Changes to Medicaid Eligibility Criteria Effective January 1

Effective January 1, 2014 some Medicaid eligibility programs will change:

 LaMOMs (pregnant women)

Income limits for pregnant women eligible for LaMOMs will reduce from up to 200 percent of the Federal Poverty Level (FPL) to 133 percent. This will not affect anyone whose application is received prior to January 1, 2014.   Those who are currently enrolled will continue to get coverage through the end of the second month following the end of their pregnancy.  Applications received on or after January 1, 2014 will be evaluated based on the new guidelines.

Medicaid Purchase Plan (working individuals with disabilities)

Income limits for individuals eligible for MPP, often referred to as the "Ticket to Work" program for working people with disabilities, will reduce from 250 percent FPL to 100 percent. Income and resources for spouses, previously not considered to determine eligibility, will count beginning January 1, 2014. Also, the resource limit will reduce from $25,000 to $10,000, and all life insurance policies, medical savings accounts, and retirement accounts will no longer be disregarded. DHH anticipates this change will affect nearly 1,200 individuals enrolled in the program, with 700 of that number having Medicare coverage as their primary insurance.

Disability Medicaid

The Disability Medicaid program, which was implemented in 2007, currently provides coverage to individuals 65 or older, or that meet the disability requirements as defined by the Social Security Administration (SSA), and whose income is below the Supplemental Security Income (SSI) program limit (currently $730 per month for an individual).  On January 1, the Disability Medicaid program will end.

Individuals, who receive SSI cash benefits, are automatically enrolled in Medicaid. Therefore, the more than 9,200 individuals currently enrolled in the Disability Medicaid program are urged to apply for SSI as soon as possible. If these individuals are not determined to be eligible for SSI, or another Medicaid program, by January 1, they will no longer receive Medicaid effective December 31, 2013.

Applicants who apply for Medicaid on or after January 1, 2014 will be referred to SSI if the applicant appears to meet the eligibility criteria for SSI.

Other Healthcare Options

Subsidized health insurance will be available to individuals at or above 100 percent FPL, who no longer qualify for Medicaid, through the Federal Health Exchange created through the Affordable Care Act (ACA). Open enrollment for assistance with health care coverage through this marketplace begins October 1, 2013, with coverage available January 1, 2014. To learn more about these options, visit www.healthcare.gov.