SSI is a cash assistance program intended to meet the basic needs of food, clothing, and shelter for those who are aged, blind, or disabled.

When a family member has a disability, SSI provides cash payments that can be used for food, medical or dental care that is not covered by health insurance, home improvements, furniture for the individual's personal needs, a down-payment on a car and monthly car payments as long as the car is used for and owned by the individual, and personal needs such as clothing and recreation. If there is money left over, it must be saved. The Social Security Administration (SSA) advises families to save the funds in an interest-bearing account or in United States Savings Bonds. A recipient may not own any resources worth more than $2,000, so families should always check with the SSA before making a major purchase on behalf of a family member.

For information on SSI payments, visit SSI Federal Payment Amounts. The basic SSI check is the same nationwide; however, some states supplement it for certain recipients. To find out which states offer a supplemental program, contact the state office or visit SSI State Supplements. Applicants can also call 1-800-772-1213.

SSI is a cash assistance program intended to meet the basic needs of food, clothing, and shelter for those who are aged, blind, or disabled.

When a family member has a disability, SSI provides cash payments that can be used for food, medical or dental care that is not covered by health insurance, home improvements, furniture for the individual's personal needs, a down-payment on a car and monthly car payments as long as the car is used for and owned by the individual, and personal needs such as clothing and recreation. If there is money left over, it must be saved. The Social Security Administration (SSA) advises families to save the funds in an interest-bearing account or in United States Savings Bonds. A recipient may not own any resources worth more than $2,000, so families should always check with the SSA before making a major purchase on behalf of a family member.

For information on SSI payments, visit SSI Federal Payment Amounts. The basic SSI check is the same nationwide; however, some states supplement it for certain recipients. To find out which states offer a supplemental program, contact the state office or visit SSI State Supplements. Applicants can also call 1-800-772-1213.

SSI pays benefits to adults and children with disabilities who have limited income and resources, as well as to people who are age sixty-five and older who meet the financial limits. A person may still be still eligible for SSI even if he or she has never worked in employment covered under Social Security.

Income

An applicant's financial resources cannot exceed $2,000 ($3,000 if married); however, not all financial resources count. Some exclusions include the home a person lives in, a car depending on use or value, burial funds up to $1,500, and life insurance with a face value of $1,500 or less Those receiving SSI should report their wages by the 6th of every month.  They must also report when they move; and if there are any changes in their income (within ten days) to the Social Security Administration. Individuals can continue to receive SSI if they move to another state. However, changes in income, such as those that occur due to living off of the installation and receiving Basic Allowance for Housing (BAH), may affect income-eligibility for SSI (combat pay and hostile fire pay, and imminent danger pay is excluded from income for SSI eligibility purposes).

When individuals reside on installation (government) housing, or in privatized military housing, Social Security considers the BAH they receive as in-kind shelter for SSI income-eligibility purposes. However, when families reside off of the installation in completely private housing and receive BAH payments, the income is considered as earned income for the service member.

Children with Disabilities Under Eighteen

For disabled children under age eighteen, there must be medical evidence of a severe physical or mental impairment that limits the child's ability to function for a continuous period of at least twelve months. For a list of qualifying conditions, visit the SSI Program website. The state office will determine if the disability qualifies for SSI and this evaluation can take several months. The very severely disabled may receive benefits while formal determination is conducted. Visit the Social Security Administration website to learn about deeming of parental income.

Children/Adults Eighteen and Above with Disabilities

When a child who receives SSI turns eighteen, there is a medical review since the criteria is different for adults. At age eighteen, individuals are expected to contribute to their income, unless they reside with, and are dependent upon, their parents. As representative payees for a disabled adult, it is important that parents report any changes that may affect the adult's eligibility. Every year, the SSA will ask parents to complete a form in order to account for the monetary benefits, and recipients may have to pay federal taxes on the money received.

A disabled person who resides in an institution may still receive SSI, depending on other income and whether Medicaid is paying for all or part of the cost of care. This option includes persons living in publicly operated community residences that serve no more than sixteen people, a public emergency shelter for the homeless, or a public or private institution where Medicaid is paying more than half the cost.

Availability Overseas

A child under 18 years of age may continue to receive SSI benefits or apply for benefits while overseas if the child is a United States citizen and is living with the parent who is a member of the United States military stationed overseas. For more information on SSI overseas availability, see Special Rules for Children of Military Personnel Living Overseas. Adults (eighteen years or older) cannot receive SSI if they leave the States, District of Columbia, or Northern Mariana Islands for more than thirty days. People who live in Puerto Rico cannot receive SSI. Adults must also report when they leave public school.

Other SSI Eligibility Information

In some States, SSI is the gateway for other federal programs such as Medicaid, Medicare premiums, food stamps, etc. Adult recipients with disabilities are also eligible for federally funded, state-administered educational and vocational rehabilitation and job training programs. In thirty-eight states and the District of Columbia, children who are disabled and receive SSI are automatically eligible for Medicaid. These states include: Alabama, Alaska*, Arizona, Arkansas, California, Colorado, Delaware, District of Columbia, Florida, Georgia, Idaho*, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Montana, Nebraska*, Nevada*, New Jersey, New Mexico, New York, Oregon*, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah*, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.

* State requires a separate application for Medicaid.

The other twelve states apply different standards with regards to disability, income, and resources.

SSI pays benefits to adults and children with disabilities who have limited income and resources, as well as to people who are age sixty-five and older who meet the financial limits. A person may still be still eligible for SSI even if he or she has never worked in employment covered under Social Security.

Income

An applicant's financial resources cannot exceed $2,000 ($3,000 if married); however, not all financial resources count. Some exclusions include the home a person lives in, a car depending on use or value, burial funds up to $1,500, and life insurance with a face value of $1,500 or less Those receiving SSI should report their wages by the 6th of every month.  They must also report when they move; and if there are any changes in their income (within ten days) to the Social Security Administration. Individuals can continue to receive SSI if they move to another state. However, changes in income, such as those that occur due to living off of the installation and receiving Basic Allowance for Housing (BAH), may affect income-eligibility for SSI (combat pay and hostile fire pay, and imminent danger pay is excluded from income for SSI eligibility purposes).

When individuals reside on installation (government) housing, or in privatized military housing, Social Security considers the BAH they receive as in-kind shelter for SSI income-eligibility purposes. However, when families reside off of the installation in completely private housing and receive BAH payments, the income is considered as earned income for the service member.

Children with Disabilities Under Eighteen

For disabled children under age eighteen, there must be medical evidence of a severe physical or mental impairment that limits the child's ability to function for a continuous period of at least twelve months. For a list of qualifying conditions, visit the SSI Program website. The state office will determine if the disability qualifies for SSI and this evaluation can take several months. The very severely disabled may receive benefits while formal determination is conducted. Visit the Social Security Administration website to learn about deeming of parental income.

Children/Adults Eighteen and Above with Disabilities

When a child who receives SSI turns eighteen, there is a medical review since the criteria is different for adults. At age eighteen, individuals are expected to contribute to their income, unless they reside with, and are dependent upon, their parents. As representative payees for a disabled adult, it is important that parents report any changes that may affect the adult's eligibility. Every year, the SSA will ask parents to complete a form in order to account for the monetary benefits, and recipients may have to pay federal taxes on the money received.

A disabled person who resides in an institution may still receive SSI, depending on other income and whether Medicaid is paying for all or part of the cost of care. This option includes persons living in publicly operated community residences that serve no more than sixteen people, a public emergency shelter for the homeless, or a public or private institution where Medicaid is paying more than half the cost.

Availability Overseas

A child under 18 years of age may continue to receive SSI benefits or apply for benefits while overseas if the child is a United States citizen and is living with the parent who is a member of the United States military stationed overseas. For more information on SSI overseas availability, see Special Rules for Children of Military Personnel Living Overseas. Adults (eighteen years or older) cannot receive SSI if they leave the States, District of Columbia, or Northern Mariana Islands for more than thirty days. People who live in Puerto Rico cannot receive SSI. Adults must also report when they leave public school.

Other SSI Eligibility Information

In some States, SSI is the gateway for other federal programs such as Medicaid, Medicare premiums, food stamps, etc. Adult recipients with disabilities are also eligible for federally funded, state-administered educational and vocational rehabilitation and job training programs. In thirty-eight states and the District of Columbia, children who are disabled and receive SSI are automatically eligible for Medicaid. These states include: Alabama, Alaska*, Arizona, Arkansas, California, Colorado, Delaware, District of Columbia, Florida, Georgia, Idaho*, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Montana, Nebraska*, Nevada*, New Jersey, New Mexico, New York, Oregon*, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah*, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.

* State requires a separate application for Medicaid.

The other twelve states apply different standards with regards to disability, income, and resources.

SSI application forms are not available online. To apply for SSI for a child with a disability, parents should call the Social Security Administration's (SSA) toll free number (1-800-772-1213) or contact the local SSI office to make an appointment.

In order to meet eligibility requirements based on a disability, applicants must submit proof from a doctor or other medical person accepted by the SSA. Applicants should plan on providing the following documents:

• social security card or a record of one's social security number
• birth certificate or other proof of age
• information about one's home, such as the mortgage or lease and landlord's name
• payroll slips, bank books, insurance policies, car registration, burial fund records, and other information about one's income and the things he or she owns
• the names, addresses, and telephone numbers of doctors, hospitals, and clinics if signing up under disability
• proof of United States citizenship or eligible noncitizen status
• checkbook or other papers that show a bank account number for direct deposit purposes

If a family is relocating, they do not need to reapply for SSI. However, families must notify the SSA and contact their current state's SSI program, as well as the program in their new state.

For additional information:

Federal Administration

Social Security Administration

1-800-772-1213

State Point of Contacts: Locate a local office using the Social Security Office locator.

Additional information about SSI benefits can be found by viewing the following websites and articles:

Understanding SSI

Benefit Eligibility Screening Tool

NICHCY State Resource Sheets

SSI application forms are not available online. To apply for SSI for a child with a disability, parents should call the Social Security Administration's (SSA) toll free number (1-800-772-1213) or contact the local SSI office to make an appointment.

In order to meet eligibility requirements based on a disability, applicants must submit proof from a doctor or other medical person accepted by the SSA. Applicants should plan on providing the following documents:

• social security card or a record of one's social security number
• birth certificate or other proof of age
• information about one's home, such as the mortgage or lease and landlord's name
• payroll slips, bank books, insurance policies, car registration, burial fund records, and other information about one's income and the things he or she owns
• the names, addresses, and telephone numbers of doctors, hospitals, and clinics if signing up under disability
• proof of United States citizenship or eligible noncitizen status
• checkbook or other papers that show a bank account number for direct deposit purposes

If a family is relocating, they do not need to reapply for SSI. However, families must notify the SSA and contact their current state's SSI program, as well as the program in their new state.

For additional information:

Federal Administration

Social Security Administration

1-800-772-1213

State Point of Contacts: Locate a local office using the Social Security Office locator.

Additional information about SSI benefits can be found by viewing the following websites and articles:

Understanding SSI

Benefit Eligibility Screening Tool

NICHCY State Resource Sheets

Social Security Disability Insurance (SSDI) pays monthly benefits to people, if they have worked long enough and paid Social Security taxes, who are unable to work for a year or more because of a disability.  An adult child may also qualify for benefits on a parent’s earnings record if he or she has a disability that started before the age of twenty-two.

Social Security Disability Insurance (SSDI) pays monthly benefits to people, if they have worked long enough and paid Social Security taxes, who are unable to work for a year or more because of a disability.  An adult child may also qualify for benefits on a parent’s earnings record if he or she has a disability that started before the age of twenty-two.

To qualify for benefits, applicants must have worked and paid into Social Security. Applicants must also have a medical condition that meets Social Security's definition of a disability, which is based on a person's inability to work. Social Security considers a person disabled if he or she cannot do the work that he or she did before and cannot adjust to other work because of the medical condition. No benefits are payable for partial or short-term disabilities. Age and income are not factors when determining eligibility.

To qualify for benefits, applicants must have worked and paid into Social Security. Applicants must also have a medical condition that meets Social Security's definition of a disability, which is based on a person's inability to work. Social Security considers a person disabled if he or she cannot do the work that he or she did before and cannot adjust to other work because of the medical condition. No benefits are payable for partial or short-term disabilities. Age and income are not factors when determining eligibility.

The Social Security Agency Disability Planner provides information on different ways to apply. Applicants can go online, or call or visit a local Social Security office.

Once a person applies for SSDI, he or she does not need to re-apply if he or she relocates. The Social Security Administration provides an online service to change the address in that person's files. A beneficiary can also call 1-800-772-1213 to make the change.

The Social Security Agency Disability Planner provides information on different ways to apply. Applicants can go online, or call or visit a local Social Security office.

Once a person applies for SSDI, he or she does not need to re-apply if he or she relocates. The Social Security Administration provides an online service to change the address in that person's files. A beneficiary can also call 1-800-772-1213 to make the change.

Eligibility is based on a person's eligibility for the Food Stamps Program, which is based on household size and income. If the person's income, together with the gross income of the entire household, is within 130 percent of the poverty line as defined by the United States Department of Agriculture of a household of a given size, that member is entitled to FSSA.

Unlike the Food Stamps Program, FSSA includes the amount of basic allowance for housing (BAH) as income. In addition, if a person lives overseas, the overseas housing allowance (OHA) and utility allowances count toward income as well.

Recertification of eligibility for FSSA is required upon every move, promotion, pay raise, and change in household income.

Eligibility is based on a person's eligibility for the Food Stamps Program, which is based on household size and income. If the person's income, together with the gross income of the entire household, is within 130 percent of the poverty line as defined by the United States Department of Agriculture of a household of a given size, that member is entitled to FSSA.

Unlike the Food Stamps Program, FSSA includes the amount of basic allowance for housing (BAH) as income. In addition, if a person lives overseas, the overseas housing allowance (OHA) and utility allowances count toward income as well.

Recertification of eligibility for FSSA is required upon every move, promotion, pay raise, and change in household income.

The Department of Defense's FSSA website allows eligible service members to initiate the application process online. To access this site, applicants must be active duty or Reserve command members.

The Department of Defense's FSSA website allows eligible service members to initiate the application process online. To access this site, applicants must be active duty or Reserve command members.

The United States Department of Agriculture (USDA) administers the Supplemental Nutrition Assistance Program (SNAP), an assistance program in which eligible low-income households purchase food with the use of coupons that can be used like cash at participating grocery stores and commissaries.

The USDA Food and Nutrition website provides a chart of allotments based on family size, which helps families understand the benefits they will receive if eligible.

The United States Department of Agriculture (USDA) administers the Supplemental Nutrition Assistance Program (SNAP), an assistance program in which eligible low-income households purchase food with the use of coupons that can be used like cash at participating grocery stores and commissaries.

The USDA Food and Nutrition website provides a chart of allotments based on family size, which helps families understand the benefits they will receive if eligible.

There are no age or categorical restrictions for eligibility. Households must meet income tests unless all members are receiving Title IV Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), or, in some places, general assistance.

SNAP is not available overseas, but the DoD program Family Subsistence Supplemental Allowance is available.

There are no age or categorical restrictions for eligibility. Households must meet income tests unless all members are receiving Title IV Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), or, in some places, general assistance.

SNAP is not available overseas, but the DoD program Family Subsistence Supplemental Allowance is available.

To apply for the Supplemental Nutrition Assistance Program:

• Locate a local SNAP office.
• Apply online by state.

The Supplemental Nutrition Assistance Program is administered by the states. Therefore, military families must reapply when transferring between states.

To apply for the Supplemental Nutrition Assistance Program:

• Locate a local SNAP office.
• Apply online by state.

The Supplemental Nutrition Assistance Program is administered by the states. Therefore, military families must reapply when transferring between states.

WIC is a federal grant program that provides nutritious foods, information on healthy eating, and health care referrals to low-income, pregnant, breastfeeding, and post-partum women and to infants and children who are found to be nutritionally at-risk. 

WIC foods include iron-fortified infant formula and cereal, iron-fortified adult cereal, vitamin C-rich fruit and/or vegetable juice, eggs, milk, cheese, peanut butter, dried beans or peas, tuna fish, and carrots. Special infant formulas and certain medical foods may be provided when prescribed by a physician or health professional for a specified medical condition. 

Click here for research on the benefits of WIC for young children.

WIC is a federal grant program that provides nutritious foods, information on healthy eating, and health care referrals to low-income, pregnant, breastfeeding, and post-partum women and to infants and children who are found to be nutritionally at-risk. 

WIC foods include iron-fortified infant formula and cereal, iron-fortified adult cereal, vitamin C-rich fruit and/or vegetable juice, eggs, milk, cheese, peanut butter, dried beans or peas, tuna fish, and carrots. Special infant formulas and certain medical foods may be provided when prescribed by a physician or health professional for a specified medical condition. 

Click here for research on the benefits of WIC for young children.

Eligibility is based on the following criteria:

• Age: Children from birth to age five and pregnant, breastfeeding, or post-partum women of any age are eligible.
• Categorical: Pregnant, breastfeeding, or post-partum women, infants, and children who are at nutritional risk are eligible. Nutritional risks are either:
  • medical-based risks such as anemia, underweight, maternal age, history of pregnancy complications, or poor pregnancy outcomes
  • diet-based risks such as inadequate dietary pattern
• Income: Gross income (i.e., before taxes are withheld) must fall at or below 185 percent of the United States Poverty Income Guidelines. A person or certain family members who participate in other benefits programs such as the Food Stamps Program, Medicaid, or Temporary Assistance for Needy Families (TANF) automatically meet the income eligibility requirement.

For more information regarding the eligibility determination for individuals from military families to include service personnel serving overseas or assigned to a military base, read the 2003 United States Department of Agriculture policy memorandum.

Eligibility is based on the following criteria:

• Age: Children from birth to age five and pregnant, breastfeeding, or post-partum women of any age are eligible.
• Categorical: Pregnant, breastfeeding, or post-partum women, infants, and children who are at nutritional risk are eligible. Nutritional risks are either:
  • medical-based risks such as anemia, underweight, maternal age, history of pregnancy complications, or poor pregnancy outcomes
  • diet-based risks such as inadequate dietary pattern
• Income: Gross income (i.e., before taxes are withheld) must fall at or below 185 percent of the United States Poverty Income Guidelines. A person or certain family members who participate in other benefits programs such as the Food Stamps Program, Medicaid, or Temporary Assistance for Needy Families (TANF) automatically meet the income eligibility requirement.

For more information regarding the eligibility determination for individuals from military families to include service personnel serving overseas or assigned to a military base, read the 2003 United States Department of Agriculture policy memorandum.

Applicants in the United States should contact their state or local agency either online or by phone.

Through TRICARE, the Department of Defense (DoD) has established the WIC Overseas Program in the three TRICARE Overseas Regions: Europe, Latin America, and the Pacific. Overseas applicants should contact their local WIC Overseas office for an appointment with a counselor who will determine the applicant’s eligibility. WIC Overseas offices are listed with a person's installation information operator. For additional information on the WIC Overseas Program, read the TRICARE fact sheet.

Relocation

WIC participants that have to relocate can continue to receive their WIC benefits until their certification period expires as long as there is proof that the individual received WIC benefits in another area or state. Before moving, participants should notify the WIC office by calling WIC toll-free numbers. In most cases, WIC staff will give the participant a special card to take to their new state's WIC office to prove participation in the program.

For additional Information:

State Point of Contacts The United States Department of Agriculture maintains a listing of the state WIC agencies to help applicants find their state's WIC website, WIC director, and his/her contact information.

Applicants in the United States should contact their state or local agency either online or by phone.

Through TRICARE, the Department of Defense (DoD) has established the WIC Overseas Program in the three TRICARE Overseas Regions: Europe, Latin America, and the Pacific. Overseas applicants should contact their local WIC Overseas office for an appointment with a counselor who will determine the applicant’s eligibility. WIC Overseas offices are listed with a person's installation information operator. For additional information on the WIC Overseas Program, read the TRICARE fact sheet.

Relocation

WIC participants that have to relocate can continue to receive their WIC benefits until their certification period expires as long as there is proof that the individual received WIC benefits in another area or state. Before moving, participants should notify the WIC office by calling WIC toll-free numbers. In most cases, WIC staff will give the participant a special card to take to their new state's WIC office to prove participation in the program.

For additional Information:

State Point of Contacts The United States Department of Agriculture maintains a listing of the state WIC agencies to help applicants find their state's WIC website, WIC director, and his/her contact information.

No, participants cannot make any substitutions or get rain checks. Keep the draft to use when the item is in stock. Participants should make sure they are aware of the expiration dates on their drafts.

No, participants cannot make any substitutions or get rain checks. Keep the draft to use when the item is in stock. Participants should make sure they are aware of the expiration dates on their drafts.

Interested women should contact their local WIC Overseas office for an appointment with a counselor who will determine their eligibility. WIC Overseas offices are listed with a person's installation information operator. Participants can also call (210) 341-3336 or email wicoverseas@choctawarchiving.com.

Interested women should contact their local WIC Overseas office for an appointment with a counselor who will determine their eligibility. WIC Overseas offices are listed with a person's installation information operator. Participants can also call (210) 341-3336 or email wicoverseas@choctawarchiving.com.

There are no enrollment fees or costs for WIC. The WIC Overseas program is a Department of Defense benefit available to those who qualify.

There are no enrollment fees or costs for WIC. The WIC Overseas program is a Department of Defense benefit available to those who qualify.

Yes, WIC participants may have a "proxy" shop for them. Participants should ask a WIC Overseas counselor for the appropriate paperwork and have the proxy formally register with the WIC Overseas office.

Yes, WIC participants may have a "proxy" shop for them. Participants should ask a WIC Overseas counselor for the appropriate paperwork and have the proxy formally register with the WIC Overseas office.

Unlike the stateside WIC program where WIC is accepted at a variety of stores, the WIC Overseas drafts can only be used in commissaries and NEXMARTs.

Unlike the stateside WIC program where WIC is accepted at a variety of stores, the WIC Overseas drafts can only be used in commissaries and NEXMARTs.

Yes. Participants can continue in the stateside WIC program without re-certification for the rest of the certification period. They will need to contact the state program when they arrive.

Yes. Participants can continue in the stateside WIC program without re-certification for the rest of the certification period. They will need to contact the state program when they arrive.

Yes, a WIC participant can continue in the program without re-certification or re-enrollment. However, participants must call their local WIC Overseas office to make arrangements to switch to the WIC Overseas drafts.  Participation will continue uninterrupted for the rest of the certification period.

Yes, a WIC participant can continue in the program without re-certification or re-enrollment. However, participants must call their local WIC Overseas office to make arrangements to switch to the WIC Overseas drafts.  Participation will continue uninterrupted for the rest of the certification period.

Medicaid is a federal program administered by the states, which covers basic health and long-term care services for individuals with disabilities and the elderly in families with low income and limited resources. Although Medicaid is intended to serve individuals with low income, the program also serves those above the income limits who meet certain criteria.

Services and Benefits

Those eligible for Medicaid benefits are entitled to the following services, unless waived under Section 1115 of the Medicaid Law. 

Services for "categorically needy" eligibility groups (to include pregnant women and infants with incomes above 133 percent and up to 185 percent of the poverty level):

• inpatient hospital services
• outpatient hospital services
• nursing facility services for beneficiaries ages twenty-one and older
• home health services
• physician services
• laboratory and x-ray services
• early and periodic screening, diagnosis, and treatment (EPSDT) for children under twenty-one
• family planning services and supplies
• medical and surgical dentistry services
• certified pediatric and family nurse practitioner services
• pregnancy services and services for other conditions that might complicate pregnancy
• nurse mid-wife services
• post-partum pregnancy-related services for up to sixty days

Services for "medically needy" eligibility groups (to include children, the elderly, or persons with disabilities who have too much income but who incur large medical or long-term care expenses):

• prenatal and delivery services
• post-partum pregnancy services for beneficiaries under age eighteen who are entitled to institutional and ambulatory services defined in a state's plan
• home health services for beneficiaries who are entitled to receive nursing facility services under the state's Medicaid plan

States may include any other services described under Medicaid law subject to any limits based on comparability of services. States may also provide different services to different groups of the medically needy.

Source: Department of Health and Human Services, Centers for Medicare and Medicaid Services, Center for Medicaid and State Operations, "Medicaid At-a- Glance 2005; A Medicaid Information Source"

Medicaid is a federal program administered by the states, which covers basic health and long-term care services for individuals with disabilities and the elderly in families with low income and limited resources. Although Medicaid is intended to serve individuals with low income, the program also serves those above the income limits who meet certain criteria.

Services and Benefits

Those eligible for Medicaid benefits are entitled to the following services, unless waived under Section 1115 of the Medicaid Law. 

Services for "categorically needy" eligibility groups (to include pregnant women and infants with incomes above 133 percent and up to 185 percent of the poverty level):

• inpatient hospital services
• outpatient hospital services
• nursing facility services for beneficiaries ages twenty-one and older
• home health services
• physician services
• laboratory and x-ray services
• early and periodic screening, diagnosis, and treatment (EPSDT) for children under twenty-one
• family planning services and supplies
• medical and surgical dentistry services
• certified pediatric and family nurse practitioner services
• pregnancy services and services for other conditions that might complicate pregnancy
• nurse mid-wife services
• post-partum pregnancy-related services for up to sixty days

Services for "medically needy" eligibility groups (to include children, the elderly, or persons with disabilities who have too much income but who incur large medical or long-term care expenses):

• prenatal and delivery services
• post-partum pregnancy services for beneficiaries under age eighteen who are entitled to institutional and ambulatory services defined in a state's plan
• home health services for beneficiaries who are entitled to receive nursing facility services under the state's Medicaid plan

States may include any other services described under Medicaid law subject to any limits based on comparability of services. States may also provide different services to different groups of the medically needy.

Source: Department of Health and Human Services, Centers for Medicare and Medicaid Services, Center for Medicaid and State Operations, "Medicaid At-a- Glance 2005; A Medicaid Information Source"

There are no age restrictions for Medicaid coverage and the income restrictions vary from state to state.

Medicaid must cover pregnant women and infants in families at or below 133 percent of the federal poverty level. For a family of three, that means an income below $21,399.70 per year. Federal Poverty Charts are available at the Medicaid website.

Medicaid may cover groups, such as pregnant women and infants, with incomes above 133 percent and up to 185 percent of the poverty level.  Medicaid calls this group "categorically needy."

Medicaid may cover groups such as children, the elderly, or persons with disabilities who have too much income (above 185 percent of poverty level), but who incur large medical or long-term care expenses and can qualify for Medicaid by "spending down," i.e., reducing their income through medical expenses. Medicaid calls this group "medically needy." States that cover the medically needy do not have to offer the same benefit package to them as they offer to the categorically needy.

Medicaid must cover children who are disabled and receive Supplemental Security Income (SSI) in the following thirty-eight states and the District of Columbia: Alabama, Alaska*, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho*, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Montana, Nebraska*, Nevada*, New Jersey, New Mexico, New York, Oregon*, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah*, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.

* State requires a separate application for Medicaid.

The other twelve states apply different standards with regard to disability, income, and resources. However, most children who receive SSI also become eligible for Medicaid.

For more information on eligibility, visit the Federal Medicaid website.

Waivers

State Medicaid programs may waive certain requirements for families in different situations:

• States may pay for medical care in the home for persons who would otherwise be financially eligible (due to the income and resources of a spouse or parent) only in an institutional setting. This is important for families facing institutionalizing a child or family member in order to receive assistance with the medical costs.
• States may target services to particular groups, such as elderly individuals, technology-dependent children, individuals with traumatic brain injuries, or persons with mental retardation or developmental disabilities. This means, however, that if a family receives services in one state, they may not automatically receive them in another state.

For more information on Medicaid waivers, contact the state Medicaid agency:

• State Toll Free Numbers
• State Websites

There are no age restrictions for Medicaid coverage and the income restrictions vary from state to state.

Medicaid must cover pregnant women and infants in families at or below 133 percent of the federal poverty level. For a family of three, that means an income below $21,399.70 per year. Federal Poverty Charts are available at the Medicaid website.

Medicaid may cover groups, such as pregnant women and infants, with incomes above 133 percent and up to 185 percent of the poverty level.  Medicaid calls this group "categorically needy."

Medicaid may cover groups such as children, the elderly, or persons with disabilities who have too much income (above 185 percent of poverty level), but who incur large medical or long-term care expenses and can qualify for Medicaid by "spending down," i.e., reducing their income through medical expenses. Medicaid calls this group "medically needy." States that cover the medically needy do not have to offer the same benefit package to them as they offer to the categorically needy.

Medicaid must cover children who are disabled and receive Supplemental Security Income (SSI) in the following thirty-eight states and the District of Columbia: Alabama, Alaska*, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho*, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Montana, Nebraska*, Nevada*, New Jersey, New Mexico, New York, Oregon*, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah*, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.

* State requires a separate application for Medicaid.

The other twelve states apply different standards with regard to disability, income, and resources. However, most children who receive SSI also become eligible for Medicaid.

For more information on eligibility, visit the Federal Medicaid website.

Waivers

State Medicaid programs may waive certain requirements for families in different situations:

• States may pay for medical care in the home for persons who would otherwise be financially eligible (due to the income and resources of a spouse or parent) only in an institutional setting. This is important for families facing institutionalizing a child or family member in order to receive assistance with the medical costs.
• States may target services to particular groups, such as elderly individuals, technology-dependent children, individuals with traumatic brain injuries, or persons with mental retardation or developmental disabilities. This means, however, that if a family receives services in one state, they may not automatically receive them in another state.

For more information on Medicaid waivers, contact the state Medicaid agency:

• State Toll Free Numbers
• State Websites

Supplemental Security Income (SSI) recipients should apply at the local Social Security office. To find the nearest office, applicants should enter their zip code using the Social Security Office Locator.

Many states have now made it possible to apply in other locations, such as hospitals, public health clinics, or, in some cases, by mail.

Some examples of what an applicant may need to bring when applying for Medicaid:

• proof of income (e.g., check stubs)
• proof of assets (e.g., bank statement, value of car, etc.)
• social security card
• two forms of identification (e.g., picture ID, social security card, birth certificate, etc.)
• proof of residence (e.g., utility bill, telephone bill, or a rent receipt)

Contact the Social Security office to determine the exact documents that will be required upon application.

Supplemental Security Income (SSI) recipients should apply at the local Social Security office. To find the nearest office, applicants should enter their zip code using the Social Security Office Locator.

Many states have now made it possible to apply in other locations, such as hospitals, public health clinics, or, in some cases, by mail.

Some examples of what an applicant may need to bring when applying for Medicaid:

• proof of income (e.g., check stubs)
• proof of assets (e.g., bank statement, value of car, etc.)
• social security card
• two forms of identification (e.g., picture ID, social security card, birth certificate, etc.)
• proof of residence (e.g., utility bill, telephone bill, or a rent receipt)

Contact the Social Security office to determine the exact documents that will be required upon application.

Medicare is the nation's largest health insurance program, which covers forty million Americans. It is for people sixty-five years of age and older, some disabled people under sixty-five years of age, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).

Services and Benefits

Medicare has two parts: Part A, which is hospital insurance, and Part B, which is medical insurance.

Part A: This helps pay for care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities, hospice care, and some home health care services.

Cost: Most people get Part A automatically when they turn sixty-five. They do not have to pay a monthly premium for Part A because they or a spouse paid Medicare taxes while they were working. If a person or his or her spouse did not pay Medicare taxes while working and he or she is age sixty-five or older, he or she may still be able to buy Part A. People can call the Social Security Administration at 1-800-772-1213 for more information about buying Part A.

Part B: This helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Nursing Home Care
Under limited conditions, Medicare will pay some nursing home care costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, a person must receive the services from a Medicare-certified, skilled nursing home after a qualifying hospital stay of at least three days.

To learn more about Medicare payment for skilled nursing home costs, families should contact a Medicare Fiscal Intermediary or the State Health Insurance Assistance Program (SHIP) in their state. The phone number for the Medicare Fiscal Intermediary or SHIP office can be found on the Medicare website.

Availability Overseas

Medicare is not available overseas.

The Centers for Medicare and Medicaid provides more information on coverage.

TRICARE and Medicare

When TRICARE beneficiaries are entitled to Medicare Part A and B, they are also eligible for TRICARE for Life. Beneficiaries entitled to Medicare Part A that decline Medicare Part B coverage will lose TRICARE eligibility (with the exception of active duty family members). For more information, see the TRICARE for Life and Medicare Fact Sheet.

Medicare is the nation's largest health insurance program, which covers forty million Americans. It is for people sixty-five years of age and older, some disabled people under sixty-five years of age, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).

Services and Benefits

Medicare has two parts: Part A, which is hospital insurance, and Part B, which is medical insurance.

Part A: This helps pay for care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities, hospice care, and some home health care services.

Cost: Most people get Part A automatically when they turn sixty-five. They do not have to pay a monthly premium for Part A because they or a spouse paid Medicare taxes while they were working. If a person or his or her spouse did not pay Medicare taxes while working and he or she is age sixty-five or older, he or she may still be able to buy Part A. People can call the Social Security Administration at 1-800-772-1213 for more information about buying Part A.

Part B: This helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Nursing Home Care
Under limited conditions, Medicare will pay some nursing home care costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, a person must receive the services from a Medicare-certified, skilled nursing home after a qualifying hospital stay of at least three days.

To learn more about Medicare payment for skilled nursing home costs, families should contact a Medicare Fiscal Intermediary or the State Health Insurance Assistance Program (SHIP) in their state. The phone number for the Medicare Fiscal Intermediary or SHIP office can be found on the Medicare website.

Availability Overseas

Medicare is not available overseas.

The Centers for Medicare and Medicaid provides more information on coverage.

TRICARE and Medicare

When TRICARE beneficiaries are entitled to Medicare Part A and B, they are also eligible for TRICARE for Life. Beneficiaries entitled to Medicare Part A that decline Medicare Part B coverage will lose TRICARE eligibility (with the exception of active duty family members). For more information, see the TRICARE for Life and Medicare Fact Sheet.

Generally, a person is eligible for Medicare if he or she or the spouse worked for at least ten years in Medicare-covered employment, is sixty-five years old, and is a citizen or permanent resident of the United States.  A person might also qualify for coverage if he or she is a younger person with a disability or with chronic kidney disease.

If a person meets one of the above conditions, he or she does not have to pay a premium for Part A. If a person chooses to enroll in Part B, the premium is usually taken out of his or her monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. In these cases, the person will not get a bill for the premium. If the person does not get any of these payments, Medicare sends a bill for the Part B premium every three months.

Please visit the TRICARE website for information about TRICARE for Life and Medicare.

Generally, a person is eligible for Medicare if he or she or the spouse worked for at least ten years in Medicare-covered employment, is sixty-five years old, and is a citizen or permanent resident of the United States.  A person might also qualify for coverage if he or she is a younger person with a disability or with chronic kidney disease.

If a person meets one of the above conditions, he or she does not have to pay a premium for Part A. If a person chooses to enroll in Part B, the premium is usually taken out of his or her monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. In these cases, the person will not get a bill for the premium. If the person does not get any of these payments, Medicare sends a bill for the Part B premium every three months.

Please visit the TRICARE website for information about TRICARE for Life and Medicare.

Under Sixty-five Years Old and Disabled

People who are under age sixty-five and disabled and have been entitled to disability benefits under Social Security will be automatically enrolled in Medicare Part A and Part B beginning the twenty-fifth month of entitlement for Social Security Disability. Three month's before a person's entitlement date, a Medicare card will be mailed out. If the person does not want Medicare Part B, he or she should follow the instructions that come with the card.

Age Sixty-five

People who already get Social Security or Railroad Retirement benefits are automatically enrolled in Medicare Part B starting on the first day of the month in which they turn age sixty-five. A Medicare card will be mailed about three months prior to a person's sixty-fifth birthday. If the person does not want Medicare Part B, he or she should follow the instructions that come with the card. If a person is approaching his or her sixty-fifth birthday and does not receive Social Security or Railroad Retirement benefits, he or she can apply for these benefits and Medicare at the same time. To apply, call or visit a local Social Security Office, or call Social Security at 1-800-772-1213. 

Medicare Costs and Medigap Policies

For current Medicare rates, visit the Medicare website. If Medicare does not cover all of a person's medical needs, he or she should look into purchasing a Medigap policy. A Medigap policy is a health insurance policy sold by private insurance companies to fill gaps in Medicare coverage. For example, if Medicare pays eighty percent of allowable medical charges, a Medigap policy might pay the other twenty percent, depending upon the policy. In most states (excluding Massachusetts, Minnesota, and Wisconsin), a Medigap policy must be one of ten standardized policies so people can compare them easily.

For more information on Medigap policies, call 1-800-MEDICARE to speak with a customer service representative.

Under Sixty-five Years Old and Disabled

People who are under age sixty-five and disabled and have been entitled to disability benefits under Social Security will be automatically enrolled in Medicare Part A and Part B beginning the twenty-fifth month of entitlement for Social Security Disability. Three month's before a person's entitlement date, a Medicare card will be mailed out. If the person does not want Medicare Part B, he or she should follow the instructions that come with the card.

Age Sixty-five

People who already get Social Security or Railroad Retirement benefits are automatically enrolled in Medicare Part B starting on the first day of the month in which they turn age sixty-five. A Medicare card will be mailed about three months prior to a person's sixty-fifth birthday. If the person does not want Medicare Part B, he or she should follow the instructions that come with the card. If a person is approaching his or her sixty-fifth birthday and does not receive Social Security or Railroad Retirement benefits, he or she can apply for these benefits and Medicare at the same time. To apply, call or visit a local Social Security Office, or call Social Security at 1-800-772-1213. 

Medicare Costs and Medigap Policies

For current Medicare rates, visit the Medicare website. If Medicare does not cover all of a person's medical needs, he or she should look into purchasing a Medigap policy. A Medigap policy is a health insurance policy sold by private insurance companies to fill gaps in Medicare coverage. For example, if Medicare pays eighty percent of allowable medical charges, a Medigap policy might pay the other twenty percent, depending upon the policy. In most states (excluding Massachusetts, Minnesota, and Wisconsin), a Medigap policy must be one of ten standardized policies so people can compare them easily.

For more information on Medigap policies, call 1-800-MEDICARE to speak with a customer service representative.