Medicaid

Is Medicaid Right for You?

Medicaid is government-funded health coverage for people in certain situations. You may qualify if you:

• Get Supplemental Security Income (SSI) benefits or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI. In either case, you automatically get Medicaid coverage and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI article.
• Have low income, no matter how much you have in resources or whether you have a disability. Income-based Medicaid is explained on this page.
• Have a disability and work, even if your income is higher. Learn more about Medicaid Buy-In for Workers with Disabilities (MBIWD).

Answer the questions on this page to see if you might qualify for income-based Medicaid. If so, it’s probably your best health coverage option because it doesn’t usually have a premium, the copayments for services are generally lower than copayments required by private plans, and Medicaid covers more services than most private plans. Also, if you qualify for Medicaid, you cannot get government help paying for an individual plan on HealthCare.gov.

Note: The rules for SSI and Medicaid are different if you are less than 18 years old. Learn about them in DB101’s Benefits for Young People article.

Do You Qualify for SSI or 1619(b)?

If you have a disability, low income, and low resources, you may qualify for SSI. If you already get SSI benefits, you automatically get Medicaid coverage and do not need to apply separately.

If you don’t get SSI benefits yet, you should learn whether you might qualify by reading DB101’s SSI article. At the same time, you should apply for Medicaid separately, because it can take Social Security several months to review your SSI application and it’s important for you to have health coverage until then.

If you used to get SSI benefits, but stopped getting them after you started working, you may qualify automatically for Medicaid through a special rule called 1619(b) as long as your gross income is below $40,936 per year. Learn more about 1619(b) in DB101’s SSI article.

If you do not get SSI benefits and do not qualify for 1619(b), income-based Medicaid might cover you.

Do You Meet Income-Based Medicaid’s Basic Requirements?

To qualify for income-based Medicaid, you must:

• Be under 65 years old
  • You can be 65 or older if you are the parent or caretaker of a child
• Not qualify for Medicare
  • You can be on Medicare if you are the parent or caretaker of a child or are pregnant
• Be a U.S. citizen or meet specific noncitizen requirements

If you are under 65, do not qualify for Medicare, and are either a U.S. citizen or a noncitizen who qualifies, income-based Medicaid might cover you.

Medicaid’s rules for immigrants:

• Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
• Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for all of the same programs that U.S. citizens can get.

Is Your Income Low Enough for Income-Based Medicaid?

These are the main income rules for income-based Medicaid:

• If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($20,783 per year for an individual; $43,056 for a family of four), you may qualify.
• If you are 18 or younger and your family’s income is at or under 211% of FPG ($65,832 per year for a family of four), you may qualify.
• If you are pregnant and your family’s income is at or under 205% of FPG ($63,960 per year for a family of four), you may qualify. The unborn baby is counted as a family member.

Income-based Medicaid counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility.

Note: There are no limits to how much money or other resources you can have for income-based Medicaid.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,060
	$5,380
	$15,060
	$5,380
Income-based Medicaid, adults (138% FPG)
Income-based Medicaid, children (211% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). For private plans with subsidies, your monthly premium amount depends on your income.

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If your income is low enough and you meet all other requirements, you should sign up for Medicaid.

More Ways to Qualify for Medicaid if You Have a Disability

If you have a disability, but don't qualify for SSI, 1619(b), or income-based Medicaid, you might still qualify for Medicaid benefits if:

• You make more money at work than income-based Medicaid allows. In that case, you could apply for Medicaid Buy-In for Workers with Disabilities (MBIWD). Learn more about MBIWD.
• You have mental health needs that private insurance or Medicare won’t pay for. If you are in this situation, talk to a benefits planner about Medicaid for people with severe and persistent mental illness (SPMI).
• You qualify for disability-based Medicaid, but not SSI. Learn more about disability-based Medicaid.

How to Sign Up

You can apply for Medicaid:

• Online, or
• By filling out the combined application form (other languages) and submitting it to your County Department of Job and Family Services (CDJFS) office.

For help with your application, visit or call your local County Department of Job and Family Services (CDJFS) office or call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or 1-800-292-3572 (TTY).

Staying on Medicaid

Usually, once you are approved for Medicaid, you will continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your County Department of Job and Family Services (CDJFS) office know or report the changes online. When you report your changes, the county will tell you whether you will continue getting Medicaid or if you have new health coverage options, like individual coverage with subsidies or MBIWD.