I am often asked what this program is all about. There is a long (comprehensive) answer, with all of its ramifications. However, in a nutshell, this is what it is about.
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, it is difficult for individuals to navigate, and it is cumbersome for states to administer. However, 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 large portion of spending in the medically needy program.