Medicaid Eligibility Tool

The Medicaid Eligibility Tool estimates eligibility for Medicaid and related programs by combining user inputs such as income, household size, state, age, pregnancy status, disability, and citizenship. It serves social services teams, clinics, and nonprofit aid programs that need to pre-screen applicants and plan enrollments efficiently. The tool applies MAGI-based rules for most cases and non-MAGI considerations where applicable, producing an eligibility status and a recommended program set. Conceptually, it counts income, applies state-specific thresholds, and maps outcomes to eligible programs. It supports scenario planning by allowing inputs to be adjusted to reflect changes in income or household size, aiding outreach and outreach planning. Unique value lies in its state-aware rule engine, rapid outputs, and export-ready summaries for filings, while maintaining privacy and conservative defaults when data is incomplete. Use cases include community health centers screening patients at intake, case managers pre-screening clients for outreach, and advocacy groups planning coverage campaigns. Outputs support documentation, eligibility appeals, and collaboration with state agencies. The tool stays aligned with current eligibility criteria through regular rule updates and provides interpretable rationales for staff when presenting results to applicants. This tool supports staff efficiency by delivering structured results that can be shared with applicants and used to triage enrollment steps, reducing unnecessary applications and follow-ups while improving accuracy and transparency in the intake process.