MA?

    Like

    1. Good question. It is usually excluded for a length of time. There’s a special rule for Social Security backpay. I believe it is six months in most states.

      Who told you that you would qualify? And do you have an approval for MA in writing?

      Some people mistakenly think they will qualify because they are looking at standard MAGI Medicaid – you cannot get this type of medical assistance if you are on Medicare. However there are many other Medicaid programs you can apply for.

      Yes, you may be able to start paying for your supplemental insurance, as a medical assistant should cover most of the same expensive. However you might wish to look into it if you think there is some special medical you need to you have that won’t be covered this way. I hope it goes well for you.

      Like

      1. If 500,000 is put into a special needs trust for me and then I die within 5 years, can I direct any of that money to family or does the pooled special needs trust get it all? I understand that the government gets to claw back any money they spent on me during the time I was alive. If they forgive educational debt of 300,000, do they get to take that back too?

        A lot of “solutions” I learn about depend on details that no one seems to know, not even specializes lawyers. We are dependent on government agents for the answers, and their answers vary significantly. I paid thousands back on educational loans that turned out to not count toward a forgiveness program because a few government agents didn’t know what they were talking about. Where can we get REAL answers about things like this? Where are these laws written down?

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        1. Hi Cass,

          I believe there are different law for first party and third party trusts, and there are some kinds of trusts where the money will not go back to the state. I don’t know where the laws are for this, but there is a lot of good info here: https://www.specialneedsalliance.org

          Sadly, I do not think student loan forgiveness is retroactive.

          Sorry for the very slow response 🌷

          Like

  5. Thanks for helping me learn about Medicaid and what it offers such as medical care, transport to doctors and the like. Since I have been thinking of what help to give my brother who is currently in need of medical health, the idea of giving him that kind of health insurance will certainly help. One of these days, I will seek the help of a Medicaid specialist to find out how that can be done.

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  6. My friend makes too much for Medicaid but can barely afford her bills and needs to see a specialist desperately. I noticed you mentioned Medicaid waivers. If she applied for this, is she required to have a home health aide come and assist her? She would only need the waiver to cover doctors visits and pay for prescriptions. Thank you for sharing all of this information.

    Like

  7. Hi, thanks for your articles so helpful! i have too much rental income to qualify for medicaid. when i recevie my award letter (soon), will i automatically have to get medicare or can I keep my health insurance? the premium for it is lower than the medicare fee and i have more benefits under it i’m sure (more doctor’s covered etc.). Can I opt to keep my health insurance and not medicare? I looked for this info for a hr and can’t find it. wondering if you know. Thanks!

    Like

    1. Hi May,

      I believe there is a way to opt out of medicare, but if your insurance comes from the healthcare marketplace, I don’t know if you will be allowed to continue it if you are medicare-eligible.

      Sorry, I don’t know these regs. You might try contacting the SHIP program. https://www.medicare.gov/contacts/#searchresult&searchType=org&stateCode=ALL%7CAll%20States&orgTypeByName=F%7CSHIP%20—%20State%20Health%20Insurance%20Assistance%20Program

      Like

  8. I’ve been following your amazing guide for the last few months and as I join more support groups it’s always the first to be recommended. I wanted to personally thank you for all your hard work to help people like me who would otherwise be wandering around in circles completely delirious. ❤

    Like

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