Who Medicaid Covers and How to Know If You Might Qualify

Medicaid covers people in specific income and family situations, but the exact rules depend on which state you live in

Medicaid is a joint federal and state program, which means each state sets its own income limits, coverage rules, and who can enroll. There is no single national income cutoff. A person who qualifies in one state may not may have access to in another, and the same person's may be able to access can change if they move. The best way to find out whether you might may have access to is to check your specific state's Medicaid program directly, since the rules vary significantly.

That said, Medicaid generally covers people who fall into one of these broad categories: children, pregnant people, parents or caretakers of children, people over 65, people with disabilities, and in some states, adults with income below a certain threshold. Income limits are usually expressed as a percentage of the federal poverty line, which changes each year. For example, one state might cover parents earning up to 138% of the poverty line, while another covers them at 100%.

Key Takeaways

• Medicaid income limits and coverage rules are set by each state, so you must check your state's program to know whether you might may have access to.
• Children, pregnant people, parents with dependent children, seniors over 65, and people with disabilities are the main groups Medicaid is designed to cover.
• Income is measured as a percentage of the federal poverty line, which increases each year, so your may be able to access can change even if your earnings stay the same.
• Some states expanded Medicaid to cover adults without children or disabilities if their income is low enough; others have not.
• You will need to report your household size, income, citizenship status, and sometimes medical conditions when you check your situation.

Children and Pregnant People

Medicaid covers children in every state, but the income limits vary. Most states cover children in families earning up to 200% of the federal poverty line or higher. Some states are more generous; a few are more restrictive. Pregnant people are also covered in all states, usually up to a higher income limit than the general adult population, and coverage typically continues for a set period after birth (usually 60 days, though some states extend it longer).

If you have a child or are pregnant, your state's Medicaid program is often the fastest way to find out what you might may have access to for, because these groups are prioritized. You will need to provide your household size, income, and the child's or your own date of birth.

Parents and Caretakers of Children

Medicaid covers parents and other caretakers (like grandparents or aunts) who care for children in the household, but only if their income falls below their state's limit. These limits are often lower than the limits for children themselves. For example, a state might cover children up to 200% of poverty but only cover parents up to 100% of poverty.

To may have access to in this category, you must live with the child, be responsible for their care, and meet your state's income threshold. The child does not have to be your biological child. If you are a grandparent or other relative raising a grandchild, you may still may have access to, though some states have additional rules about guardianship or custody.

People Over 65 and People with Disabilities

Medicaid covers people age 65 and older regardless of disability status, but they must meet income and asset limits. Asset limits (how much money or property you can own) vary by state but are often around $2,000 for an individual. Income limits for seniors are typically higher than for working-age adults without disabilities.

People under 65 with disabilities also may have access to for Medicaid in every state, but they must meet both income and asset limits, and they usually must have a disability recognized by the Social Security Administration. This means you typically need to be receiving or have been approved for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) to may have access to under this category. Some states have additional disability pathways that do not require SSI or SSDI approval.

Low-Income Adults Without Children or Disabilities

In 2014, states gained the option to expand Medicaid to cover adults earning up to 138% of the federal poverty line, regardless of whether they have children or disabilities. As of now, most but not all states have chosen to expand. If you live in an expansion state and your income is below the limit, you may may have access to even if you do not fit into the other categories listed above.

If you live in a state that has not expanded Medicaid, you generally cannot may have access to as a low-income adult unless you are a parent, caretaker, over 65, or have a disability. This is an important distinction: your may be able to access depends partly on where you live. You can find out whether your state has expanded Medicaid by checking your state's Medicaid website or calling their customer service line.

Citizenship and Immigration Status

Medicaid is available only to U.S. citizens and certain categories of immigrants. You must be a citizen or a may have access to non-citizen to enroll. may have access to non-citizens include people with a green card, refugees, asylees, and some other visa holders. Undocumented immigrants are not may be able to access for regular Medicaid in most states, though some states offer limited coverage for emergency services or pregnancy-related care regardless of status.

When you check your situation, you will need to provide proof of citizenship or immigration status. This might be a birth certificate, passport, green card, or other government-issued document. If you are unsure whether your status qualifies, your state's Medicaid program can tell you during the intake process.

How to Find Out What Your State Covers

The fastest way to learn what your state's specific rules are is to visit your state's Medicaid website directly. Most state programs have an online tool where you can enter your household size and income and get an when ready answer about whether you might may have access to. You can also call your state's Medicaid customer service line and speak to someone who can walk you through the rules.

You will need to have your household income information ready, including wages, benefits, and any other sources of money coming into your home. Your state will also ask for your household size (everyone you live with and claim as a dependent) and your citizenship or immigration status. If you have a disability, you may need to provide information about that as well.

Frequently Asked Questions

Does Medicaid cover people who are working?

Yes. Medicaid does not require you to be unemployed. Your income limit is based on your total household earnings, not your employment status. Many people who work part-time or earn low wages may have access to for Medicaid. If your income is below your state's threshold, you may may have access to even if you have a job.

What if my income changes during the year?

You should report income changes to your state's Medicaid program. If your income goes up and you no longer may have access to, your coverage will end. If your income goes down, you may become newly may be able to access. Some states allow you to update your information online; others require you to call or submit a form. Check your state's website for the process.

Can I have Medicaid and Medicare at the same time?

Yes. People who may have access to for both programs are called "dual may be able to access." This is common among seniors and people with disabilities. If you receive Medicare, you can still may have access to for Medicaid if your income and assets fall below your state's limits. Medicaid can help pay Medicare premiums and cover services Medicare does not.

What if I am self-employed or have irregular income?

Self-employed income counts toward your household income. Most states average your income over a set period (often the past three months or the past year) to determine your monthly earnings. If your income varies, you may may have access to in some months and not others. Report your expected annual income when you check your situation.

Do I have to be a resident of the state to may have access to?

Yes, you must live in the state where you are explore for Medicaid. You do not have to have lived there for a certain length of time, but you must be a current resident. If you move to a different state, you will need to explore for that state's Medicaid program instead.