Medicaid is based on income, household size, and sometimes disability or age — not on employment status

Whether you can get Medicaid depends on your state's rules, your household income, and sometimes your age or disability status. There is no single national Medicaid program; each state sets its own income limits and decides which groups of people it will cover. This means a person who qualifies in one state may not may have access to in another, even with the same income and family size.

The fastest way to learn about you may have access to is to contact your state Medicaid office directly or use your state's online pre-screening tool. Many states let you enter your income and household information without submitting a formal request, and you get an answer in minutes. If you do not know your state's website, call 211 (a free referral line) and ask for your state Medicaid office phone number.

Key Takeaways

  • Medicaid income limits vary by state and household size; you must check your specific state's rules, not national averages.
  • Most states now cover adults earning up to 138% of the federal poverty line, but some states have lower limits or do not cover working adults at all.
  • You will need to report your household income, size, and citizenship status; have recent pay stubs, tax returns, or a letter from your employer ready.
  • Your state Medicaid office or 211 can tell you in one call whether you likely may have access to, and they can walk you through the next steps.
  • If you are denied, you have the right to request a hearing to challenge the decision, and your state must tell you how to do this in writing.

Income limits and household size

Medicaid uses your household income — not just your own income — to decide whether you may have access to. Your household includes you, your spouse if you are married, and any children under 19 who live with you. Some states count other relatives; your state office can tell you exactly who counts.

The income limit depends on your state and your family size. Most states that expanded Medicaid cover adults earning up to 138% of the federal poverty line. For 2024, that means a single adult earning roughly $1,800 per month or a family of three earning roughly $3,800 per month could may have access to in an expansion state. However, some states have lower limits, and a few do not cover working-age adults without children or a disability. Your state Medicaid office has the exact numbers for your household size.

Income includes wages, self-employment earnings, Social Security, unemployment benefits, and child support. It does not include food stamps, housing vouchers, or most one-time payments. If your income changes during the month, report the change to your state Medicaid office; they may recalculate your status.

Who qualifies beyond income

Income is not the only factor. Most states must cover children under 19, pregnant people, and parents of dependent children if they meet the income limit. Many states also cover people over 65, people who are blind, and people with disabilities — sometimes with higher income limits than working-age adults without disabilities.

You must also be a U.S. citizen or a may have access to immigrant. may have access to immigrants include people with a green card, refugees, asylees, and some other visa holders. Your state Medicaid office can tell you whether your immigration status qualifies. If you are not sure, bring your immigration documents when you contact them.

Some states have separate Medicaid programs for specific groups — for example, a program for people with HIV, or a program for pregnant people. Your state office can tell you whether you fit into any of these groups and whether they have different income limits.

What documents to gather before you contact your state office

Have your household income information ready. This means recent pay stubs (usually the last two months), a tax return from the past year, or a letter from your employer stating your income. If you are self-employed, bring your most recent tax return and a record of income for the current month. If you receive benefits like Social Security or unemployment, bring the letter or statement showing the amount.

You will also need proof of your household size and relationships. A birth certificate, marriage certificate, or custody order works. You need proof of citizenship or immigration status — a birth certificate, passport, green card, or visa. Some states also ask for proof of residency, such as a utility bill or lease in your name.

You do not need to have all of these documents before you call or start an online application. Your state office will tell you exactly what they need, and you can submit documents later. However, having them ready speeds up the process.

How to start the process

Contact your state Medicaid office by phone, mail, or online application. Most states have a website where you can start an application or check whether you likely may have access to without submitting anything formal. The website address is usually your state name plus "medicaid.gov" — for example, "california.medicaid.gov" — but search "[your state] Medicaid" to be sure.

If you prefer to call, dial 211 and ask for your state Medicaid office phone number. They will transfer you or give you the number. When you call, have your income information and household details ready. The office will ask you questions and may tell you on the spot whether you likely may have access to.

If you apply online, the process usually takes 15 to 30 minutes. You enter your household size, income, and citizenship status. Some states give you a result immediately; others mail you a decision within two to four weeks. If you are approved, your state will tell you when coverage starts — usually the first day of the month after approval, but sometimes the same day.

What happens if you are denied

If your state denies your request, they must send you a written notice explaining why. Read it carefully. Common reasons include income too high, missing documents, or not meeting your state's rules for your age or family status.

You have the right to request a hearing to challenge the decision. The notice will tell you how to request one — usually by phone or mail within 30 to 60 days. At a hearing, you can present new information or documents and explain why you think the decision was wrong. You do not need a lawyer, though you can bring one.

If your income or household situation changes after a denial, you can apply again. Some people are denied the first time because they did not report all household members or because their income was slightly over the limit; a change in circumstances can lead to approval on a second application.

Medicaid coverage after approval

Once you are approved, your state will send you a Medicaid card or tell you how to access your coverage online. Coverage usually starts on the first day of the month after approval. You can use your card at any doctor, hospital, or pharmacy that accepts Medicaid in your state.

You must report changes to your state Medicaid office: a new job, a change in income, a move, or a change in household size. If you do not report changes, your coverage could be canceled. Most states let you report changes online, by phone, or by mail.

Your coverage continues as long as you remain under the income limit and meet your state's other rules. Your state will send you a renewal notice, usually once a year, asking you to confirm your information. If you do not respond, your coverage may be canceled.

Frequently Asked Questions

What if I work but my income is too high for Medicaid?

Some states have programs for working people with higher incomes, such as Medicaid for people with disabilities who work. Your state Medicaid office can tell you whether you fit into any of these groups. You can also look into the Marketplace (healthcare.gov), where you may be able to buy insurance with a tax credit that lowers your monthly cost.

Can I get Medicaid if I am not a citizen?

It depends on your immigration status. Refugees, asylees, and people with a green card usually may have access to. Some visa holders also may have access to. Undocumented immigrants do not may have access to for regular Medicaid in most states, though some states cover emergency care or pregnancy. Call your state Medicaid office with your immigration documents to find out what you can access.

How long does it take to get approved?

Most states aim to make a decision within 30 days of receiving a complete application. Some states are faster — a few can approve you the same day you apply online. If your state asks for more documents, the clock may restart. Call your state office to ask how long their current wait time is.

What if my income changes after I am approved?

Report the change to your state Medicaid office right away. If your income goes up, your coverage may end or your cost-sharing may increase. If your income goes down, you may become may be able to access for more help. Your state will recalculate your status and send you a new notice.

Can I have both Medicaid and Medicare?

Yes. If you are 65 or older or have a disability, you may may have access to for both. People with both are called "dual may be able to access." Your state Medicaid office can tell you whether you may have access to for both programs and how they work together to cover your care.