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Medicaid Deductible 

What happens if my income is over the Medicaid income limits? 

If your income is higher than the income limits for Medicaid, you may qualify by meeting a Medicaid “deductible.” The Medicaid deductible is the difference between your income and the Medicaid income limit. The Medicaid deductible is always calculated every six months. If you have medical bills up to your deductible amount you may qualify for Medicaid. Not every Medicaid category has a deductible program. Most children are eligible under the deductible program except the OBRA Kids and BadgerCare recipients. Only disabled and pregnant adults are eligible for the deductible program. 

You and your 15-year-old daughter apply for Medicaid. The only income in your household is the $950 you earn from your job. This makes you both over-income for for all categories of Medicaid. Your daughter may qualify if she meets a deductible. Because the OBRA Kids program has no deductible program, she must be tested for the AFDC-related Medicaid category. 

Her deductible is calculated as follows: 

Gross family income   $950
Earned income deduction - $ 90
Net income   $860
AFDC-related income for two - $591
Income over Medicaid limit   $269
Medicaid deductible for six-month period: $269×6 = $1614
If your family has $1614 in medical bills, your daughter may qualify for Medicaid. You will not qualify for Medicaid because there is no deductible program for adults who are not disabled or pregnant. You may be eligible for BadgerCare in July 1999.
Can I pay my deductible and become eligible for Medicaid?  

Yes, if you do not have medical bills, you can pay your deductible up front and get a medical card. You will be eligible from the time you pay your deductible, so it is always better to pay at the beginning of your deductible period. Ask your caseworker how you can do this.

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