Medicaid Program: Categorically Needy vs Medically Needy

What is the difference between categorically needy and medically needy under the Medicaid program?

Which group qualifies based on low income, and which group may not qualify due to high medical expenses?

Answer:

The categorically needy are individuals who qualify by category such as having low income, while the medically needy are those who might not qualify usually but have high medical expenses.

Under the Medicaid program, there are two distinct eligibility groups: categorically needy and medically needy. These groups have specific criteria for qualification based on different factors.

Categorically Needy:

The categorically needy are individuals who are considered eligible for Medicaid based on specific categories they fall under. These categories include low-income individuals, families with dependent children, the elderly, and disabled individuals. They qualify for Medicaid based on their income level and do not need to have high medical expenses to be eligible.

Medically Needy:

On the other hand, the medically needy are individuals who may not qualify for Medicaid initially due to their income or assets being too high. However, they have significant medical expenses that make it difficult for them to afford healthcare on their own. The medically needy can "spend down" their income or assets on medical care and services until they reach the state's Medicaid eligibility levels.

It is important to differentiate between these two groups to ensure that individuals who genuinely need Medicaid assistance receive the support they require based on their specific circumstances.