MEDICAID

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Medicaid is a program that provides health coverage to some low-income Texas residents. Medicaid covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met. Legal residents who are not U.S. citizens may be eligible for Medicaid.

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

In Texas you may be eligible for Medicaid if you are an infant, a child, pregnant, or a parent of a dependent child and your family income meets the Medicaid income standards.

Income eligibility levels for these categories are described below. Your assets and some expenses also may be taken into account, so you should contact the Texas Department of Human Services for more information.

Low income persons eligible for Medicaid in Texas

Category                Income eligibility (as percent of federal poverty level)

Infant                              185%
Child 1-5                          133%
Child 6-19                         100%
Non-Working Parent            13%
Working Parent                   27%
Pregnant woman                185%

* 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 2009:

Size of Family Unit               Poverty Guideline (annual income)
      1                                        $ 10,830
      2                                        $ 14,570
      3                                        $ 18,310

For larger families, add $3,740 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 $36,620, or a monthly income of $3,052.

* Contact your local department of social services for the most up to date information and for other eligibility requirements that may apply.

· Families who get cash benefits from TANF (also known as Temporary Assistance for Needy Families) can get Medicaid. In addition, your children may qualify for Medicaid if your family’s income meets certain income standards.

· Very poor elderly or disabled people who get Supplemental Security Income (SSI) benefits can also qualify for Medicaid. You do not need to submit a separate application for Medicaid.

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 if you are elderly or you are still considered disabled and you continue to have medical need.

· People who have high medical expenses may also qualify for Medicaid. You may qualify as medically needy if you 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 below the poverty level, Medicaid will pay your Medicare monthly premium and your Medicare deductibles and coinsurance. This is called the Qualified Medicare Beneficiary (QMB) program.

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

Contact your local Department of Human Services for more information about other eligibility requirements.

· There may be other ways that Medicaid can help. To find out if you or other members of your family qualify for Medicaid, contact the Texas Department of Human Services. To obtain the locations and telephone numbers of sites near you call (800) 252-8263.


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