This article will explain what medically needy means, how and where the program works, and how it differs from traditional Medicaid eligibility and the ACA’s expansion of Medicaid.
What Does “Medically Needy Mean” in Terms of Medicaid Eligibility? The term medically needy refers to individuals who:
Are in one of Medicaid’s traditional eligibility categories—blind, aged, pregnant, disabled, a child, or the parent of a minor child. Have income is too high for regular Medicaid eligibility (regular Medicaid eligibility requires the person to have low income, in addition to being blind, aged, pregnant, disabled, a child, or the parent of a minor child; note that this is different from the ACA’s expansion of Medicaid eligibility, which is based strictly on household income and applies to people age 18-64 with income up to 138% of the poverty level) Have medical expenses significant enough that when subtracted from the person’s income, it brings the after-medical-expense income down to a level that the state deems eligible for Medicaid under its medically needy program....