Is APA-Related Medicaid Right for You?

Medicaid is government-funded health coverage for people in certain situations. You may qualify if you:

If you get Adult Public Assistance (APA) benefits or qualify for SSI’s 1619(b) rule, you automatically get APA-related Medicaid and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI and APA article.

Otherwise, answer the questions on this page to see if you might qualify for APA-related Medicaid. If so, it’s probably your best health coverage option because it doesn’t usually have a premium, the copayments for services are generally lower than copayments required by private plans, and Medicaid covers more services than most private plans. Also, if you qualify for Medicaid, you cannot get government help paying for an individual plan on Healthcare.gov.

Note: The rules for qualifying for APA-related Medicaid are explained in much greater detail in DB101’s SSI and APA article.

Medicaid’s rules for immigrants:

  • Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
  • Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, if their income is at or below 400% of the Federal Poverty Guidelines (FPG), they can get private coverage subsidized by the government.
  • Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for all of the same programs that U.S. citizens can get.

Note: You can get Medicaid coverage if you are a Native American born in Canada or Mexico who has rights to cross the border.

Are you 65 or older or do You Have a Disability That Meets Social Security’s Standards?

To qualify for APA-related Medicaid, you must either be 65 or older or you must have a disability that meets Social Security’s definition of disability.

For adults, Social Security says you have a disability if:

  • You have a physical or mental impairment or combination of impairments
  • Your impairments limit your ability to work, preventing you from earning Substantial Gainful Activity ($1,180 per month or $1,970 per month if you’re blind), and
  • Your condition has lasted or is expected to last for at least 12 months.

If you currently get a disability benefit like Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), you already meet Social Security’s disability standards.

If not, Social Security, in collaboration with Alaska Disability Determination Services (DDS), will check to see if your disability qualifies for Medicaid. Learn more about the disability determination process in DB101's SSI and APA article.

If you are 65 or older or you already have a disability determination from Social Security or think that your disability will meet Social Security’s standards, APA-related Medicaid might cover you.

Do You Have Very Low Resources?

Resources are money and property you own. For APA-related Medicaid, you and your family must have very low resources:

  • If you are single, the most you can have is $2,000 in resources.
  • For couples, the limit is $3,000.

Some resources don’t count towards APA-related Medicaid’s resource limit, like the home you live in and one car. Learn more about APA-related Medicaid's resource limit and what things don't count as resources in DB101's SSI and APA article.

Additionally, if your disability began before you turned 26, you can open an ABLE account and the money in your account will not be counted by Medicaid. Learn more about ABLE accounts.

If your family’s resources are below the limit, APA-related Medicaid might cover you.

Note: Real property, including the buildings on it, that is owned by an Alaska Native or American Indian is not a countable resource for APA-related Medicaid.

Do You Have Very Low Income?

To qualify for APA-related Medicaid, you must have countable income that is $1,393 per month or less if you live on your own ($2,063 or less for couples where both people have a disability or are at least 65 years old).

For APA-related Medicaid eligibility, not all of your income is counted. For APA-related Medicaid, your income is counted using SSI’s countable income calculation:

For example, you could make $2,000 per month at work and still qualify for APA-related Medicaid, because more than half of your earned income wouldn’t be counted. Learn more about how your income is counted for APA-related Medicaid and what the income limits are in other situations in DB101's SSI and APA article.

If your income is low enough and you meet all other requirements, you should sign up for Medicaid. If you qualify for APA-related Medicaid, you may also get a monthly payment from the APA program. Learn more in DB101's SSI and APA article.

If your income or resources are too high and you have a disability

If you work, look into the Working Disabled Medicaid Buy-In program if your income or resources are too high for APA-related Medicaid. The Working Disabled Medicaid Buy-In has higher limits. Learn more about the Working Disabled Medicaid Buy-In.

If you don't work, a Medicaid Qualifying Income Trust (QIT), sometimes called a Miller Trust, may help you get APA-related Medicaid even if your income is over the standard limit. A QIT must be created following certain rules related to how the money is managed and whom it must benefit. For more information about QITs, call the Disability Law Center of Alaska at 1-800-478-1234, Alaska Legal Services, or a private attorney who does these trusts. When you call an attorney, have a list of your regular medical expenses. This list will make it easier to figure out whether a QIT would help you.

Example: Frida's SSDI benefits are too high for her to get APA-related Medicaid and her Medicare coverage means she can't get income-based Medicaid. She starts putting some of her SSDI benefits into a QIT each month and becomes eligible for APA-related Medicaid. The APA-related Medicaid coverage covers some of her medical expenses that Medicare doesn't cover, like personal assistance services and some prescription drugs.

More Ways to Qualify for Medicaid if You Have a Disability

There are other ways to qualify for Medicaid if you have a disability. You might qualify for income-based Medicaid if:

  • Your disability does not meet Social Security’s definition of disability. APA-related Medicaid is only for people who have disabilities meeting this standard.
  • You have more resources than are allowed by APA-related Medicaid.
  • You make enough money that you would have to pay a monthly premium for the Working Disabled Medicaid Buy-In.

You might qualify for APA-related Medicaid instead of income-based Medicaid if:

  • You also get Medicare. Usually, income-based Medicaid doesn’t cover people getting Medicare, but APA-related Medicaid does. It may even help pay your monthly Medicare premiums and other Medicare expenses like deductibles and coinsurance.
  • You are 65 years old or older.
  • You make more money at work than income-based Medicaid allows. In that case, you might also qualify for the Working Disabled Medicaid Buy-In.

Learn more about income-based Medicaid and the Working Disabled Medicaid Buy-In.

How to Sign Up

You can apply for Medicaid:

If you use the combined application for services, you can also apply for other benefits at the same time, such as APA, Food Stamps, and Alaska Temporary Assistance Program (ATAP). If you apply for Medicaid online, you will have to apply for other benefits separately.

Staying on Medicaid

Usually, once you are approved for Medicaid, you will continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your Division of Public Assistance (DPA) office know within 10 days. When you report your changes, the DPA will tell you whether you will continue getting Medicaid or if you have new health coverage options, like individual coverage with subsidies or the Working Disabled Medicaid Buy-In program.