Age Limit for Medicaid — Frequently Asked Questions

Medicaid mainly caters to the following groups of people — teenagers, adults, pregnant women, foster kids, seniors, and persons with disability.

Therefore, it generally covers children under the age of 18 and seniors 65 years and above. The underlying eligibility criteria for these groups is low income.

However, different states provide particular age limits and eligibility stipulations for medical assistance depending on specific circumstances.

For instance, middle income families may be eligible for Medicaid for a disabled, blind, or terminally ill child who requires long term health care or nursing home care.

Below is a look at the most frequently asked questions regarding age limit eligibility for Medicaid.

What Is the Age Limit for Medicaid Eligibility Criteria for Children?

Parents or guardians can apply for Medicaid for children and teenagers aged 18 years or below if you can prove that your family’s household income is limited.

This is because, even if both parents are working, they may not be able to afford private health insurance.

However, if your income is approaching the household income limit or it is slightly higher, you may be required to pay a higher enrollment fee or co-pay for some Medicaid services.

However, children from middle income families may be eligible if they are terminally ill or below ages 1-5 years.

Children may be eligible for Medicaid services even if one or both parents are working. Children who are ill or need nursing home care have higher eligibility.

In all states, Medicaid coverage for children entails routine checkups, doctor’s visits, prescriptions, emergency services, dental services, optical services, laboratory and x-ray services, immunizations, and mental health services. Some states offer additional benefits.

You can easily find a healthcare provider in your area who accepts Medicaid for children. If you already had a doctor for your child before qualifying for Medicaid, ask them if they accept the program.

If they do not, find another provider in your area. Check with your state office for hospitals and healthcare providers that accept Medicaid.

What Is the Age Limit for Medicaid Eligibility for Seniors?

In most states, teenagers from low income families are eligible for the Medicaid program up to the age of 19 years.

Teenagers living on their own may be allowed to apply for Medicaid on their own or have an adult apply for them. Some states cover young adults up to 21 years. However, their income may be factored in when determining eligibility.

What Is Medicaid Age Limit for Foster Kids?

In most states, there is mandatory Medicaid eligibility for foster kids under the age of 19 years. Young adults who have aged out of foster care are eligible for Medicaid until they are 26 years old.

There is no income limit for these foster youths. This is regardless of whether the state they live in does not cover adults. It also applies whether the applicant was enrolled into foster care by the state or opted out of the federal assistance program.

The CMS also established a waiver to enable youth in foster care in one state to easily apply for Medicaid in another state. That said, foster kids who left foster care before turning 18 may not be eligible for Medicaid.

Can My Child or Teenager Remain Enrolled in Medicaid After Their Age Limit Has Lapsed?

Unless there are special circumstances in play, such as disability or terminal illness, that require nursing home care, your child will be automatically delisted from Medicaid after they exceed the stipulated age limit.

Medicaid is renewed annually. Therefore, your child will not pass the eligibility criteria for the next renewal after the stipulated age limit.

Otherwise, keep renewing their coverage if they are still within the age limit. Medicaid renewal and enrollment are open throughout the year.

Are Adults Eligible for Medicaid?

Initially, Medicaid was only accessible to specific categories of adults, including persons with disabilities and low income pregnant women.

However, over the years, numerous states have expanded coverage to the general adult population as long as your income is below the stipulated threshold and you meet the other eligibility criteria.

Medicaid expansion gives adults aged 18-64 a chance for coverage if their income is below 138% federal poverty level. However, applicants must still meet other eligibility criteria.

States that have adopted and implemented Medicaid expansion for adults include Oklahoma, Utah, Missouri, Utah, Idaho, Virginia, Vermont, New Hampshire, Rhode Island, Massachusetts, Arkansas, Kentucky, Montana, Nebraska, Connecticut, Delaware, and Maine, among others.

South Dakota adopted the Medicaid expansion but has not implemented it yet. Several others have neither adopted nor implemented the expansion.

For example, Wyoming, Alabama, Kansas, Texas, Mississippi, Georgia, Tennessee, North Carolina, South Carolina, Florida, and Wisconsin.

Is There an Age Limit for Medicaid Eligibility for Seniors?

As mentioned above, one of the primary groups to which Medicaid caters is seniors aged 65 years and above. However, they still have to meet the financial eligibility criteria in their state.

That said, persons aged 65 years disabled, blind, living in a nursing home,  or needing long term care but can stay at home and use community care services have a better chance of qualifying.

There is no cap for applying for Medicaid for seniors. You could be 100 years and still qualify.

Persons aged 65 years and above may have dual eligibility for both Medicaid and Medicare. In some states, such as Maryland, if you qualify for SSI benefits or disability benefits, you automatically qualify for Medicaid.

However, you do not have to be a beneficiary of SSI benefits to qualify for Medicaid. You just need to prove that you are financially constrained.

Conclusion

As evidenced by the FAQs discussed above, the standard age limit for Medicaid qualifications across the US is 0-18 years and 65 years and above.

However, with most states adopting and implementing Medicaid expansion, persons aged 18-64 states in these states may be eligible.

Specific age limits apply in different states for specific groups, including young foster adults, teenagers living on their own and the medical condition of various qualifying individuals.