Medicaid Eligibility Factors

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  • Topic: Medicaid, Social Security number, Medicare
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  • Published : December 16, 2012
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Medicaid Eligibility Factors
Carma Palonis
HCR/230
November 28, 2012
SAMANTHA BAME

Medicaid Eligibility Factors
* I will discuss the factors that determine Medicaid eligibility, and whether a procedure or service is covered. I will also answer the question of when can a provider bill a Medicaid patient directly for services? *

There are several factors that determine Medicaid eligibility in Pennsylvania; you must fit into one of these categories:  Individuals who are aged (65 years and older), blind, or disabled {SSI- related for Medicaid purposes}  Families with children under age 21 {TANF-related for Medicaid purposes}  Single and married individuals with a temporary disability, age 59-64, limited income or special circumstances (undergoing drug and alcohol treatment, victim of domestic violence, or caring for a child or disabled person) {GA-related for Medicaid purposes}

 Special Medicaid conditions 
After determining which of the above categories you fit into, move on to the three parts to Medicaid Eligibility which are Income, Other, and Resources

INCOME:  Medicaid eligibility is determined using income and household size in comparison to income limits.  Examples counted towards income: * Wages         * Interest * Dividends * Social Security * Veterans' Benefits * Pensions * Spouse's Income if applicable and living with him/her| Examples NOT counted toward income: * TANF * SSI * Food Stamps * Low Income Home Energy Assistance * Program (LIHEAP) benefits * Foster Care payments * Certain housing or utility subsidies * Weatherization payments|

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OTHER:  Medicaid eligibility is also determined by other factors.     Identity can be verified using an individual’s Social Security Number (SSN) or another piece of identification  (i.e. Driver’s License)    Social Security Number (SSN) must be provided for each person applying of Medicaid. County Assistance Office staff will help you apply for an SSN for...
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