The Medically Needy Medicaid eligibility option enables states to provide Medicaid coverage to individuals who meet the Categorically Needy eligibility requirements, but exceed the income standards. States can also use this option to extend children's coverage up to age 21. All states that offer medically needy programs must cover children under age 18 who, except for income, would otherwise be eligible for Medicaid coverage.
All of the following states had a “medically-needy” category of Medicaid eligibility in place as of 2009. If you live in one of these states, and you do not meet the Medicaid income requirements, your child may still qualify for Medicaid if he/she is disabled and under the age of 18. Medicaid eligibility in such cases can be based on the child’s income – not the family’s – and thereby give the child access to Medicaid’s mandatory EPSDT benefits which include Behavioral Health Rehabilitation Services (BHRS).
the District of Columbia
- If states offer a medically needy program, they must cover:
- Pregnant women
- Children under 18
- States have the option of covering:
- Children over 18 but under 21
- Parents and other caretaker relatives
- Elderly individuals
- Individuals with disabilities (who are not "children under 18")
Since Medicaid eligibility varies by state, the groups and categories of people who qualify for Medicaid can change from time to time. To find out if your child qualifies for Medicaid, you should contact your State Medicaid Office for specific details about eligibility in your state. Be sure to ask if your state has adopted the “Medically Needy” category of eligibility like these states have.