Your children's Medicaid may be able to access depends on your household income, your state, and their age

Medicaid covers children in most states if your household income falls below a certain threshold. That threshold varies by state — some states cover children up to 200% of the federal poverty line, others go higher. Your state's Medicaid program sets its own income limit, so a family that qualifies in one state may not in another.

Children do not need to be citizens to get Medicaid in most states, though some states have different rules for immigrant children. Your state Medicaid office can tell you whether immigration status affects your children's coverage. If your children are already born, the process is straightforward: you report your household income and family size, and the program determines whether they fall within the limit.

Pregnant women and newborns have separate, usually more generous income limits in every state. If you are pregnant or have a newborn, contact your state Medicaid program directly — the rules that apply to older children often do not apply to them.

Key Takeaways

  • Your state sets the income limit for children's Medicaid, and it varies widely — contact your state Medicaid office or use your state's online tool to find the exact threshold for your household size.
  • Children do not need to be U.S. citizens in most states, though some states restrict coverage for certain immigrant children; your state program can confirm this.
  • Pregnant women and newborns typically have higher income limits than older children, so check your state's rules for pregnancy and birth coverage separately.
  • You will need to report your household income and family size; your state program will tell you within days or weeks whether your children are covered.
  • If your income changes or your family size changes, you can update your information at any time — you do not have to wait for an annual renewal.

How income limits work and what counts as household income

Your state Medicaid program looks at your household's gross monthly income — the money your family earns before taxes and deductions. The program compares that number to the federal poverty line and multiplies it by a percentage your state has chosen. If your income is below that result, your children are covered.

Household income includes wages from jobs, self-employment income, Social Security, unemployment benefits, and child support you receive. It does not include food stamps, housing assistance, or most tax refunds. Some states count child support differently, so ask your state program what counts and what does not.

If you are self-employed or your income varies month to month, most states will average your income over the past three months or use your most recent tax return. Tell the Medicaid office about your actual situation — they have seen variable income before and know how to handle it.

What to do if your income is above the limit

If your household income is above your state's Medicaid threshold, your children may still be covered through the Children's Health Insurance Program (CHIP). CHIP is a separate program that covers children in families earning too much for Medicaid but not enough to afford private insurance. Income limits for CHIP are higher than Medicaid — often 200% to 400% of the poverty line, depending on your state.

Some states run CHIP and Medicaid as one program, so you apply once and the office determines which program covers your children. Other states run them separately, and you may need to apply to CHIP if Medicaid denies you. Your state Medicaid office will tell you whether CHIP is available and how to apply.

If your income is above both Medicaid and CHIP, your children may be covered through your employer's health plan or you can purchase coverage on the health insurance marketplace. Some families may have access to for tax credits that lower the cost of marketplace plans based on household income.

How to report your information and what documents you need

You can apply for Medicaid through your state's online portal, by mail, in person at your local Medicaid office, or sometimes by phone. Most states have a website where you can start an application immediately. Search "[your state] Medicaid apply" to find the right link.

You will need to provide your household's names, dates of birth, Social Security numbers (or a statement that you do not have one), and proof of income. Proof of income can be recent pay stubs, a tax return, a letter from your employer, or a bank statement showing regular deposits. If you are unemployed, a statement from your state unemployment office counts.

You will also need to show proof of your state residency — a utility bill, lease, or ID with your current address. If you are applying for a newborn, bring the birth certificate. The Medicaid office will tell you exactly what documents they need; you do not have to guess.

How long approval takes and when coverage starts

Most states process Medicaid applications within 30 days. Some states are faster — as little as 7 to 10 days if you apply online and your documents are clear. A few states take longer if they need to verify information with your employer or another agency.

Coverage usually starts on the first day of the month in which you applied, though some states backdate coverage to the date you submitted your application. A few states cover newborns retroactively — meaning coverage goes back to the date of birth even if you apply weeks later. Ask your state program when your children' coverage will start.

You will receive a notice in the mail telling you whether your children are covered and what their coverage includes. Keep this notice — you will need it when you take your children to the doctor or pharmacy. If you are denied, the notice will explain why and tell you how to appeal.

What happens if your income or family size changes

You do not have to wait for an annual renewal to report changes. If your income increases, decreases, or your family size changes, contact your state Medicaid office right away. Some changes may end your children's coverage; others will not affect it.

If you get a job or your income goes up, your children's coverage may end if your household income now exceeds the limit. If you lose a job or your income drops, your children may become newly covered or move from CHIP to Medicaid. If you have another child, that child can be added to your case.

Most states let you report changes online, by phone, or by mail. The sooner you report a change, the sooner the program can update your coverage. If you do not report a change and it turns out your children were not actually covered, you could face bills from the doctor or hospital.

Medicaid coverage for children with disabilities or special health needs

Children with disabilities or chronic health conditions may be covered by Medicaid even if your household income is above the normal limit. Some states have a separate program called Medicaid for Individuals with Disabilities (MID) or a similar name. These programs look at the child's income and resources separately from the family's income.

If your child has a disability, ask your state Medicaid office whether they may have access to under a disability pathway. You will likely need medical documentation of the disability and proof of the child's own income (if any). The income limit for disability coverage is often much higher than for children in general.

Children with serious health conditions like cystic fibrosis, sickle cell disease, or cancer may also be covered through programs that do not count family income at all. These programs exist in most states but have different names. Your child's doctor or hospital social worker can help you find out whether your child qualifies.

Frequently Asked Questions

Do my children need to be citizens to get Medicaid?

In most states, no — children who are lawful permanent residents, refugees, or asylees can get Medicaid. Some states restrict coverage for certain immigrant children, and a few states have different rules. Contact your state Medicaid office with your children's immigration status and they will tell you whether they can be covered.

What if I do not have a Social Security number for my child?

You can still apply. Most states allow you to submit an application without a Social Security number and provide one later. Some states will issue a state ID number instead. Tell the Medicaid office that you do not have a number and ask what to do next.

Can my children stay on Medicaid if I get a job and my income goes up?

It depends on how much your income increases and your state's rules. Some states allow children to stay covered for a few months even if income goes above the limit. Others end coverage immediately. Contact your state Medicaid office before you start a new job so you know what will happen.

What if I was denied and I think the decision was wrong?

You have the right to appeal. The denial notice will explain how to file an appeal and the deadline — usually 30 to 60 days. You can appeal by mail, phone, or in person. Bring any new documents or information that shows why your children should be covered.

Do I have to renew my children's Medicaid every year?

Yes, most states require annual renewal. You will receive a notice in the mail telling you when to renew and how. You can renew online, by mail, or in person. If you do not renew by the deadline, your children's coverage will end, even if they still may have access to.