MEDICAID

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Medicaid is a program that provides health coverage to some low-income Washington 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 after they have been in the U.S. for five years. Questions concerning immigration status and eligibility should be directed to the Washington Department of Social and Health Services.

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

In Washington you may be eligible for Medicaid if you are a child, a parent of a child, or pregnant, 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.  For more information, you should contact the Washington State Department of Social and Health Services at (800) 563-3022 or visit them online at: http://www1.dshs.wa.gov/.

Low income persons eligible for Medicaid in Washington*

Category - Income eligibility (as percent of federal poverty level)
Child up to 19 - 200% (In 2007, monthly income of about $2,862 for a family of 3)
Parent - 100%
Pregnant woman - 185%
Parents
   Working  - 79%
   Non-working - 39%
* Eligibility information was complied from State Health Facts Online (Henry 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 2007:

Size of Family Unit                       Poverty Guideline (annual income) (100%)
               1                                     $10,210
               2                                     $13,690
               3                                     $17,170
For larger families add $3,480 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 $34,340 or a monthly income of $2,862.

Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

  • Families participating in Temporary Assistance for Needy Families (TANF) (also known as Washington Work First cash assistance program) are automatically covered.

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, your children may qualify for Medicaid themselves if your family’s income meets the Medicaid income standards.

Families on TANF, children and pregnant women are required, in most counties, to be enrolled in Healthy Options, on of the Washington State DSHS Medicaid managed care plans.

  • Pregnant women, once eligible, are eligible throughout pregnancy regardless of changes in income or how many people live in the home. Coverage is available for 60 days after pregnancy ends. Newborns are covered for one year.
  • Very poor elderly, blind or disabled people who get Supplemental Security Income (SSI) benefits automatically qualify for Medicaid.

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

Washington State has a program called Health Care for Workers with Disabilities. This program has an income limit of 220% of the poverty level with certain income deductions and premiums assessed to the individual to participate in the cost of care.

  • 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 may qualify as medically needy if their health insurance is limited or does not cover 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 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 135% of the poverty level, Medicaid will pay for your monthly Medicare premiums only.  This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.

If you are disabled and working, DSHS will pay your Medicare Part A premium if your income is not greater than 200% of the poverty level.

  • There may be other ways that Medicaid can help. To find out if you or other members of your family qualify for Medicaid, contact your local Community Services Office or Adult and Aging Office. You can also apply for Medicaid there.

Contact your county DSHS office for more information about other eligibility requirements. To obtain the locations and telephone numbers of sites near contact the Washington State Department of Social and Health Services at (800) 563-3022 or visit them online at: http://www1.dshs.wa.gov/


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