Your Source for Health Reform

Topic: Medicaid Eligibility



In general, Medicaid eligibility is based on income and family size, but there are different categories of eligibility, and it can be complicated. Some Medicaid programs are designed for people in specific age groups or with specific medical needs.


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Eligible Uninsured Latinos

This February 2014 ASPE research brief from HHS details demographics, Medicaid eligibility, and financial assistance eligibility of eligible uninsured Latinos.

Defining Households for Medicaid and Premium Tax Credits

This August 2013 presentation from the Center on Budget and Policy Priorities explains why household size and composition matter in determining eligibility for Medicaid and for subsidies under the ACA. The rules for how this is done are illustrated with some simple examples.

Modified Adjusted Gross Income under the ACA

This July 2914 tip sheet from the UC Berkeley Labor Center explains how the MAGI will be calculated for ACA purposes and summarizes relevant federal regulations.

Medicaid Eligibility, Enrollment Simplification, and Coordination

This December 2012 brief from the Kaiser Family Foundation summarizes the major provisions of the CMS final rule, issued March 23, 2012.

Cost-Sharing for Medicaid, All Kids and Illinois Healthy Women

Passage of the “SMART Act” (Public Act 097-0689, the “Save Medicaid Access and Resources Together” Act) brought about changes to participant cost-sharing for Medicaid, All Kids and Illinois Healthy Women. This August 2012 information notice from HFS details the changes in co-pays and co-pay collection for participating providers.

Simplifying Enrollment and Eligibility with MAGI

This October 2011 fact sheet from Families USA explains the MAGI, or Modified Adjusted Gross Income, which states must transition to from their current income counting rules in Medicaid as coverage is expanded in 2014. The MAGI is essentially the amount of income people report on their taxes. (more…)

When 133 Equals 138: FPL Calculations in the Affordable Care Act

SHADAC’s January 2011 explanation of Medicaid eligibility under the Affordable Care Act for non-disabled childless adults.

Keeping Coverage Continuous: Smoothing the Path between Medicaid and the Exchange

A key challenge for those implementing the reform law is how to manage churning, when people cycle in and out of public programs as their income varies. What approaches are states and the federal government taking to minimize the disruption from churning? Will people be able to keep their provider as they move from Medicaid to private coverage and back? This May 2011 briefing, sponsored by the Alliance for Health Reform and The Commonwealth, addressed these and related questions.

Medicaid ACA Eligibility: Challenges for States

SHADAC’s April 2011 webinar and two presentations on eligibility challenges that states face under the ACA’s Medicaid provisions.

Illinois Cares Rx Elimination – Frequently Asked Questions

This July 2012 brief from the Make Medicare Work Coalition discusses the elimination of Illinois Cares Rx and answers the most frequently asked questions from counselors who are assisting clients to navigate the changes. It includes information on: Illinois Cares Rx special enrollment periods and switching Medicare Part D plans; Medicaid spend-down; Circuit Breaker, Ride Free, and license plate discount programs; and Medicare Part D premium issues.

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