Each state sets its own Medicaid eligibility guidelines. The program is geared towards people with low incomes, but eligibility also depends on meeting other requirements based on age, pregnancy status, disability status, other assets, and citizenship.
States must provide Medicaid services for individuals who fall under certain categories of need in order for the state to receive federal matching funds. For example, it is required to provide coverage to certain individuals who receive federally assisted income-maintenance payments and similar groups who do not receive cash payments. Other groups that the federal government considers "categorically needy" and who must be eligible for Medicaid include:
•Individuals who meet the requirements for the Aid to Families with Dependent Children (AFDC) program that were in effect in their state on July 16, 1996
•Children under age 6 whose family income is at or below 133% of the Federal poverty level (FPL)
•Pregnant women with family income below 133% of the FPL
•Supplemental Security Income (SSI) recipients
•Recipients of adoption or foster care assistance under Title IV of the Social Security Act
•Special protected groups such as individuals who lose cash assistance due to earnings from work or from increased Social Security benefits
•Children born after September 30, 1983 who are under age 19 and in families with incomes at or below the FPL
•Certain Medicare beneficiaries