Medicaid Eligibility Chart (Page 4 of 4) in pdf

Resource

Program

Income Limit

Income Disregards

Limit

Excluded From Resources

Counted Toward Resource Limit

Other Requirements



Must be a child under age 18 in

Family Size

Income

the home

$124.00

No income disregards

resource



Deprivation does not have to exist

Parent/Caretaker Relative

$220.00

limit

$276.00

$334.00

$388.00

Additional 5% Income



Must be between ages 19 - 64

133% of FPL

Disregard if needed:



Cannot be pregnant

138% of FPL



Not eligible for or enrolled in

Health Care Independence

Family Size

Income

Family Size

Income

Medicare

Program

$1273.48

$1321.35



Cannot be eligible for

$1719.03

$1783.65

Parent/Caretaker Relative

$2164.58

$2245.95

$2610.13

$2708.25

$3055.68

$3170.55

Add $445.55 for each

Add $462.30 for each

additional member

Family



NON-MAGI

A home

Cash on hand or in the bank

Size_____



(less income received that month)

Families

Family Size

Income

Household and personal goods

Deduct $90 for work

$2000

(a) Pregnant Women only

$108.33



Stocks and bonds

Spend Down

Student loans and grants

related expenses.

$3000

(b) Under-18: Children under 18

$216.66



(a) Pregnant Women



Accessible trust funds

Other bona fide loans

$3100

years only

$275.00

(b) Under-18 (U-18)



Cash surrender value of life

One burial plot per family

Deduct actual

$3200

$333.33

insurance policies

member

childcare expenses up

unemployment of parent

Add $58.33 for each

(d) AFDC



U.S. Savings Bonds

to $200 a month for a

Add $100

(d) Deprivation due to absence,

additional member



Other personal property

child under age 2 or

for each

death or disability of parent

Deduct outstanding

$175 a month for a

additional



Equity value in excess of $1500 is

medical bills if income

child age 2 or older.

person

counted for one car: Full equity

exceeds limit for

value is counted for additional cars

household size

* This is a brief summary of eligibility requirements. Other factors will also enter into determining your eligibility for a program. Unless otherwise noted, all categories receive “full” Medicaid. Benefit

packages are defined by the Department of Human Services, Division of Medical Services. This information was current at the time this summary was prepared but changes may have been made

subsequently due to federal regulations, state laws, court decisions or other factors. DHS cannot be bound by any information in this reference chart that conflicts with current policy or program

requirements.

Arkansas’ complete Medicaid Policy can be found at

Additional information is available at

Apply for benefits on line at

For an application form, call 1-855-372-1084.

Division of County Operations

1/2014