Medicaid provides health care coverage, at little or no cost, to low-income people. The program is run in conjunction between the federal and state governments, but coverage differs between states. You can lose your Medicaid coverage for a number of reasons -- including moving to a state in which you are ineligible. Some reasons for the loss of coverage you may have anticipated. For example, nationwide, the program covers low-income pregnant women, but you may no longer be eligible once your baby is born.
Federal Eligibility Standards
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On the federal level, Medicaid provides care for low income:
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- pregnant women
- families and children
- people with disabilities
- senior citizens.
If you're receiving Medicaid as part of family coverage, you may lose eligibility once you turn 19. The qualifications for single adults are far more stringent.
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If your state implements the Affordable Care Act's Medicaid expansion, you are eligible for coverage if your income is up to 138 percent of the Federal Poverty Level. If your state doesn't implement the Medicaid expansion, you can lose coverage if you don't fall into one of the national Medicaid categories.
Supplemental Security Income and Medicaid
If you've received Supplemental Security Income payments and return to work, you can generally keep your Medicaid coverage, even if you now earn too much to qualify for SSI. That's as long as you're still disabled or blind, the criteria for SSI, along with low income, and meet other SSI requirements. The amount you can earn and still qualify for Medicaid depends upon state regulations. Other requirements for retaining Medicaid include:
- you can't work without Medicaid benefits
- your gross earnings aren't sufficient to replace Medicaid, SSI and public funding for necessary attendants
- your SSI payment eligibility lasted at least one month.
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Getting married and losing your SSI because your combined incomes exceed eligibility limits doesn't necessarily mean you will lose Medicaid coverage. Much depends on your state of residence, and whether you still meet the Medicaid retention criteria. If you do lose Medicaid, you may qualify for Affordable Care Act coverage and subsidies.
Income Levels
While earning more money or otherwise receiving more income is generally a good thing, it can mean that you're no longer eligible for Medicaid. The key is your income and your state's eligibility standards. Those standards are reflected in either monthly income or a percentage of the FPL for the number of people in your family. For example, as of 2014, a single adult in California is ineligible once her monthly income exceeds $1,293, while a single adult in Wisconsin can't have a monthly income in excess of $924. In 2015, 29 states set Medicaid eligibility levels for parents -- and other adults -- at 138 percent of the FPL. As of 2015, that was $16,243 for a single adult.
Medicaid Fraud
Of course, if you defraud the Medicaid program you can lose your coverage. Examples of recipient fraud include:
- Loaning your Medicaid to others
- Not reporting income or resource changes
- Giving or selling Medicaid drugs to others
- Not reporting employment
- Not reporting additional household members.
In many states, Medicaid fraud is treated as grand larceny. If convicted, not only may you lose your Medicaid eligibility, but you could face liens on your home or other property and civil lawsuits. You may even go to jail.
Incarceration, Institutionalization and Medicaid
If you are incarcerated, Medicaid doesn't pay for medical care. However, you can apply for Medicaid while in jail or prison so you can receive benefits more quickly upon release. Some states do allow incarcerated individuals to stay on Medicaid, even though they do not receive benefits while in jail or prison.
Those institutionalized in non-prison or jail settings are usually able to keep Medicaid coverage, as long as the facility meets state and federal certification standards.
State Law Changes
You may lose your Medicaid eligibility even though your income remains the same. The state you live in may change eligibility standards and lower income limits, tied to a percentage of the federal poverty level. For example, if a state that formerly tied eligibility levels to 201 percent of the FPL lowers the standard to 155 percent, quite a few residents will lose Medicaid benefits. When Connecticut made that change in its state budget, an estimated 23,700 low-income parents lost their coverage.