5 Things You Need to Know about Medicaid Eligibility

You or someone you know may be either on Medicaid already or eligible to participate in Medicaid. This is because Medicaid is the largest health insurer in the United States. Yes, 72.5 million Americans get health coverage through Medicaid each year (including 1.4 million Colorado citizens). Despite its size, Medicaid is tailored to a very specific group of individuals who must meet certain eligibility requirements. Here are five things to know:

1)  Who is eligible? Medicaid is specifically tailored to meet the needs of low income individuals including children from birth to age 18, pregnant women age 19 or older, parents and caretakers with a dependent child, and adults without dependent children—provided that each of these individuals or households must have income levels that are below a certain percentage of the Federal Poverty Level (FPL) to qualify. Individuals who receive Supplemental Security Income (SSI) are also eligible. 

Colorado elected to receive the Medicaid expansion under the Affordable Care Act of 2010 and by doing so, signed up an additional 400,000 people for Medicaid coverage. To do this, the federal government increased the income level thresholds to allow more individuals to become eligible. 

2) What are the income levels required? First, the income levels that are required vary depending upon the category of individuals. Children and pregnant women have a higher income ceiling to qualify for Medicaid than adult individuals with no dependents. Under Colorado’s Medicaid program, also known as Health First Colorado, a pregnant woman is eligible for Medicaid if she makes up to $1,931 per month (or 195% of the FPL). A child in a family of six will be eligible if the household income is $3,856 or less per month (or 142% of the FPL). An adult by themselves aged 19 to 65 is eligible if they make up to $1,776 per month (or 133% of the FPL). There are no enrollment fees or monthly premiums. 

The Affordable Care Act also streamlined the eligibility standards by implementing a new system called MAGI - Modified Adjusted Gross Income. MAGI is designed to use one set of income requirements across all programs offering insurance, except for individuals over the age of 65. It considers the person’s tax filings and taxable income to establish whether an individual is eligible based on their income. 

3) Other eligibility requirements: Generally, to be eligible, an individual must be a U.S. citizen or lawful permanent resident and must be a resident of the state in which they are receiving Medicaid. Of course, some groups are also limited by age (children), pregnancy, and if they have any dependents in the household. 

4) When does eligibility end? As with most programs tied to income, increases in income may affect eligibility. Children, once they reach their 18th birthday, are no longer eligible at the child income level, so to remain eligible they must meet a lower monthly income threshold. Similarly, if the size of the household changes, it could also affect eligibility. 

Medicaid eligibility does not have to be confusing or intimidating. If you have questions about Medicaid eligibility, contact Attorney Carolyn Duncan who can help guide you through the rules and regulations. She is ready to help you today!


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