Editing Medicaid (section)

=== Non-PPACA eligibility ===
While Medicaid expansion available to adults under the PPACA mandates a standard income-based test without asset or resource tests, other eligibility criteria such as assets may apply when eligible outside of the PPACA expansion,<ref name=":6" /> including coverage for eligible seniors or disabled.<ref>{{Cite web|url=https://familiesusa.org/1115-waiver-element-asset-tests|title=1115 Waiver Element: Asset Tests|date=2017-11-09|website=Families USA|language=en|access-date=2019-06-13|archive-url=https://web.archive.org/web/20180119102248/http://familiesusa.org/1115-waiver-element-asset-tests|archive-date=January 19, 2018|url-status=dead}}</ref> These other requirements include, but are not limited to, assets, age, pregnancy, disability,<ref>{{cite web|url=http://www.id-dd.com/medicaremedicaid/|archive-url=https://archive.today/20141115034713/http://www.id-dd.com/medicaremedicaid/|url-status=dead|archive-date=15 November 2014|title=Medicare/Medicaid|website=ID-DD Resources|access-date=15 November 2014}}</ref> blindness, income, and resources, and one's status as a [[Citizenship of the United States|U.S. citizen]] or a [[Us resident|lawfully admitted immigrant]].<ref name=":4" />

As of 2015, asset tests varied; for example, eight states did not have an asset test for a buy-in available to working people with disabilities, and one state had no asset test for the aged/blind/disabled pathway up to 100% of the [[Federal poverty level|Federal Poverty Level]].<ref>{{Cite web|url=https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015-report/|title=Medicaid Financial Eligibility for Seniors and People with Disabilities in 2015 - Report|last1=Watts|first1=Molly O'Malley|last2=Cornachione|first2=Elizabeth|date=2016-03-01|website=The Henry J. Kaiser Family Foundation|language=en-us|access-date=2019-06-13|archive-url=https://web.archive.org/web/20180921100242/https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015-report/|archive-date=September 21, 2018|url-status=dead}}</ref>

More recently, many states have authorized financial requirements that will make it more difficult for working-poor adults to access coverage. In [[Wisconsin]], nearly a quarter of Medicaid patients were dropped after the state government imposed premiums of 3% of household income.<ref name=":5">{{Cite web|url=http://www.policymattersohio.org/wp-content/uploads/2015/02/Making-Medicaid-work-1.pdf|title=Making Medicaid Work|website=www.policymattersohio.org}}</ref> A survey in [[Minnesota]] found that more than half of those covered by Medicaid were unable to obtain prescription medications because of [[Copayment|co-payments]].<ref name=":5" />

The [[Deficit Reduction Act of 2005]] (DRA) requires anyone seeking Medicaid to produce documents to prove that he is a United States citizen or resident alien. An exception is made for Emergency Medicaid where payments are allowed for the pregnant and disabled regardless of immigration status.<ref>{{cite web|title=Healthcare for Wisconsin Residents|url=http://www.dhs.wisconsin.gov/medicaid/Publications/p-10164.pdf|publisher=Wisconsin Department of Health and Family Services|access-date=October 5, 2011|archive-url=https://web.archive.org/web/20111130165600/http://www.dhs.wisconsin.gov/medicaid/Publications/p-10164.pdf|archive-date=November 30, 2011|url-status=dead}}</ref> Special rules exist for those living in a nursing home and disabled children living at home.

==== Supplemental Security Income beneficiaries ====
Once someone is approved as a beneficiary in the [[Supplemental Security Income]] program, they may automatically be eligible for Medicaid coverage (depending on the laws of the state they reside in).<ref>{{Cite web|url=https://www.ssa.gov/disabilityresearch/wi/medicaid.htm|title=Medicaid Information|website=www.ssa.gov|language=en|access-date=2018-07-13}}</ref>

==== Five year "look-back" ====
The DRA has created a five-year "look-back period." This means that any transfers without fair market value (gifts of any kind) made by the Medicaid applicant during the preceding five years are penalizable.

The penalty is determined by dividing the average monthly cost of nursing home care in the area or State into the amount of assets gifted. Therefore, if a person gifted $60,000 and the average monthly cost of a nursing home was $6,000, one would divide $6000 into $60,000 and come up with 10. 10 represents the number of months the applicant would not be eligible for Medicaid.

All transfers made during the five-year look-back period are totaled, and the applicant is penalized based on that amount after having already dropped below the Medicaid asset limit. This means that after dropping below the asset level ($2,000 limit in most states), the Medicaid applicant will be ineligible for a period of time. The penalty period does not begin until the person is eligible for Medicaid.<ref>42 U.S.C. 1396p</ref>

Elders who gift or transfer assets can be caught in the situation of having no money but still not being eligible for Medicaid.

====Immigration status====
{{See also|Immigration to the United States}}

Legal permanent residents (LPRs) with a substantial work history (defined as 40 quarters of Social Security covered earnings) or military connection are eligible for the full range of major federal means-tested benefit programs, including Medicaid (Medi-Cal).<ref name=RL33809>{{cite report|title=RL33809 Noncitizen Eligibility for Federal Public Assistance: Policy Overview |date=December 12, 2016|publisher=[[Congressional Research Service]]|url=https://www.everycrsreport.com/reports/RL33809.html}} {{PD-notice}}</ref> LPRs entering after August 22, 1996, are barred from Medicaid for five years, after which their coverage becomes a state option, and states have the option to cover LPRs who are children or who are pregnant during the first five years. Noncitizen SSI recipients are eligible for (and required to be covered under) Medicaid. Refugees and asylees are eligible for Medicaid for seven years after arrival; after this term, they may be eligible at state option.

Nonimmigrants and unauthorized aliens are not eligible for most federal benefits, regardless of whether they are means tested, with notable exceptions for emergency services (e.g., Medicaid for emergency medical care), but states have the option to cover nonimmigrant and unauthorized aliens who are pregnant or who are children, and can meet the definition of "lawfully residing" in the United States. Special rules apply to several limited noncitizen categories: certain "cross-border" [[Native Americans in the United States|American Indians]], [[Hmong people|Hmong]]/Highland Laotians, [[parole]]es and conditional entrants, and cases of abuse.

Aliens outside the United States who seek to obtain [[Visa policy of the United States|visas]] at U.S. consulates overseas or admission at U.S. ports of entry are generally denied entry if they are deemed "likely at any time to become a public charge."<ref name=R43220>{{cite report|title=R43220 Public Charge Grounds of Inadmissibility and Deportability: Legal Overview |date=February 6, 2017|publisher=[[Congressional Research Service]]|url=https://www.everycrsreport.com/reports/R43220.html}} {{PD-notice}}</ref> Aliens within the United States who seek to adjust their status to that of lawful permanent resident (LPR), or who entered the United States without inspection, are also generally subject to exclusion and [[deportation]] on public charge grounds. Similarly, LPRs and other aliens who have been admitted to the United States are removable if they become a public charge within five years after the date of their entry due to causes that preexisted their entry.

A 1999 policy letter from immigration officials defined "public charge" and identified which benefits are considered in public charge determinations, and the policy letter underlies current regulations and other guidance on the public charge grounds of inadmissibility and deportability. Collectively, the various sources addressing the meaning of public charge have historically suggested that an alien's receipt of public benefits, per se, is unlikely to result in the alien being deemed to be removable on public charge grounds.