It is prudent to verify Medicaid benefits eligibility before beginning a Medicaid application, because when an applicant asks “What are the requirements for Medicaid?” each state may have a different set of rules. The Affordable Care Act spawned Medicaid expansion in many states, including Louisiana. As a result, many states have amended their Medicaid eligibility requirements to be more inclusive of individuals who need long term health care.
The Medicaid eligibility requirements in Louisiana generally match the federal standard. This means that an individual who is eligible for Medicaid in LA may be pregnant, disabled, supporting a dependent, receiving financial assistance through another government program, or under 19 years of age, as well as living in a household that meets the income requirement. In collaboration with the Affordable Care Act, the state of Louisiana has expanded Medicaid to include low income residents with pre-existing, chronic conditions, including cancer, hypertension, and diabetes.
But what are the income requirements for Medicaid in Louisiana? First of all, the household income range needed to meet Medicaid benefits eligibility will vary depending on household size and eligibility. Because Medicaid is a health care coverage program available based upon financial need, the income limit will generally be low in proportion to the household size. Beneficiaries of financial assistance programs such as SNAP or FITAP may automatically meet income qualifications.
This section on qualifications for Medicaid in Louisiana will cover topics on:
- General Medicaid eligibility requirements in Louisiana
- Income requirements for Medicaid in Louisiana
General Medicaid Eligibility Requirements in Louisiana
Besides financial need, a person who is eligible for Medicaid is generally determined to be due to an increased need for access to healthcare. Individuals who meet Medicaid benefits eligibility will be more likely to need chronic care or their health monitored. Individuals who are pregnant or disabled, for example, are likely to require regular doctor’s visits, medication, and long term care. It is for this reason that adults without children or disabilities may have more difficulty qualifying for Medicaid in LA. Able bodied adults without dependents are generally ineligible for Medicaid health coverage, even with a low income. Few states have expanded their Medicaid programs to provide coverage to this demographic through the Affordable Care Act.
In 2016, many states, including Louisiana, expanded Medicaid benefits eligibility to be more inclusive of individuals who may need help affording health care. For the state of Louisiana, this translated into adjusted Medicaid eligibility requirements to include individuals who may have previously been excluded from receiving Medicaid in LA. The Affordable Care Act help facilitate the expansion of Medicaid, providing comprehensive healthcare for low-income individuals with pre-existing chronic illnesses and disabilities. Under expanded Medicaid in Louisiana, thousands of residents have benefitted from preventative care, having diseases such as diabetes or cancer detected in its early stages and receiving extensive care to treat it.
To meet state Medicaid benefits eligibility in LA, an individual must:
- Be a legal residence of Louisiana (United States citizenship not required)
- Be a recipient of SSI (Supplemental Security Income)
- Meet the disability guidelines as defined by the Social Security Administration OR have vision that is 20/200 or worse
- Be pregnant
- Be a parent living with a child under the age of 19
- Receive financial assistance from the Family Independence Temporary Assistance Program (FITAP)
- Be a child under the age of 19
Income Requirements for Medicaid in Louisiana
Petitioners interested in learning “What are the Medicaid application guidelines in LA?” need to understand that Medicaid is a healthcare program that is reserved for low-income individuals. All petitioners need to demonstrate that they have a financial need for free or low cost health care in order to obtain Medicaid benefits. In reference to income requirements, the income range varies depending on household size and eligibility.
Generally speaking, applicants will meet Medicaid eligibility requirements if they are receiving benefits through Supplemental Nutrition Assistance Program (SNAP), the Family Independence Temporary Assistance Program (FITAP), or any other financial need based government assistance program. Medicaid benefits eligibility is able to extend to these programs because they often use similar income eligibility guidelines. Beneficiaries of certain government financial assistance programs may not need to fill out an application for Medicaid.
Applicants still asking “What are the income requirements for Medicaid?” should understand that the United States government uses the Federal Poverty Level, or FPL, as a general figure. The FPL is an important determining factor in how to qualify for Medicaid, as well as most other financial need based government assistance programs. The FPL is contingent upon household size and is adjusted every year to remain proportionate to the overall cost of living.
In reference to household income, determining who is eligible for Medicaid can be calculated by using the FPL. As of 2017, the FPL according to household size is:
- For household size of one, $11,880
- Household size of two, $16,020
- Household size of three, $20,160
- Household size of four, $24,300
- Household size of five, $28,440
- Household size of six, $32,580
- Household size of seven, $36,370
- Household size of eight, $40,890
- For each additional family member, add $4,160
In terms of calculating Medicaid coverage income requirements the FPL is used as a guide. Rarely are income limits only 100 percent of the Federal Poverty Level. Typically, income eligibility for government programs, Medicaid included, will likely be a percentage of the FPL that is greater than 100 percent but less than 400 percent of the FPL. To determine Medicaid benefits eligibility in Louisiana, prospective petitioners may calculate an estimate of if income qualifications are met using the FPL as a guide.
To meet Medicaid eligibility requirements, applicants must have a household income that is:
- 212 percent or less of the FPL for children
- 133 percent or less of the FPL for pregnant women
- 100 percent or less of the FPL for individuals who are disabled but employed
- 138 percent or less of the FPL for families with children
Low income children who do not meet Medicaid benefits eligibility may still qualify for other low cost health insurance plans through the state of Louisiana.