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Strict Medicaid Requirements

Riddle Brantley LLP   |  June 16, 2015   |  

Medicaid is a joint federal and state program of reimbursement to doctors, hospitals and other health care providers for treating low-income individuals.  The eligibility requirements are very strict.

As set forth on the North Carolina Medicaid website, “Medicaid serves low-income parents, children, seniors, and people with disabilities.”  Among the requirements, you should be aware that:

  • You must be a U.S. citizen or legal resident and either have a Social Security number or have applied for one.
  • An individual without children or other special circumstances must be found to be disabled and have practically no income and own practically no property of any kind to qualify. The income and property ownership limitations are set forth here.
  • Families with children are often able to get their children enrolled, but only if they meet those strict income and property ownership limits.
  • Furthermore, ALL sources of income are counted, including SSD benefits.

Most Medicaid recipients do not pay for any of the medical services they get under the program, but some do require a small co-payment for certain services.

Most disability claimants who are awarded SSD benefits are automatically disqualified from the Medicaid program because the average SSD monthly award is approximately $1,100/month, and that level of income is normally higher than the Medicaid system allows.