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Medicaid Eligibility Before the Affordable Care Act

Under federal rules governing the Medicaid program, individual states have broad discretion to expand Medicaid eligibility beyond federally-mandated categories. In Michigan, there are no fewer than 40 different ways to qualify for Medicaid or other government-supported medical assistance. Eligibility requirements vary widely among the eligibility categories, and eligibility determinations are made based on a complex matrix of policies that specify income and asset standards, categorical definitions, group compositions, benefit limits, and exclusions. Asset tests apply; that is, there are limits to the amount of assets an individual may own to be eligible. With the exception of some very limited programs (e.g. the Adult Medical Program), childless adults who are not pregnant or disabled are not eligible for Medicaid coverage. See Appendix 2 for descriptions of the 40 eligibility categories.

Medicaid Eligibility After the Affordable Care Act

Under the Patient Protection and Affordable Care Act (ACA), states have the option to expand Medicaid eligibility to non-elderly citizens and qualified resident immigrants with incomes at or below 138 percent of the federal poverty limit including those who are not pregnant, disabled, under 21, or parents of dependent children—and there are no asset tests. To ensure that there are no gaps in coverage, the ACA also preserves eligibility at different income levels for parents with dependent children, pregnant women, children under age 19, and those who receive Supplemental Security Income (SSI) or qualify as “medically needy” (high medical expenses relative to income).

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Suggested citation: Ogundimu, Tomi; Fangmeier, Joshua; Stock, Karen; Udow-Phillips, Marianne. Medicaid Eligibility in Michigan: 40 ways. July 2012. Center for Healthcare Research & Transformation. Ann Arbor, MI.