Menu Close


Community. Purpose. Technology.

Determine Your Eligibility for Medicaid

Medicaid is the largest healthcare coverage program in the US that, along with CHIP (Children’s Health Insurance Program), provides health benefits to 72 million US citizens. It’s a healthcare program that’s provided jointly by both federal and state governments. The federal law binds states to provide Medicaid to mandatory eligibility groups, including children, pregnant women, and people receiving SSI (Supplemental Security Income). However, US states have the option to cover additional groups of individuals who meet certain criteria. Here, we’ll discuss the eligibility requirements, so you’re aware if you’re eligible for Medicaid.

How to Determine the Eligibility for Medicaid?


To determine the eligibility for Medicaid, Affordable Care Act uses MAGI (Modified Adjusted Gross Income) to evaluate the financial eligibility of individuals. With a single income evaluation process, it’s become easier to apply and register in the Medicaid program. The MAGI methodology replaces the previous Medicaid eligibility, in which the eligibility was determined like the Aid to Families with Dependent Children program, which was abandoned in 1996. In a nutshell, the new criteria evaluate tax filing and taxable income to enroll in Medicaid. However, people who have conditions like disability, blindness, or people who’re over the age of 65, are exempted from MAGI-based income evaluation.


To get enrolled in Medicaid, certain non-financial terms should also be met. Generally, people wishing to avail certain Medicaid benefits must be residents of the same state where it’s offered. Additionally, they must be US citizens or eligible non-citizens, like permanent residents. Age, pregnancy, and parenting status are also evaluated to determine eligibility for Medicaid.

Medically Needy Program

To provide health coverage to people who don’t otherwise qualify for Medicaid programs, states have the authority to establish a medically needy program to cover certain medical conditions. This comes in handy for individuals whose income is too high for MAGI-based income evaluation. Additionally, such individuals can also opt for Medicaid assistance by incurring the costs of part of their medical expenses. Once the expenses exceed a certain level prescribed by the state, the rest of the cost is covered by the state under the medically needy program.

When Does My Coverage Start?

You don’t need to wait long to start receiving medical benefits after submitting your application. Once your eligibility is confirmed, the coverage comes into effect from the day of application submission. In other cases, coverage is effective from the first day of the month of application submission. If you were eligible previously, Medicaid could even cover you for up to 3 months before you applied. However, if you’re no longer eligible, the coverage would become non-effective at the end of the prevailing month.  If you’re looking for Medicaid-assisted treatment for opioid addiction, Suboxone Clinic Frederick is here to help. Our professional Medicaid suboxone doctors use medication and scientific techniques to treat patients at our suboxone detox center in Maryland. We’re one the most renowned suboxone clinics in Frederick, Maryland, providing effective treatment to patients across the US. Get in touch with us today for further queries.