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Medically Needy

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Updated August 03, 2010

Definition:

More than 40 states plus the District of Columbia operate medically needy programs, which allow them to provide Medicaid to certain groups of individuals who are not otherwise eligible for Medicaid.

If you have been denied Medicaid coverage because your income is too high, you might qualify as a "medically needy" individual based on your income and health status.

If your state offers a medically needy program, it must cover:

  • Pregnant women
  • Children under 18

Your state also has the option to cover:

  • Children up to 21
  • Parents and other caretaker relatives
  • Elderly individuals
  • Individuals with disabilities

Your state’s medically needy program may also expand coverage to people who “spend down” by incurring medical expenses so that their income falls below a state-established medically needy income limit. The opportunity to spend down may be particularly important to you if you are elderly and reside in a nursing home. Also, children and adults with disabilities who live in the community may have high prescription drug, medical equipment, or other health care expenses.

The Affordable Care Act, passed in March 2010, will significantly expand the number of people in the country who are eligible for Medicaid. This expansion may cover many of the people who currently are in a medically needy program.

To find the Medicaid Agency in your state, use the interactive map from the National Association of State Medicaid Directors.

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