Print This Article

Financial Eligibility Overview

Categorical and medical eligibility is covered in Chapter 2. Here we begin an aerial fly-over of financial eligibility. In this chapter we are painting with a broad brush. Subsequent chapters will examine financial eligibility and planning techniques in more detail.

In reviewing financial eligibility, it is important to know which class of assistance the applicant is seeking. Medicaid eligibility can be divided into three broad classes of assistance, each having it own financial criteria: (a) mandatory categorically needy; (b) optional categorically needy; and (c) medically needy. A State must allow an individual eligible for more than one class of assistance to have eligibility determined for the category he  or she selects. 42 C.F.R. § 435.404.

Federal law defines Mandatory categorically needy at (42 U.S.C. § 1396a(A)(10)(A)(i)) and defines Optional categorically needy at (42 U.S.C. § 1396a(a)(10)(A)(ii)). At the State’s option, Medically Needy individuals may also be served. (42 U.S.C. § 1396a(a)(10)(C)). Mandatory coverage is also listed in 42 C.F.R. Part 435, Subpart B, § 435.100 through 435.172 (listing Mandatory Coverage).

Start Here

Enter your name and email address to keep up with what’s new at EZ Elder Law!

  • This field is for validation purposes and should be left unchanged.