MEDICAID

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 Medicaid is a program that provides health coverage to some low-income Iowa residents. Medicaid covers families with children and pregnant women, medically needy individuals, the elderly, and persons with disabilities, if state and federal guidelines are met.  Legal residents who are not U.S. citizens may be eligible for Medicaid.  However, non-citizens who do not have immigration documents cannot enroll in Medicaid.  Questions concerning immigration status and eligibility should be directed to the Iowa Department of Human Services.

  • For certain categories of people, eligibility for Medicaid is based on the amount of your household income.

Medicaid-eligible individuals include infants, children, pregnant women, and parents whose family income meets the Medicaid income standards.

If you are in one of these categories of persons but your income is above Medicaid eligibility limits, you may qualify for Medicaid if your income minus your medical expenses meets “eligibility needy” thresholds.

Income eligibility levels for these categories are described below.  Your assets and some expenses also may be taken into account, so you should contact your local department of social services for more information.

Low income persons eligible for Medicaid in Iowa*

Category — Income eligibility (as percent of federal poverty level)
Infant — 200% (monthly income of $2,767 for a family of 3)
Child Age 1-19 — 133% 
Working Parent — 79%   
Non-Working Parent — 32%
Pregnant women — 200%
Medically Needy
          Individual — 67%
          Couple – 50%

* Eligibility information was compiled from State Health Facts Online, the Kaiser Family Foundation, and may have changed since this guide was published.  Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

To get an idea of how your income compares to the federal poverty level, use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2006:

Size of Family Unit                       Poverty Guideline (annual income)
               1                                             $  9,800
               2                                             $13,200
               3                                             $16,600
–For larger families add $3,400 for each additional person
–So, for example, using this guideline, 200% of the federal poverty level for a family of 3 would be an annual income of $34,200, or a monthly income of $2,767.
–Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

  • Families who get cash benefits from Temporary Assistance for Needy Families (TANF) can get Medicaid.

Parents should know that when you get a job and your TANF benefits end, you generally can stay on Medicaid for a 12-month transitional period.

Parents should know that when your family’s TANF benefits end, your children may also qualify for transitional Medicaid coverage for 12 months.  Or, they may qualify for Medicaid themselves if your family’s income meets the Medicaid income standards.

  • People who are aged, blind or disabled may be eligible for Medicaid under the Supplemental Security Income (SSI)-related programs. Eligibility is determined by following the general policies of the Supplemental Security Income (SSI) program.

Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage at least for a limited time.

  • Persons who are disabled but employed and have higher income levels may be eligible for Medicaid benefits under the Medicaid for Employed People with Disabilities (MEPD) program. To qualify for MEPD, you must be employed, disabled and under the age of 65 with a family income of less than or equal to 250% of the poverty level. MEPD enrollees with income levels over 150% of the federal poverty level must pay a premium based on income level.
  • People who have high medical expenses may also qualify for Medicaid. You may qualify as medically needy if you are a child, a parent of a dependent child, pregnant, elderly, or disabled and have high medical expenses that when subtracted from your income, would make you eligible for Medicaid coverage. For example, people who have to pay a lot for prescription drugs, nursing home care, or other long term care services sometimes qualify as medically needy if they don’t have health insurance that covers these services.
  • Retired or disabled people who have low incomes and are enrolled in Medicare may also qualify for help from Medicaid. Even though your income may be too high to qualify for Medicaid insurance coverage, there may be other ways Medicaid can help you.

If your household income is 100% of the poverty level or below, Medicaid will pay your monthly premium for Medicare Part A and B, your Medicare deductibles and coinsurance.  This is called the Qualified Medicare Beneficiary (QMB) program.

If your household income is above 100% but below 120% of the poverty level, Medicaid will pay for your monthly Medicare Part B premiums only.  This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.

If your household income is 120% or below 135%, Medicaid will cover the costs of your Medicare Part B premiums.  This is called the Expanded Specified Low-Income Medicare Beneficiary Program.


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