Medicaid Eligibility Requirements

Proper health care can be achieved when there are enough finances to support the costly diagnostic tests and processes, and lengthy stays for inpatients. Insurance is one of the healthcare system service components that protect individuals against dangerous risks when needing costly health care services. Insurance covers in this context determine the extent to which the insured person can receive health services, it also outlines how and where the health services will be received. Consequently, the insurance company is entitled to manage the payment of funds to the institutions that provide health care.

Furthermore, health insurance can be categorized as Medicare or Medicaid. Medicare is a centralized health insurance program for older people and some young people who are disabled. This is a module of Social Security program that enrolls anybody eligible for the benefits realized through the program. On the other hand, Medicaid is an insurance program that covers low-income people, and sometimes seriously sick or disabled individuals (Williams, 2007). Medicaid eligibility varies from state to state. Therefore, the following paragraphs compare the eligibility requirements of California to Montana.

An individual with a low income does not entirely qualify for Medicaid assistance. There exist many poor people, with low incomes, who do not meet the requirements for such insurance programs. This is because they do not concur with the eligibility requirements of the Medicaid program in their respective states. However, both Montana and California consider an individual’s income level when applying for Medicaid. In California, the Medicaid program is known as Medi-Cal, which offers health and long-term healthcare coverage for individuals.

To be eligible for Medi-Cal, the California administrative state categorizes individuals into the following groups: children, adults, elderly, and needy people with disabilities, medically needy, and immigrants. Eligibility requirement for children in California are based on age and federal poverty levels. Babies up to 1 year with family incomes of at most 200% FPL, children 1 to 5 years with 133% FPL, and those with 6 to 19 up to 100% FPL are qualified. For adults, Medi-Cal provides services for parents with up to 100% FPL, and pregnant women with at most 200% FPL. Adults with no children can be eligible for a special program called Family PACT.

Elderly and individuals with disabilities qualify for Medi-Cal by meeting the specified qualities by the Supplemental Security Income (SSI) program. The minimum requirement for this category of people is up to 100% FPL. The medically needy people are those with high income but with high medical expenses. To qualify, they need to have incomes up to 83% FPL and married individuals should have income up to 97% FPL. For immigrants, the Medi-Cal requires that they meet other eligibility requirements to qualify for full Medicaid. Immigrants without satisfactory documents are provided with limited Medi-Cal coverage (Medi-Cal, 2009).

On the other hand, the eligibility requirements for Montana are more less the same as California with several differences, in that, income levels and resources are considered. The categories of people who are eligible for Medicaid are: parents or adults with children under age 19, pregnant women, children, women diagnosed with cancer, elderly people (65 or older), blind or disabled people. California categorizes Medicaid as full or basic. To be eligible for full Medicaid coverage, an individual must be under the age of 21, blind or disabled, pregnant, or aged above 65 years; the person gets all services provided by Medicaid.

Otherwise, a basic coverage is granted, in which dental care, vision exams, eyeglasses, and personal care services are not offered. Consequently, the Montana Medicaid is categorized into the following: family-related Medicaid and aged or disabled people Medicaid. The financial eligibility requirements for family-related Medicaid and their federal poverty level are: new born child – no income limit, children under 6 – 133% FPL, children aged 6 to 9 – 100% FPL, Medically needy children – 33% FPL, family – 33% FPL, transitional family – 185%FPL, pregnancy – 150%, FPL, breast and cervical cancer treatment – 200%FPL.

For aged, blind, and disabled people, Medicaid can be offered through non-financial program if a person collaborate with third part liability, meet the age criteria, or provide valid social security number (Montana, 2009). Consequently, Medicaid eligibility for this group of individuals does not have true income limits as compared to those in California.

In essence, a person must be a U.S citizen to be eligible for Medicaid. More so, immigrants with legal documentations can qualify for such healthcare insurance. In this paper, we have discussed the eligibility requirements for Medicaid in California and Montana. The various minimum requirements outlined show that Medicaid coverage varies from state to state in regard to income levels of applicants. However, the general categories of people that are eligible for Medicaid include: children, adults (married or single with certain income levels), disabled individuals, and elderly people.


Medi-Cal. (2009). Find Out if I Qualify – Medi-Cal Eligibility. Web.

Montana. (2009). Medicaid: Are you eligible?. Web.

Williams, J. S. (2007). Introduction to Health Services. (7th Edition). Clinton Park, NY: Delmar Thomson Learning.

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