Estate Planning Basics: Will You Qualify for Medicaid?

If you need long term care and cannot afford private medical insurance, you’ll need to apply for Medicaid. Medicaid is a health care program that is run and administered by federal and state governments. It is essentially designed for low-income American citizens who are disabled or aged 65 and above. Here is everything you need to know about Medicaid eligibility and whether you qualify for the program. 

Medicaid eligibility typically depends on the state, but the general requirements include: 

  • Must meet federal and state requirements in terms of immigration status, residency, and documentation of citizenship
  • Must meet financial need requirements under state and federal laws
  • May qualify based on certain disability (e.g. blindness)

In states where the Medicaid program has been expanded, individuals earning up to 138% of the FPL (federal poverty level) are eligible for coverage. There are a few states that cover individuals with a higher income level as well. MAGI (Modified Adjusted Gross Income) is used to determine Medicaid financial eligibility for most adults, parents, pregnant women, and children. 

Applying for Medicaid

Medicaid is available to certain groups of people based on factors such as age, income level, and pregnancy status. However, individuals from other population groups can also apply for the program if Medicaid has been expanded in their state to cover higher income levels. To apply for Medicaid, you need to go online at healthcare.org and request for an application from the Medicaid office in your state. Your application will be forwarded to your state’s Medicaid website. You can also apply for other benefits, for example, food stamps. 

You will need certain documents, forms, and information as proof of: 

  • Age
  • Income
  • Citizenship 
  • Disability
  • Assets and other resources
  • Insurance
  • Residency or homeownership

How to qualify for Medicaid

Although Medicaid is funded by the federal government, it is run at the state level where every state has its own laws regarding this program. The financial eligibility varies from one state to the other, so it is important to ensure that your balance sheet is in line with your state’s threshold. Generally, if you are single, your net worth should not exceed $2,000, including cash and other assets unless otherwise indicated by your state. 

If you apply on the grounds of disability, you will have to prove that you are disabled (with a few exceptions such as women with cervical or breast cancer). You must also prove your residency and show that you are a U.S. citizen or have a green card. 

You may need to reduce your estate if your income or assets exceed the limit for your state. One approach is to gift your assets or properties to a reliable party (such as your children) to use on your behalf. In some cases, you could also create a spend down trust – based on your state laws. Keep in mind that there is a risk of losing your assets if the de-facto owner gets into financial trouble. 

Qualifying for Medicaid can be complicated without the right guidance. Get all of the help you can from our attorneys before you begin the process. For more information, contact Luis E. Barreto & Associates, P.A. today.

Written by Luis E. Barreto

Luis E. Barreto

Luis is a probate and guardianship litigator with over 23 years of experience in the field. Determination of heirs, will contests, breaches of fiduciary duty, removal of personal representatives, guardians and trustees are just some of the types of litigation he addresses. In addition, he administers non-contested estates and guardianships.