Medicaid “Categorically Related”
Eligibility Groups
- Infants up to age 1 and pregnant women not covered
under the mandatory rules whose family income is no more
than 185% of the FPL (each State can set a percentage
below 185%)
- Children under age 21 who meet criteria more liberal
than the AFDC income and resource requirements that were
in effect in their State on July 16, 1996.
- Institutionalized individuals eligible under a
“special income level” (set by each State up to 300% of
the SSI Federal benefit rate).
- Individuals who could be eligible if
institutionalized, but who are receiving care under home
and community-based services waiver.
- Certain aged, blind or disabled persons who have
incomes above those requiring mandatory coverage, but
below the FPL.
- Recipients of State supplementary income
payments.
- Certain working and disabled persons with family
income less than 250% of the FPL who would qualify for
SSI if they did not work.
- TB-infected persons who would be financially eligible
for Medicaid at the SSI income level if they were within
a Medicaid-covered category (coverage is limited to
TP-related services and drugs).
- Certain uninsured or low-income women who are
screened for breast or cervical cancer through a program
administered by the CDC. The Breast and Cervical Cancer
Prevention and Treatment Act of 2000 provides these women
with medical assistance and follow-up diagnostic services
through Medicaid.
- “Optional targeted low-income children” included
within the State Children’s Health Insurance
Program.
- “Medically needy” persons who would qualify for one
of the mandatory or optional groups except their
income/resources are above the eligibility level set by
their State. Persons may “spend down” by incurring
medical expenses that reduce their income.
