What Is Medicaid?

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Medicaid is a partnership between the Federal Government and the various States intended to provide health insurance coverage for the poor and chronically disabled. It is funded by both partners and is administered by the individual States.

There are many categories of Medicaid and the benefits of each vary by category. The categories are determined by the Medicaid Recipient’s annual income in relation to the Federal Poverty Level (FPL) and the Medicaid Recipient’s Resources in relation to the limit for Supplemental Security Income, or SSI, eligibility. The FPL is determined by income and family size. The SSI limit varies by County and is determined by and available from Medicaid by dialing 211 on your touch-tone phone.

The chart below shows the various FPL’s for Calendar Year 2017 and how they vary with both income and family size. For example, the Federal Poverty Level for a couple with no children is $16,020.

Family  Percentage of the Federal Poverty Level (FPL) 

 Household Size

 100%

 133%

 150%

200%

250%

 300%

400%

 1

$12,060

$16,040

$18,090

$24,120

$30,150

$36,180

$48,240

 2

16,240

 21,599

24,360

  32,480

40,600

48,720

64,960

 3

20,420

 27,159

30,240

  48,840

51,050

61,260

81,680

 4

24,600

 32,718

36,900

  49,200

61,500

73,800

98,400

 5

28,780

 38,277

43,170

  57,560

71,950

86,340

115,120

 6

32,960

 43,837

49,440

  65,920

82,400

98,880

131,840

 7

37,140

 49,396

55,710

  74,280

92,850

111,420

148,560

 8

41,320

 54,956

61,980

  82,640

103,300

123,960

165,280

For families/households with more than 8 persons, add $4,180 for each additional person.

The following is a brief description of each of the various Medicaid Eligibility Categories:  

QMB 

An individual entitled to Medicare Part A with an income of 100% of the Federal Poverty Level (FPL) or less and resources that do not exceed twice the limit for Supplemental Security Income (SSI) eligibility and is not otherwise eligible for full Medicaid Benefits through the State. Medicaid pays their Medicare Part A premiums, if any, Medicare Part B Premiums, and Medicare deductibles and Coinsurance for Medicare services provided by Medicare providers to the extent consistent with the Medicaid State Plan.

QMB+ Qualified Medicare Beneficiaries  Plus

An individual who meets the standards for QMB eligibility, and who also meets the criteria for full Medicaid benefits. Medicaid pays their Medicare Part A premiums, if any, Medicare Part B Premiums, and Medicare deductibles and Coinsurance and provides full Medicaid benefits to the extent consistent with the State Plan. These individuals often qualify for full Medicaid benefits by meeting Medically Needy standards, or by spending down excess income to the Medically Needy level.

SLMB – Specified Low Income Medicare Beneficiary without other Medicaid

An individual entitled to Medicare Part A, with an income that exceeds 100% of the FPL but less than 120% of the FPL with resources that do not exceed twice the limit for Supplemental Security Income (SSI) limit, and who is not otherwise eligible for Medicaid. These individuals are eligible for Medicaid payment of the Medicare Part B premium only. They do not qualify for any additional Medicaid benefits.

SLMB+ Specified Low Income Medicare Beneficiary without other Medicaid Plus

An individual who meets the standards for SLMB eligibility, and who also meets the criteria for full State Medicaid benefits. These individuals are entitled to Medicaid payment of the Medicare Part B premiums, in addition to full State Medicaid benefits. These individuals often qualify for full Medicaid benefits by meeting Medically Needy standards or by spending down excess income to the Medically Needy level.

QI – Qualifying Individual

An individual entitled to Medicare Part A, with an income of at least 120% of the FPL but less than 135% of the FPL with resources that do not exceed twice the Supplemental Security Income (SSI) limit, and who is not otherwise eligible for Medicaid benefits. This individual is eligible for Medicaid payment of the Medicare Part B premiums.

QDWI – Qualified Disabled and Working Individual

An individual who has lost Medicare Part A benefits due to a return to work but is eligible to enroll in and purchase Medicare Part A. The individual’s income may not exceed 200% of the FPL and resources may not exceed twice the SSI limit. The individual may not be otherwise eligible for Medicaid. These individuals are eligible for Medicaid payment of the Medicare Part A premium only.

FBDE – Other Full Benefit Dual Eligible

An individual who does not meet the income or resource criteria for QMB or SLMB, but is eligible for Medicaid either categorically or through optional coverage groups based on Medically Needy status, special income levels for institutionalized individuals, or home or community-based waivers.

These are just generalized descriptions of these categories. If you believe you may fall into one of these categories, dial 211 on your touch-tone phone and get connected with Medicaid directly for further information and evaluation of your eligibility.