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Are You Eligible For Medicaid (Title 19)?

This article was produced by LARCC in cooperation with CLS, GHLA, NHLAA, and SLS.

Are You Eligible For Medicaid (Title 19)?

Medicaid is health insurance that helps people pay some or all of their medical bills. Call 1-855-805-HEALTH (4325) to apply.

Medicaid may be free for

  • families with children- monthly income less than about $2700/family of 2,
  • pregnant women- monthly income less than about $3500/family of 2, and
  • adults without children at home- monthly income less than about $1810/family of 2.

Medicaid may have a co-pay or monthly cost for

  • families with children- monthly income between about $2700 and $4200/family of 2, and
  • people with certain medical conditions.

Call 1-855-805-HEALTH (4325) to find out which program you qualify for.

Medicaid with a spend-down

If your income is too high to qualify for free Medicaid, you may be able to get Medicaid after you “spend-down” some of your money.  You will get a notice from DSS that tells you the amount you must spend-down, when your spend-down period starts and ends, and where to send the proof about your spend-down. Spend-down periods are 6 months.

Remember! Keep copies of everything you give DSS.  Keep all notices and envelopes that DSS sends you.

One way to meet your spend-down amount is to have medical bills.

  • You don’t have to PAY the medical bills; you can use unpaid bills to meet your spend-down.
  •  As soon as you have medical bills in the amount of your spend-down, you can get Medicaid.

Example: Bob applied for Medicaid on January 1. Bob’s 6 month spend-down period is January 1–June 30.  Bob’s spend-down amount is $600. 

On January 1st, Bob starts his 6 month spend-down period with no Medicaid coverage. On March 15 his medical bills total $600.  Bob is covered by Medicaid for any NEW medical bills from March 15-June 30

On July 1 Bob has a NEW 6 month spend-down period and amount.

  • You can use UNPAID medical bills from a previous period to meet your spend-down amount in the current period.
  • Sometimes it takes almost the whole 6 months to meet your spend-down.  Plan ahead to get longer coverage.

Example: Luz’s 6 month spend-down period is March 1 – August 31. Luz’s spend-down amount is $500.

On August 20 she has $500 in medical bills.  If these bills are UNPAID, she can give them to DSS at the start of her next period, September 1.

Luz will be covered by Medicaid for all medical bills during her spend-down period September 1 - February 28.

Bills you can use toward your spend-down:

  • Doctor, hospital, and ambulance services.
  • Prescription and over-the-counter drugs and vitamins prescribed by your doctor.
  • Medical supplies, such as bandages, gauze, etc.
  • Health insurance premiums, co-payments, and deductibles.

Remember!

  • If your income or living situation changes, your spend-down amount may change. Tell DSS about any change within 10 days.
  • Save all your medical bills. Keep track of the date and amount of each bill, and the date you pay a medical bill.
  • If you don’t meet your spend-down amount in one period, you can use the same bills again for the next period.
  • If you don’t pay medical bills you may be charged late fees and penalties.  Ask your doctor or pharmacist if you can pay over time.  If bill collectors are harassing or taking legal action against you, call SLS for help 800-453-3320, 860-344-0380.  Read our booklet Debt Collection.

Other programs that pay some or all of your medical bills

  • MED-Connect lets you work and keep your Medicaid, often without a spend-down.  You’re eligible if you
    • are disabled, even if you don’t get SSI/SSDI,
    • earn income, even if you are self-employed or only work a few hours a week, and
    • have income less than about $6250/month and assets less than about $10,000/1 person or $15,000/married couple.
  • Breast and Cervical Cancer Program covers all medical needs (not just cancer treatment) during the time you need cancer treatment. You’re eligible if you
    • don’t have insurance, and
    • aren’t eligible for Medicaid or Medicare.
    • Get screened at an Early Detection site. Call 860-509-7804 to find a site
    • NO income or asset limits for this program.
  • Home Care Program for Elders pays for home health aides, skilled nursing, emergency response alert, meals on wheels, adult day care and other services.  You’re eligible if you
    • are 65 or older, and
    • need help with daily living activities like bathing, shopping, or taking medications.
    • Income limits are higher than for regular Medicaid.
    • To apply call the DSS Alternate Care Unit at 800-445-5394.
  • Personal Care Assistance Program pays for assistants to help with your daily living activities. You’re eligible if you
    • have a disability, and
    • need help with daily living activities like bathing, shopping, or taking medications.
    • Income limits are higher than for regular Medicaid.
    • To apply call DSS at 1-855-626-6632.
  • Acquired Brain Injury Program offers home and community-based services to help you live at home instead of in a nursing home.  You’re eligible if
    • you have a disability related to a brain injury.
    • Income limits are higher than for regular Medicaid.
    • To apply call DSS at 1-855-626-6632.

Tips

  • If DSS won’t pay for something your doctor ordered, ask for the reason in writing. Call SLS for help 800-453-3320, 860-453-3320.
  • Be careful not to go above your income limit. Even a few cents over from interest on a bank account can cause your Medicaid coverage to stop as of the day you went over the limit.   You could pay for some large medical bills to keep your income below the limit.

This booklet was produced by the Legal Assistance Resource Center of Connecticut in cooperation with Connecticut Legal Services, Greater Hartford Legal Aid, New Haven Legal Assistance Association, and Statewide Legal Services. 

The information in this booklet is based on laws in Connecticut as of April 2014. We hope that the information is helpful. It is not intended as legal advice. For advice on your situation, call Statewide Legal Services or contact a lawyer.

For more information, contact:

Statewide Legal Services: 860-344-0380 (Central CT & Middletown) or 1-800-453-3320 (all other regions).

For people over 60, click here to get help from legal aid.

Not from Connecticut?

Most of the information on this web site is for Connecticut residents only.
Visit LawHelp.org to find a legal services program and/or a legal information web site in your area.