Medicaid Planning for Seniors and People with Disabilities
Medicaid is a vital federal–state partnership program. It provides health and long-term care coverage for millions of Americans. For seniors and individuals with disabilities, it is often the most important safety net. It covers medical care, nursing home services, and community-based supports.
Medicaid eligibility rules follow federal guidelines. However, each state has its own criteria. This means qualifying for coverage can vary depending on where you live. The Kaiser Family Foundation (KFF) recently released findings from its 2022 50-state survey. It reviewed how people aged 65+ or those with disabilities can qualify for Medicaid financial assistance.
Free Health Insurance for Those Who Qualify
The study found that in 2019, 8.5 million people aged 65 and older and 10 million people with disabilities were enrolled in full-benefit Medicaid. Eligibility for these groups is determined through what is called “non-MAGI” pathways.
MAGI (Modified Adjusted Gross Income) is the method used to determine Medicaid eligibility for parents, children, and pregnant people with low incomes.
Non-MAGI pathways are based on age, disability status, income, and resources rather than MAGI.
Those who qualify through non-MAGI pathways receive free health insurance based on their income, family size, and (in many states) their assets. Non-MAGI coverage is crucial for older adults, people with disabilities, and those who are blind.
Expanded Coverage Options
All states must cover people who receive Supplemental Security Income (SSI) under non-MAGI rules, but states can also choose to offer additional options, such as:
Katie Beckett (TEFRA) Option: Extends Medicaid to severely disabled children, counting only the child’s income (not parents’).
Medically Needy Option: Allows seniors and disabled individuals who “spend down” their income on medical expenses to qualify.
Poverty-Level Coverage: Covers those up to 100% of the Federal Poverty Level (FPL) — $1,133 per month for an individual in 2022.
Family Opportunity Act Buy-In: Lets significantly disabled children qualify with partial premium payments.
Section 1915(i) Option: Provides coverage for people with significant functional needs who don’t meet the level of care required for institutional placement.
Each pathway has unique income and asset rules. This makes eligibility complicated. A Medicaid planning attorney can help identify the most appropriate route based on your situation.
State Rules and COVID-19 Changes
The KFF survey also outlines state-by-state criteria for Medicaid eligibility. This includes both mandatory and optional pathways, as well as expansions made after January 2022.
During the COVID-19 public health emergency, many states temporarily expanded eligibility by raising income and asset limits and reducing or eliminating premiums. The Centers for Medicare & Medicaid Services (CMS) encourages states to continue these policies to improve access to Home & Community-Based Services (HCBS).
Why Medicaid Planning Matters
For many seniors and people with disabilities, Medicaid is their only source of health and long-term care coverage. Understanding the rules in your state can be confusing. However, proper planning can help you qualify and protect your assets.
At Aging in Maine, we help families navigate Medicaid (MaineCare) eligibility and long-term care planning.
📞 Call us at (207) 848-5600 to schedule a consultation or visit our CONTACT page for more information.
