Yes, there are special rules for certain groups when it comes to income eligibility for Medicaid. Here are a few examples:
Special Income Level Group
- Eligibility Criteria: This group is optional for states, but many choose to cover it. To qualify, individuals must be aged, blind, or have a disability, and be institutionalized in a facility like a nursing home for at least 30 consecutive days. The income limit for this group is significantly higher than other pathways to Medicaid. In the past, it was noted that the income limit was up to $2,130 per month, which is much higher than the standard limits for other groups.
- Application in Home and Community-Based Services (HCBS): While targeted at institutionalized individuals, states can use similar rules to make eligibility available for HCBS. This allows individuals with higher incomes to receive long-term care while living at home.
Modified Adjusted Gross Income (MAGI) Based Coverage
- Eligibility Hierarchy: The Affordable Care Act expanded eligibility using MAGI. This includes mandatory coverage groups like children, pregnant women, and non-aged, non-disabled adults up to 133% of the Federal Poverty Level (FPL).
State-Level Variations
- Optional Coverage: States have the flexibility to cover additional groups beyond mandatory ones. For example, they can opt to cover more pregnant women or non-aged, non-disabled adults beyond the federal minimums.
These rules highlight how income eligibility for Medicaid can vary significantly based on the population and specific state policies.
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