Medicaid is the nation’s public health insurance program for low-income Americans, and is jointly financed by the Federal and State governments. The program finances health and long-term care services for children and adults in low-income working families and for the elderly and disabled. Individuals must meet both financial and categorical criteria to qualify and be either a U.S. citizen or have five years of legal residency.
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Federal law mandates eligibility for certain groups, and states have authority to expand eligibility beyond federal minimums through waivers or amendments to their State Medicaid Plans.
States cannot receive federal matching funds to extend Medicaid to adults under age 65 without children, unless they are pregnant or disabled. As a result, over 40% of low-income adults without children are uninsured.
According to Medicaid: An Overview of Spending on “Mandatory” vs. “Optional” Populations and Services, Kaiser Commission on Medicaid and the Uninsured (2007), there are two broad categories of Medicaid eligibility: Mandatory and Optional populations, which are described below.
Mandatory Populations include:
Optional Populations can include:
Immigrants who have entered the U.S. illegally cannot qualify for basic Medicaid benefits, although they are eligible for Medicaid coverage for emergency medical care (if they meet all other financial and non-financial requirements). Most categories of immigrants who are legally residing in the U.S. and who meet all other financial and non-financial requirements are eligible for Medicaid coverage for emergency care, but, depending on the year in which they entered the country, they may or may not be eligible for the full range of Medicaid services.