happens if my income is over the
If you have income that
is higher than the Medicaid income limits, 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 period
is calculated every six months. Once you meet your deductible you may qualify
for Medicaid for the rest of the six months.
Which Medicaid groups
have a deductible?
The Medicaid groups that
have a deductible program are AFDC-Medicaid, AFDC-Related Medicaid for
children (not for caretaker relatives), Healthy Start for children under
age six and pregnant women and SSI related Medicaid for persons over age
65 or disabled. There is no deductible in the OBRA Kids or BadgerCare programs.
Example: You apply
for Medicaid for yourself and your 15-year-old daughter. The only income
in your household is the $950 you earn each month from your job. You and
your daughter are over-income for all of the Medicaid categories. Your
daughter will only be eligible for AFDC-related Medicaid if she meets a
deductible is calculated as follows:
income for two
over Medicaid limit
deductible for six-month period:
If your family incurs $1,614
in medical bills, your daughter will qualify for Medicaid for the rest
of the six months. Because there is no deductible program for parents who
are not disabled, you will not be eligible for Medicaid at this time. You
may however, be eligible for BadgerCare. Your daughter will have
a choice of getting Medicaid with a deductible or BadgerCare.
What kind of medical bills
can I use to
meet my deductible?
Medical bills you have incurred
within 3 months prior to your month of application, whether paid or not,
can be used to meet your deductible. Old bills, regardless of the date,
can be used to meet your deductible, as long as you still owe them. Medical
bills used to meet a previous deductible or bills paid by the Medicaid
program cannot be used to meet your current deductible. Medical bills of
your spouse or minor children can be used to meet your deductible.
What happens if my income
If you have a Medicaid deductible
and your income changes significantly, contact your worker and a new deductible
amount may be calculated.
Can I pay my deductible
You can pay your deductible
for six months up front and get a Medicaid card right away without waiting
to get medical bills. Ask your caseworker how you can do this.