Is my income too high for Medicaid?
Asked by: Ms. Tara Ziemann | Last update: June 11, 2025Score: 4.4/5 (4 votes)
What happens if I make too much money while on Medicaid?
If your income is too high for Medicaid, a spend down will let you use extra money on medical expenses until you qualify. Not all states have a spend down program for Medicaid eligibility. Those that do often have different income limits and rules. Not all states offer a spend down option.
What is Virginia's Medicaid income limit?
Virginia has very restrictive Medicaid eligibility: Pregnant women and children through age 18 cannot have income higher than 148 percent of federal poverty level (FPL) or $30,240 for a family of three. (Virginia's FAMIS program covers children and pregnant women up to 205 percent FPL or $41,880 for a family of three.)
Does Medicaid actually check your income?
Some states use a computerized system to cross reference a Medicaid applicant's reported income. For instance, in California, an electronic database, the Income Eligibility Verification System (IEVS), is used to match the income information provided by the applicant to other databases to verify it is accurate.
How do I protect my income from Medicaid?
One such option to protect assets is a Medicaid Trust. By placing some of your assets in an appropriate trust, you can protect them from Medicaid and have them not be counted when you are applying for benefits.
What to do if Medicaid tells you your income is too high
Do you have to pay back Medicaid if you get a job?
No. Unlike employer-sponsored plans, Medicaid is not tied to your job. You'll still have it even if you lose your job because of COVID-19 or for any other reason. If you find a job, your new financial situation will determine whether you qualify for Medicaid.
How much income is too much for Medicaid?
The income limits for Medicaid applicants can change depending on the state where they live, their marital status and the Medicaid program. In general, however, the income limits are low. In most states in 2025, the income limit for receiving long-term care at home or in a nursing home through Medicaid is $2,901/month.
What affects Medicaid eligibility?
Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.
What is the look back period for Medicaid in Hawaii?
Medicaid's Look-Back Rule
Hawaii has a 60-month (5 year) Medicaid Look-Back Period that immediately precedes the date of one's Nursing Home Medicaid or Home and Community Based Services application.
Can you own a house and be on Medicaid in VA?
Ownership of real property must be considered when determining your Medicaid eligibility but does not necessarily keep you from receiving Medicaid. The Medicaid eligibility worker will need to see copies of the deeds and tax statements to evaluate the rules that apply in your situation.
What are the four types of Medicaid?
- State-operated fee-for-service (FFS)
- Primary care case management (PCCM)
- Comprehensive risk-based managed care (MCO model)
- Limited-benefit plans.
How much money can you have in the bank with Medicaid in Virginia?
Have countable resources of not more than $2,000 for one person or $3,000 for a couple. Resources are things such as bank accounts (checking, savings, certificates of deposit, Christmas club, etc.), stocks, bonds, the cash value of some life insurance policies, property that does not adjoin your home, etc.
Why are people being kicked off Medicaid?
So, because states kept people on the Medicaid program for three years during the pandemic, there are a number of people who have had changes in circumstances, they have gotten new jobs, they have increased their hours at their existing jobs, and because of that increase in income, are no longer eligible.
How to keep Medicaid while working?
WHAT WILL HAPPEN TO MY MEDICAID IF I GO TO WORK? In most cases, if you are blind or have a qualifying disability, regardless of age, and you have Medicaid before you go to work, your Medicaid will continue while you are working as long as your disabling condition still exists.
How often does Medicaid check your bank account?
Medicaid agencies can check your account balances for bank accounts at any financial institution you've used in the past five years. They will check when you submit an application and on an annual basis, but checks can occur at any time.
Who gets denied Medicaid?
The most common reason an applicant is denied Medicaid is income or assets above the eligibility criteria. In most states in 2025, an applicant's monthly income must be less than $2,901/month, and their assets (including money in bank accounts) must be less than $2,000.
What are the downsides of Medicaid?
Disadvantages of Medicaid
One of the primary reasons for this is that Medicaid reimbursements are lower than those of commercial insurers for most procedures and treatments.
Who is automatically eligible for Medicaid?
SSI is a federal program providing cash assistance to low-income persons with disabilities (under age 65) and seniors (age 65 and older). In most states, SSI beneficiaries are a mandatory population for state Medicaid programs and are automatically eligible for Medicaid.
What happens if you make too much money while on Medicaid?
If you're over the Medicaid income limit, some states let you spend down extra income or place it in a trust to help you qualify for Medicaid. If you receive long-term care but your spouse doesn't, Medicaid will allow your spouse to keep enough income to avoid living in poverty.
Will I lose my Medicaid if I get Medicare?
People who have both Medicare and full Medicaid coverage are “dually eligible.” Medicare pays first when you're a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.
How does a spend down work with Medicaid?
During the “look back”, all past transfers are reviewed. If one has gifted assets or sold them under fair market value during this timeframe, a Penalty Period of Medicaid ineligibility will be established. California has no asset limit (eff. 1/1/24), and therefore, Asset Spend Down is not relevant for this state.
How many hours can you work with Medicaid?
How many hours can you work on Medicaid? There is no limit on how many hours someone on Medicaid can work. Medicaid eligibility is based more on income than hours worked. The rules vary by state, but many allow Medicaid recipients to work full-time if their monthly or annual earnings remain under the income limits.
What happens if I don't tell Medicaid I got a job?
Legally you are required to report income changes. If your monthly income is over the Medicaid threshold, then yes you will lose Medicaid. If you don't report your income change and LDH catches it, they can come after you for recipient fraud.