Owen Clinic
(619) 543-3995

Medicaid

Medicaid is a health and medical services federal government program that supports health care coverage for people with low income and few assets.

Table of Contents

Medicaid Eligibility Pathways for People with HIV/AIDS

Eligibility Category Eligibility Criteria
Individuals receive federal matching funds
  • People who receive federally assisted income-maintenance payments
  • Similar groups who do not receive cash payments
Other categories of people that may be eligible
  • Who meet the requirements for the Aid to Families with Dependent Children (AFDC) program that were in effect in their state on July 16, 1996
  • Children under age 6 whose family income is at or below 133% of the Federal poverty level (FPL)
  • Pregnant women with family income below 133% of the FPL
  • Supplemental Security Income (SSI) recipients
  • Recipients of adoption or foster care assistance under Title IV of the Social Security Act
  • Special protected groups, such as individuals who lose cash assistance due to earnings from work or from increased Social Security benefits
  • Children born after September 30, 1983 who are under age 19 and in families with incomes at or below the FPL
  • Certain Medicare beneficiaries
More broadly defined group of people that may be eligible
  • Infants up to age 1 and pregnant women whose family income is not more than a state-determined percentage of the FPL
  • Certain low-income and low-resource children under the age of 21
  • Low-income institutionalized individuals
  • Certain aged (65 years old or older), blind, or disabled adults with incomes below the FPL
  • Certain working-and-disabled persons with family income less than 250 percent of the FPL
  • Some individuals infected with tuberculosis
  • Certain uninsured or low-income women who are screened for breast or cervical cancer
  • Certain "medically needy" persons, which allow States to extend Medicaid eligibility to persons who would be eligible for Medicaid under one of the mandatory or optional groups, except that their income and/or resources are above the eligibility level set by their State

What does it cover?

Mandatory Federal Coverage Requirement
  • Inpatient hospital services
  • Outpatient hospital services
  • Prenatal care
  • Vaccines for children
  • Physician services
  • Nursing facility services for persons aged 21 or older
  • Family planning services and supplies
  • Rural health clinic services
  • Home health care for persons eligible for skilled-nursing services
  • Laboratory and x-ray services
  • Pediatric and family nurse practitioner services
  • Nurse-midwife services
  • Federally qualified health-center (FQHC) services and ambulatory services
  • Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21

Additional Optional Services provided by State
  • Diagnostic services
  • Clinic services
  • Intermediate care facilities for the mentally retarded (ICFs/MR)
  • Prescribed drugs and prosthetic devices
  • Optometrist services and eyeglasses
  • Nursing facility services for children under age 21
  • Transportation services
  • Rehabilitation and physical therapy services
  • Home and community-based care to certain persons with chronic impairments

Where to apply?

Consumer Center for Health Education & Advocacy
The Health Consumer Alliance
1764 San Diego Avenue Ste. 200
San Diego, CA 92101

Department of Health and Human Services Agency
North Central Family Resources
5055 Ruffin Road,
San Diego, CA 92123
Phone: 866-262-9881 (toll-free)

How can I get better informed?

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