Screening for Eligibility in Medicaid and the State Children's Health Insurance Program (SCHIP)

About this Manual

This screening manual contains questions that can help you determine whether someone qualifies for Medicaid or SCHIP coverage. Federal and state-specific information is also included. You can use the screening questions to create a state-specific screening tool (see state adaptations instructions in table of contents).

Introduction

Background
Where to get state-by-state information and federal documents about Medicaid and SCHIP eligibility
Medicaid’s relationship to other federal public benefit programs
Table: Links for information about Medicaid and SCHIP eligibility

Medicaid/SCHIP Screening Questions:

Children and Families (includes the following questions)

Is the person pregnant?
Is the person under age one?
Is the person under age six?
Is the person at least age 6 but under age 19?
Is the person age 19 or 20?
Is the person a child in foster care or an adopted child?
Is the person a child with a disability?
Is the person a child with a disability so severe that he or she could be admitted to a medical institution?
Is the person a parent of a dependent child or a child not eligible under any of the previous questions?
Is the person a relative caring for a dependent child?
Has the person's family income recently increased?

High Medical Expenses (includes the following questions)
Does the person or family have significant medical expenses?
received within the last three months?

Special Situations (includes the following questions)
Is the person an immigrant?
Is the person homeless, or has the person recently moved into the state?
Did the person leave a job that offered COBRA benefits?

Age and Disabilities (includes the following questions)
Does the person have a disability, or is the person blind?
Is the person working despite blindness or disability?
Is the person at least age 65 and living in the community rather than in an institution?
Does the person receive Medicare?
Is the person’s health condition severe enough to qualify for nursing home coverage?
Does the person want care at home or in the community even though his or her condition is serious enough to qualify for nursing home care?
Did the person at one time receive SSI benefits?

Diseases (includes the following questions)
Does the person need breast or cervical cancer treatment?
Does the person have sickle cell anemia?
Does the person have tuberculosis?

Other (includes the following question)
If the person is not qualified under any of the above categories, does he or she live in a state that uses a Section 1115 waiver to expand eligibility? (For example, is this person an adult who is neither disabled nor elderly and does not have dependent children?)