Medicaid Disability Requirements

Medicaid is a health insurance program established by the Federal government and the States in order to provide medical coverage to the impoverished, the blind, the disabled and the elderly. States are not required to take part in Medicaid but as of 2010, the health insurance program is available in all 50 states. While Medicaid is a federal assistance program, each state is given the flexibility to determine eligibility guidelines, design benefits and services for coverage and regulate rates.

However, the Centers for Medicare and Medicaid Services has set a mandatory eligibility standard that must be recognized by all states as a condition for receiving federal matching payments. Among those included in the mandatory eligibility groups are low-income families with children, as well as those who are Supplemental Security Income (SSI) recipients and babies born to Medicaid-qualified mothers. It is also important to note that pregnant women and children below the age of six who belong to families that have an overall family income less than 133 percent of the current federal poverty level belong to this group. There are mandatory services as well, such as physician and hospital services, Early and Periodic Screening, Diagnostic and Treatment services for those who are below 21 years of age, and nursing facility services for those who are above 21 years of age.

In addition, other groups may be granted Medicaid coverage by each individual state as determined by their own guidelines. This may include disabled children and adults, individuals requiring nursing home care or home health care, babies and pregnant women in families that have an overall family income that is above the 133 percent but below than 185 percent of the federal poverty level, and people who have depleted their income and resources to pay for medical bills and can no longer afford to continue to pay for these.

There are many different types of disability and can be classified as physical disabilities or mental disabilities.

Mental Disability – this is a wide-ranging term for disabilities that brings about a diminished capacity to learn, think or that affects an individual’s conduct or awareness of situations. This may include, but is not limited to, mental retardation, depression, Alzheimer’s disease, attention deficit hyperactivity disorder, bipolar disorder and schizophrenia.

Physical Disability – this is a wide-ranging term that pertains to disabilities that diminish the body’s capacity to function normally. This may also pertain to illnesses that may not be perceptible such as immune disorders like HIV/AIDS. Physical disabilities may include, but are not limited to, traumatic brain injuries, cerebral palsy, multiple sclerosis, muscular dystrophy and Parkinson’s disease.

For a person to qualify for Medicaid on the basis of disability, he or she must meet a variety of criteria in relation to the severity of the disability, income and resource guidelines, immigration status, and residency in the state where he or she is applying for Medicaid.

As each of these standards varies from one state to another, it is advised that a person applying for Medicaid should seek the help of qualified caseworkers in their area to assess their current situation and to evaluate whether their disability will qualify them for Medicaid.


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