Who is eligible?
Medicaid provides coverage to:
- Children in foster care or subsidized adoption
- Children with disabilities (birth to 19)
- Other children up to age 21
- Pregnant women
- Women with breast or cervical cancer
- Parents or caretakers of deprived children
- Workers with disabilities
- Other blind and disabled individuals
- Individuals age 65 or older
- Low-income Medicare beneficiaries (Medicare Savings Programs).
Most children under age 19 become continuously eligible for Medicaid. That is, once they are determined eligible, they stay eligible for up to 12 months without regard to changes in circumstances. Similarly, most pregnant women who become elegible remain eligible through their pregnancy and for at least 60 days after the preganancy ends.
Medicaid coverage may begin up to 3 calendar months prior to the month of application.
Individuals that are not covered by Medicaid are adults between the ages of 21 and 65 who are not blind or disabled, pregnant, or a cartaker of deprived children.
Medicaid Eligibility Requirements (last updated April 2013)
The following is a general outline of Medicaid Program eligibility requirements.
State Residence
You must be a state resident to qualify for Medicaid through North Dakota.
Citizenship
You must be a United States citizen or an alien who is lawfully admitted for permanent residence. Some lawfully admitted aliens may have to wait for five (5) years before full Medicaid benfits are available, however, there is no waiting period for coverage of emergency services.
Asset Limits
There is no asset limit for children, families, or pregnant women in the Children and Families coverage group or the Women's Way program. Generally, a person who is blind, disabled, or age 65 or older can have up to $3000 in countable assets (such as savings accounts, checking accounts, stocks, bonds, or other type of asset) to qualify for Medicaid. The limit for couples is $6000. For each additional person in the household, $25 can be added to the asset limits. Individuals who qualify for the Workers with Disabilities coverage are allowed an additional $10,000.
Spousal Impoverishment Prevention Coverage
This coverage applies to couples where one needs Nursing Care Services in a facility or at home. The spouse receiving the nursing care services is allowed $3000. The spouse who remains in the community is entitled to keep half of the couple's countable assets, but not less than $23,184 and not more than $115,920 for calendar year 2013 (adjusted every January). The spouse receiving the nursing care services may keep up to $50 of their monthly income and may deem income to bring the income of the spouse in community up to $2,267 per month and any dependent household members up to $630 (adjusted every July).
Assets that are not counted:
Your home, one automobile, burial plans (with limits), self-employment property (including tools, equipment and livestock), non-saleable property, personal effects and clothing, household goods and furniture, Indian trust and restricted lands, and per capita and judgment funds. Other miscellaneous assets may also be excluded.
Income:
Depending on the amount of net income, individuals may be eligible for full Medicaid benefits or may be responsible for a portion of their medical bills which is called their recipient liability. Children who are not eligible for full Medicaid benefits may be eligible for Healthy Steps or the Caring for Children Program. Medicaid looks at a family's total countable income and subtracts allowed expenses to establish net income.
Some of the more common allowable expenses are:
- Taxes and other work related expenses
- Health insurance premiums
- Dependent care expenses
- Child support paid to a non household member
- Other deductions may apply
Individuals in a nursing home are allowed to keep $50 of their monthly income to meet their personal needs. They also keep enough to cover their health insurance premiums and certain other expenses. If the individual has a family at home with lower income, the individual can give some of his/her money to the family at home.
Individuals residing in an ICF-MR are allowed $85 to meet their personal needs. They also keep enough to cover their health insurance premiums and certain other expenses.
General Medicaid Income Levels Effective April 1, 2013
| Family Size | Full Coverage for Entire Family | Medically Needy - |
Children Age 6-19 | Preg. Women and Child to Age 6 |
|---|---|---|---|---|
1 |
$311 | $795 | $958 | $1,274 |
2 |
$417 | $1,073 | $1,293 | $1,720 |
3 |
$523 | $1,351 | $1,628 | $2,165 |
4 |
$629 | $1,629 | $1,963 | $2,611 |
5 |
$735 | $1,907 | $2,298 | $3,056 |
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