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Learn About Requirements for Medicaid in California

What are the Medicaid application guidelines in California? Knowing how to qualify for Medicaid coverage is beneficial for state residents who need health insurance. If you qualify for Medicaid benefits, then the government of California will provide you with free or low-cost health care coverage. Medicaid provides free or low-cost health care coverage to many other eligible groups, such as low-income individuals, families, pregnant women, the elderly and children. While all states must follow the Medicaid eligibility requirements set by the United States government that regulate the program, each state has the ability to set its own Medicaid eligibility requirements. Learn how to qualify for Medicaid and who is eligible for Medicaid in California be reviewing the following sections.

What are the requirements for Medicaid in California?

How to qualify for Medicaid depends on the general requirements set by the United States government that each state must follow. In order to qualify for Medicaid benefits eligibility, you must first be a U.S. citizen, a legal alien or a permanent resident of the country. You must also be a resident of California if you want to receive financial assistance from the state government. Other factors that dictate California’s Medicaid eligibility requirements include the size and the make-up of your family or household, including how many children and elderly people live with you, the kind of disability a member has as well as the amount of income the household makes every year. Download our national Medicaid guide to learn more about requirements for Medicaid coverage.

What are the income requirements for Medicaid in California?

Since California expanded its Medicaid program, your Medicaid benefits eligibility may come from your income alone if you make less than a certain amount every year. The income requirements for Medicaid vary depending on how many people are in your household. The amount of income you need to earn to qualify for Medicaid is typically based on how many people you need to support with the amount of money you make in a year. For instance, if you live in a household with six or more eligible members, then you can have a higher income than a single applicant and still qualify for benefits. Likewise, your income may influence Medicaid costs and coverage. However, there are many factors that go into determining your Medicaid eligibility.

The income requirements for Medicaid changed when the Affordable Care Act was implemented in 2010. The old method of determining your eligibility for Medicaid relied on a system that ended in 1996, called Aid to Families with Dependent Children (AFDC). The new method of determining your Medicaid benefits eligibility is through a methodology called the Modified Adjusted Gross Income (MAGI). MAGI considers your taxable income and tax filing relationships to help the California government determine your eligibility for Medicaid. However, not everyone has to use MAGI to determine their eligibility for Medicare. If you are blind or have a disability, then your Medicaid eligibility will be determined using the same system the Social Security Administration uses to determine your eligibility to receive Supplemental Security Income. Download our Medicaid guide to learn more about the requirement to enroll in a Medicaid health care plan.

Who meets the requirements for Medicaid in California?

Many people in California meet the Medicaid eligibility requirements. The following is a list of eligible people or groups:

  • You meet the Medicaid eligibility requirements if you are 65 years of age or older, and you meet the income, resource and family size requirements.
  • You meet the Medicaid eligibility requirements if you are blind or disabled based on the Social Security Administration’s criteria and you meet the government’s income, resource and family size and make-up requirements.
  • You meet the Medicaid eligibility requirements if you are or have children younger than 21 years of age and also meet the income, resource and family size requirements for Medicaid as set by the California government. Children who qualify for Medicaid may receive information about Medicaid CHIP, the Children’s Health Insurance Program.
  • You meet the Medicaid eligibility requirements if you are a pregnant woman who meets the income, resource and family size requirements for Medicaid as set by the California government.
  • You meet the Medicaid eligibility requirements if you are in the country and state with a refugee status. However, this will depend on how long you have been in the United States for.

When you initiate the California Medicaid application process, your Medicaid benefits eligibility for any of the aforementioned groups will be determined and your qualifications will be assessed.

In order to help as many of their citizens as possible meet the Medicaid eligibility requirements, states have the option to establish a medically needy program. California is one of the many states that chose to do so. California’s Medicaid eligibility requirements for the medically needy program includes individuals with significant health needs who have an income that would otherwise be too high to qualify for Medicaid under any other eligible group.

If you are “medically needy” but still do not meet the Medicare eligibility requirements, then you may still be able to receive Medicare benefits under the medically needy eligibility group. You can do this through something called “spending down.” This is when you compare the amount of income you make per year with the amount you need to qualify for Medicare as someone who is medically needy. The difference is the amount you would need to spend in order to become eligible for Medicaid.

Who does not meet Medicaid requirements California?

Many applicants do not meet the Medicaid eligibility requirements in California and will have their applications denied. The income requirement for Medicaid enrollment is the most common reason many individuals and families do not qualify. If you do not qualify for Medicaid based on earnings, then it is likely your household income is higher then the required level for a household of your size. It is important to know information about Medicaid eligible to qualify for coverage to avoid a denial.