1. Qualifying factors that must be met before a patient receives benefits (medical services) under a specified insurance plan, government program, or managed care plan. 2. Refers to the process whereby an individual is determined to be eligible for health care coverage through the Medicaid program. Eligibility is determined by the State. Eligibility data are collected and managed by the State or by its fiscal agent. In some managed care waiver programs, eligibility records are updated by an enrollment broker who assists the individual in choosing a managed care plan in which to enroll.
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UK: Conditions that govern a person’s right of entry into a pension scheme or right to receive a particular benefit. The conditions may relate to age, service, status and type of employment but there must be no discrimination in eligibility on grounds of sex. The Barber judgment applies to all retirement benefits earned after 17 May 1990 and is endorsed by regulations under PA95 for equal treatment between the sexes.