Medicaid Eligibility: What You Need To Know

Medicaid eligibility gets complex when you want to get coverage for nursing home care. Medicaid is a joint federal and state program that provides health coverage to over 72 million Americans, including seniors and individuals with disabilities. It’s the largest source of health coverage in the U.S. To participate in Medicaid, federal law requires states to cover certain groups of individuals, such as those receiving Supplemental Security Income (SSI)…typically the elderly.


Financial Eligibility for Medicaid

The Affordable Care Act (ObamaCare) established a new calculation for Medicaid eligibility, which is based on Modified Adjusted Gross Income (MAGI). Using one set of income counting rules and a single application across programs makes it easier for people to apply and enroll in the appropriate program. The MAGI-based methodology looks at a person’s taxable income and tax filing relationships to determine their financial eligibility for Medicaid.

Exemption from MAGI Rules. Those whose eligibility is based on blindness, disability, or age (65 and older) are exempt from the MAGI-based income counting rules. Instead, Medicaid eligibility for those age 65 and older or who have blindness or a disability is determined with the income methodologies of the Supplemental Security Income (SSI) program administered by the Social Security Administration.

Medicare Dual Eligibility. Eligibility for the Medicare Savings Programs, where Medicaid pays Medicare premiums, deductibles, and/or coinsurance costs for beneficiaries eligible for both programs is termed “dual eligible.” Their eligibility is determined using SSI methodologies.


Medicaid Eligibility in Florida

Medicaid is a federal program, but it’s administered by each state individually. The Federal Government has enacted laws concerning the program, but each state has flexibility that allows it to apply the law differently for its residents.

To qualify for the Florida Medicaid benefit program, you must be a resident of Florida; a U.S. national, citizen, permanent resident, or legal alien; in need of health care/insurance assistance; whose financial situation would be characterized as low income or very low income; and be 65 years of age or older. Over 75% of all Florida Medicaid beneficiaries are now enrolled in managed care plans, such as health maintenance organizations (HMOs).

If you’re eligible for Medicaid in Florida, you can enroll at or apply online at ACCESS Florida. There’s also a paper form. This application is for aged or disabled individuals who aren’t currently receiving Supplemental Security Income (SSI).


Contact Us

If you have questions about Florida Medicaid, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.