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BENEFITS BASIC MEDICAID ELIGIBILITY REQUIREMENTS**

SPECIAL PROVISIONS EFFECTIVE 07/2025 BASIC ELIGIBILITY REQUIREMENT WHOSE INCOME and RESOURCES COUNT MONTHLY INCOME LIMIT Updated 04/2026 RESOURCE LIMIT Updated 04/2026

DEDUCTIBLE/SPEND DOWN S-ABD, SSI cases Full Medicaid coverage only if a Medicaid application is submitted • Beneficiaries receiving Supplemental Security Income (SSI) -Federal cash assistance program for the aged, blind, and disabled, are automatically entitled to Medicaid. No separate application or Medicaid determination is required. • Beneficiaries receiving State/County Special Assistance (SA) - program for aged and disabled individuals who are primarily in adult care facilities- includes Medicaid eligibility. • Beneficiaries receiving Special Assistance In-Home- the individual must be determined Medicaid categorically needy eligible.

Aged MAA Full Medicaid Coverage Age 65 or older Spouse’s income and resources if live together 100% of Poverty Level 1 – $1,330 2 – $1,804 SSI Limits 1 - $2,000 2 - $3,000 YES If income exceeds income limit and the indicator is “yes,” the individual or family may be able to be eligible for Medicaid if they can meet a deductible. See discussion of Medical Deductible on page 2 of this same column.

Individuals in nursing facilities generally do not have to meet a deductible to be eligible for Medicaid. However, they must pay all of their monthly income, less a $70 personal needs allowance and the cost of medical expenses not covered by Medicaid or other insurance to the nursing facility. Medicaid pays the remainder of their cost of care. Protection of income for spouse at home: When an individual is in a nursing facility and has a spouse living at home, a portion of the income of the spouse in the facility may be protected to bring the income of the spouse at home up to a level specified by federal law. Currently, that amount is $2,643.75/mo. and can be as much as $3,948.00 depending upon at-home spouse’s cost for housing. The amount protected for the at-home spouse is not counted in determining the eligibility of the spouse in the nursing facility.

Protection of resources for spouse at home: Additionally, the countable resources of the couple are combined and a portion is protected for the spouse at home. That portion is ½ the total value of the countable resources, but currently not less than $31,584 or more than $157,920. The amount protected for the at-home spouse is not countable in determining the eligibility of the spouse in the facility.

Transfer of resources: When a person gives away resources and does not receive compensation with a value at least equal to that of the resources given away, he may be penalized. Medicaid will not pay for care in a nursing facility or care provided under the Community Alternative Program (CAP) or other in-home health services & supplies for a period of time that depends on the value of the transferred resource. Blind MAB Full Medicaid Coverage Blind by Social Security Standards Spouse’s income and resources if live together. Parents’ income and resources if under age 18 and live with parents. 100% of Poverty Level 1 – $1,330 2 – $1,804 SSI Limits 1 - $2,000 2 - $3,000 YES Disabled MAD Full Medicaid Coverage Disabled by Social Security Standards Spouse’s income and resources if live together. Parents’ income and resources if under age 18 and live with parents. 100% of Poverty Level 1 – $1,330 2 – $1,804 SSI Limits 1 - $2,000 2 - $3,000 YES Health Care for Working Disabled (HCWD) MAD Full Medicaid Coverage For Basic Coverage, the beneficiary does not have to meet the Social Security SGA requirement to be disabled. For Medically Improved coverage, the beneficiary does not have to meet the Social Security medical requirements for disability. Spouse’s income and resources if live together. Parents’ income and resources if under age 18 and live with parents. 150% of Poverty Level 1 - $1,995 2 -$2,705

200% of Poverty Level 1 - $2,660 2 - $3,607

Min. CSRP limit $32,532 NO Qualified Medicare Beneficiaries MQB-Q Payment of Medicare premiums and deductibles and co- insurance charges for Medicare covered services Entitled to Medicare Parts A & B Spouse’s income and resources if live together. Parents’ income and resources if under age 18 and live with parents. 100% of Poverty Level 1 – $1,330 2 – $1,804 1 - $9,950 2 - $14,910 NO Specified Low Income Medicare Beneficiaries MQB-B Payment of Medicare Part B premium Entitled to free Medicare Part A Spouse’s income and resources if live together. Parents’ income and resources if under age 18 and live with parents. 120% of Poverty Level 1 - $1,596 2 - $2,164

1 - $9,950 2 - $14,910 NO Qualifying Individual MQB-E Payment of Medicare Part B Premiums Entitled to free Medicare Part A Spouse’s income and resources if live together. Parents’ income and resources if under age 18 and live with parents. 135% of Poverty Level 1 - $1,796 2 - $2,435 1 - $9,950 2 - $14,910 NO NOTE: Total number of eligible individuals is limited to available funds. Working Disabled MWD Payment of Medicare Part A premiums

Lost entitlement to free Medicare A due to earnings but still has disabling impairment. Spouse’s income and resources if live together. Parents’ income and resources if under age 18 and live with parents. 200% of Poverty Level 1 - $2,660 2 - $3,607 2X SSI Limits 1 - $4,000 2 - $6,000 NO Traumatic Brain Injury (TBI) Full Medicaid Coverage Age 18 and older and eligible for MAABD or SAABD Spouse’s income and resources if live together. 300% of Poverty Level 1-$3,990 2-$5,410 SSI Limits 1 - $2,000 2 - $3,000 NO