The Role Age Plays in Medicaid Eligibility

• by Christian Worstell
• January 12, 2024

Age may or may not play a factor in Medicaid eligibility, as there are different types of Medicaid programs, various ways to qualify and rules that differ by state. In this Medicaid eligibility guide, we’ll break down the role that age plays in Medicaid eligibility, enrollment and benefits. 

Is Medicaid Age-Based?

There is no universal age at which to qualify for Medicaid, and age may or may not factor into your eligibility at all depending on where you live.

One type of Medicaid is the Aged, Blind and Disabled (ABD) Medicaid program. ABD Medicaid requires you to be at least 65 years old, have blindness or another disability and meet certain financial requirements. Because you have to be at least 65 to qualify for this type of Medicaid coverage, you could consider it to be “age-based.” 

Another type of Medicaid program is Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). This program is available to individuals under the age of 21 who live in households that meet certain financial criteria. This type of Medicaid also has an age restriction and could therefore also be considered age-based. 

ABD and EPSDT are required by federal law to be included in all state Medicaid programs. But as long as certain federal requirements are met, state Medicaid programs are free to offer their own Medicaid benefits and eligibility guidelines to people who might not otherwise be eligible for these two programs. Age may or may not play a role, depending on where you live. 

For example, Medicaid in North Carolina is only available to those age 65 and over or 21 and under unless you are pregnant, are responsible for a child age 18 and under, disabled or require long-term care. 

But in North Dakota, Medicaid is available to all low-income adults, regardless of age. 

It could be said that Medicaid is age-based in some states and for some programs, but it is not universally age-based. 

Which States Have Age Restrictions for Medicaid?

The following 12 states have thus far opted not to expand their Medicaid programs to all low-income adults and instead require certain age, disability or other criteria for eligibility:

1. Alabama
2. Florida
3. Georgia
4. Kansas
5. Mississippi
6. North Carolina
7. South Carolina
8. South Dakota
9. Tennessee
10. Texas
11. Wisconsin
12. Wyoming

Who Qualifies for Medicaid?

Medicaid qualification is different in every state. You must be a resident of the state in which you are applying for benefits and must be a U.S. citizen or otherwise qualified non-citizen such as a lawful permanent resident.

Federal law requires every state to provide Medicaid to the following mandatory eligibility groups that meet certain income and asset requirements:

1. Low-income families (must care for a child age 18 and under)
2. Pregnant women
3. Children
4. Individuals receiving disability benefits

As you can see from the federal guidelines, the only reference to age is in regards to children. Each state governs its own Medicare program in adherence to federal regulations. Some states may have an age requirement in order to qualify for its Medicaid program while other states may not. 

You can find your state’s Medicaid eligibility requirements to learn more.  

How Old is the Medicaid Program?

Medicaid was signed into law in 1965 alongside Medicare and is offered in all 50 states, the District of Columbia and U.S. territories. 

How Can I get Help With Medicaid? 

If you need assistance with your Medicaid eligibility, application or benefits, you may contact your state Medicaid program.

Medicaid and Medicare Dual Eligibility

People who are eligible for Medicare and Medicaid are considered “dual eligible.” In this case, you may qualify for a certain type of Medicare Advantage plan called a Dual Eligible Special Needs Plan (D-SNP).

You can compare plans online to find out if D-SNPs are available where you live.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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