Medicaid and MediCal

Medicaid provides health coverage or nursing home coverage to certain categories of low-asset people, including children, pregnant women, parents of eligible children, people with disabilities and the elderly needing nursing home care. Having limited assets is one of the primary requirements for Medicaid eligibility, but poverty alone does not qualify an individual to receive Medicaid benefits unless he/she also falls into one of the defined eligibility categories.

The eligibility categories for receiving Medicaid are:

  • Pregnant women and children under 6 with family income at or below 133% of the federal poverty level.
  • Children ages 6 to 19 with a family income at or below the federal poverty level.
  • Adults who take care of children under age 18.
  • Individuals who receive Supplemental Security Income
  • Teenagers up to age 21 who are living on their own
  • People who are over 65, blind or disabled

Some individuals who do not meet the income requirements may still receive Medicaid benefits because they are medically needy. If you do not live in a state with a medically-needy program and you do not meet the income requirements, you may not qualify for Medicaid.

In general, you must be a U.S. citizen to qualify for Medicaid. Legal immigrants may be able to qualify in certain circumstances. Illegal immigrants who would otherwise qualify for Medicare may be able to receive Medicaid assistance in emergency situations only.
Medicaid coverage can be retroactively applied up to three months before the application was made as long as you were Medicaid eligible for coverage during that period. So, if you incurred medical bills before you applied for Medicaid, you may be able to have those bills covered as long as you make your Medicaid application within the specified timeframe.

Individuals receiving some state program benefits not related to health care may automatically be eligible for Medi-Cal. Those receiving Supplemental Security Income, which provides cash assistance for low-income, elderly and disabled citizens, are eligible to receive Medi-Cal, as are residents who get refugee assistance, who are in the Foster Care or Adoption Assistance Program, those receiving In-Home Supportive Services, and those participating in CalWORKS.

In most states, if you receive Supplemental Security Income (SSI), you may be automatically eligible for Medicaid. The SSI application is also an application for Medicaid.Supplemental Security Income (SSI) is a need-based benefit program that is administered by Social Security. Eligibility for SSI is dependent upon the financial resources of the applicant. SSI disability claimants must go through the same disability medical determination process as individuals who file for Social Security Disability Insurance (SSDI) disability. In that sense, there is no difference between SSDI and SSI.

 You may be eligible to receive SSI in addition to monthly Social Security benefits, if your Social Security benefit is low enough to qualify. The amount of your SSI benefit depends on where you live. However, many states add money to the basic check. Generally, the more income you have, the less your SSI benefit will be. If your calculable income is over the allowable limit, you cannot receive SSI benefits. If your application for SSI is approved, you usually can get Medicare automatically. A separate Medicaid application is not necessary.