C. Eligibility

• Library: A Practical Guide to Elder and Special Needs Law in South Carolina (SCBar) (2014 Ed.)

C. Eligibility

1. Overview

To qualify for the Medicaid program, an applicant must meet both eligibility requirements and program requirements. These requirements may be grouped together:

• Qualification 1: Categorical eligibility. An applicant must fit into one of the coverage groups listed in C.2. below.
• Qualification 2: Meets the non-financial eligibility requirements. An applicant must meet certain requirements that are unrelated to financial need.
• Qualification 3: Meets the financial eligibility requirements. An applicant must have limited assets and low income. The extent of allowable assets and income varies among the different eligibility coverage groups.
• Qualification 4: Agrees to comply and does comply with program requirements. An applicant must follow certain procedures to apply for Medicaid, prove eligibility, and report changes in circumstances.

Applicants must pass all qualification tests to receive Medicaid benefits. The Medicaid agency must make eligibility determinations with "reasonable promptness." 42 U.S.C. § 1396a(a)(8). The regulations allow for 90 days for determinations of applicants applying on the basis of disability and 45 days for all other applications. 42 C.F.R. § 435.912(c)(3).

2. Categorical Eligibility

It is a common misconception that any indigent person may qualify for Medicaid. The fact is that many do not. For example, an able-bodied 64-year-old man who has only $50 to his name does not qualify for Medicaid. While limited assets and income are one of the requirements of the program, a person must also fit into one of the following coverage groups.

• Receiving cash assistance, such as SSI or Optional State Supplementation (OSS),
• Aged (65 or older),
• Blind,
• Disabled,
• A child under age 19,
• A pregnant woman,
• An adult with a dependent child(ren), or
• Diagnosed and found to need treatment for either breast or cervical cancer or pre-cancerous lesions (CIN II/III or atypical hyperplasia).

MPPM 102.06, available at http://medsweb.scdhhs.gov/mppm/mppmtoc.htm.

3. Non-financial Eligibility Requirements

In addition to fitting one of the categories of people who may qualify for Medicaid, a person's residency and citizenship status, factors that are unrelated to financial need, affect one's eligibility for Medicaid.

(1) A person must live in South Carolina to qualify for South Carolina's Medicaid program. Length of residency is not a factor; however, one's intention to reside in South Carolina is. Temporary

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