How is Medicaid eligibility determined?

Medicaid is a healthcare coverage program that is administered jointly by the federal government and the Government of New York State. It provides coverage to adults, children, elderlies and those with disabilities. According to federal laws, states are required to cover certain groups of individuals under this health program, based on certain parameters, in addition to mandatory inclusions such as low income families, pregnant women, children and recipients of Supplemental Security Income.

In addition to the categories mentioned already, states can choose to cover other groups such as those receiving home-and community-based healthcare services. However, those inclusions are based on certain eligibility criteria that were put in place by the Patient Protection and Affordable Care Act, 2010. Those eligibility criteria can be divided into two categories: financial eligibility and non-financial eligibility.

Financial eligibility for Medicaid is determined by a technique that is known as Modified Adjusted Gross Income or MAGI. This methodology considers taxable income and tax filing relationships to determine an individual or groups eligibility under New York's Medicaid program. Noteworthy here is that the MAGI methodology does not involve asset or resource tests and also does not allow income disregards that can vary from one state to another or from one prospective eligible population group to another.

The blind, the disabled or those over the age of 65 are exempt from the MAGI-based method of income determination. For those cases, the eligibility is determined based on the same guidelines that are applicable for SSI benefits. There are also some groups or individuals for whom the financial eligibility tests is not conducted. Those are people whose eligibility is acknowledged based on their enrollment in other programs such as programs for breast and cervical cancer treatment and prevention. Additionally, children and young adults who meet certain criteria are considered to be eligible, without conducting tests.

Non-financial eligibility for Medicaid pertains to aspects that are non-financial. For example, Medicaid coverage for a group is generally limited to the state of which they are residents. The beneficiaries must either be a citizen of the United States or a legal non-citizen such as permanent residents. There are also certain groups of beneficiaries, whose coverage is limited by age, parenting status or pregnancy.

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