What Is The Medically Needy Program?
I am sometimes asked what this program is all about. There is a longer (and somewhat tedious) answer, than what I am about to write, but this explanation is certainly a sufficient starting point.
The medically needy program provides states the option to extend Medicaid eligibility to individuals with high medical expenses whose income exceeds the maximum threshold, but who would otherwise be eligible for Medicaid. The program accounts for a small share of Medicaid enrollment and it is difficult for individuals to navigate. In fact, it is so cumbersome that states actually have difficulty administering it.
Still, the medically needy program remains an important and consequential pathway to Medicaid eligibility, acting as a last-resort to Medicaid eligibility for those whose medical expenses overwhelm their income. Elderly living in nursing homes and children and adults with disabilities who live in the community and incur high health care costs comprise a significant portion of spending in the medically needy program.