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.

• 2021 ABD Financial Limits
• 2021 Family Medicaid Financial Limits

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).

A fundamental concept is that Medicaid law does not alter rights based on other laws. Medicaid evaluates those rights to determine whether they impact eligibility.