Medicaid: what you need to know

Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers.

Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. The rules for counting your income and resources vary from state to state and from group to group.

Medicare Health Insurance is free. A person will receive Medicaid immediately (only need $1 of SSI to get Medicaid). Many individuals who qualify for Medicaid based on disability also receive cash assistance under the Supplemental Security Income (SSI) program. In almost all states, SSI eligibility automatically qualifies an individual for Medicaid coverage. However, some states use more restrictive eligibility criteria than those used by the SSI program. This means that in those states (commonly referred to as 209(b) states) receipt of SSI does not guarantee eligibility for Medicaid. Individuals not receiving SSI but seeking coverage based on disability must demonstrate that they have an impairment that prevents them from performing “substantial gainful activity” for at least one year. Once a disability determination is made, the individual must then undergo an asset test and meet specific income requirements in order to be considered for Medicaid eligibility.

How to apply

To apply for Medicaid or to request more information about Medicaid, call your state medical assistance office.  To get the local phone number, call the Centers for Medicare & Medicaid Services at 1-800-633-4227 (TTY, 1-877-486-2048).