Medicaid covers people based on income, family size, age, disability status, and pregnancy — but the exact rules depend on which state you live in

Whether you can receive Medicaid is determined by your state's Medicaid program, not by a single national standard. Each state sets its own income limits, decides which groups of people it covers, and runs its own enrollment process. A person who qualifies in one state may not may have access to in another. The fastest way to find out what your state requires is to contact your state Medicaid office directly or use the federal Medicaid website to locate it.

Medicaid is jointly funded by the federal government and individual states, which is why the rules vary so much. The federal government sets a floor — certain groups that states must cover — but states can choose to cover more people and set higher income limits if they want to. Some states have expanded Medicaid to cover more adults; others have not. This means your income, family situation, and state of residence all matter.

Key Takeaways

  • Income limits and covered groups vary by state, so you need to check your specific state's rules rather than relying on national averages.
  • Most states cover children, pregnant people, parents of dependent children, and people over 65 or with disabilities, but income thresholds differ.
  • Some states have expanded Medicaid to cover adults earning up to 138% of the federal poverty level; others have not.
  • Your state Medicaid office or a local community health center can tell you in one conversation whether you meet your state's requirements.

Income limits and family size

Medicaid looks at your household income and compares it to the federal poverty level for your family size. Each state then sets its own income limit as a percentage of that poverty level. For example, one state might cover a single adult earning up to 100% of the poverty level, while another covers adults earning up to 138% of the poverty level. A family of three in one state might have a different income limit than a family of three in another state.

Your household income includes wages, self-employment income, Social Security, unemployment benefits, and some other sources. It does not include certain things like food stamps (SNAP) or housing assistance. When you contact your state Medicaid office, they will ask you for your household size and recent income — usually your last two months of pay stubs or tax returns — so they can compare it to your state's specific limit.

Who states must cover

Federal law requires every state to cover certain groups. These include children under 19 in households earning up to 138% of the federal poverty level, pregnant people and new parents (usually for 60 days after birth), people over 65, and people who receive Supplemental Security Income (SSI) because of disability or age. States must also cover people who are medically needy — meaning they have high medical bills that reduce their countable income below the state limit.

Beyond these required groups, states have the option to cover more people. The biggest difference between states is whether they have expanded Medicaid to cover non-elderly, non-pregnant adults. States that have expanded cover adults earning up to 138% of the federal poverty level. States that have not expanded typically only cover adults if they are parents of dependent children, and even then the income limits are often much lower. You can find out whether your state has expanded Medicaid by asking your state Medicaid office or checking the federal Medicaid website.

Disability and SSI

If you receive Supplemental Security Income (SSI) because you have a disability or are over 65, you are automatically covered by Medicaid in most states. SSI is a federal cash benefit program run by Social Security, and Medicaid may be able to access is tied to it. If you receive SSI, you do not need to apply to Medicaid separately — your state will enroll you automatically or you can contact your state Medicaid office to confirm your coverage.

If you have a disability but do not receive SSI, you may still may have access to for Medicaid under your state's rules for people with disabilities. Income limits for disabled adults vary by state. Some states use the SSI income limit (currently $943 per month for an individual, though this changes yearly); others use higher limits. Your state Medicaid office can tell you whether your income and disability status meet your state's requirements.

Pregnancy and new parents

Every state must cover pregnant people and people who have recently given birth. The income limits for pregnant people are often higher than for other adults in the same state. Coverage for new parents typically lasts 60 days after the birth, though some states extend it longer. If you are pregnant or have recently given birth, contact your state Medicaid office or a local community health center to find out your state's specific income limit and how long coverage lasts.

Children born to a parent covered by Medicaid are usually automatically covered for the first year of life, even if the parent's income changes. After that, the child's coverage depends on the child's own income and your state's rules for children. Your state Medicaid office can explain what happens to your child's coverage after the first year.

Immigration status and citizenship

Medicaid is generally only for U.S. citizens and certain immigrants with legal status. Lawful permanent residents (green card holders) are usually covered. Refugees and asylees are covered for their first year in the United States. Undocumented immigrants are not covered by regular Medicaid in most states, though some states offer limited emergency Medicaid or state-funded programs for undocumented people.

If you are not a U.S. citizen, bring proof of your immigration status when you contact your state Medicaid office. They can tell you whether you meet your state's citizenship or immigration requirements. Some states have additional programs for immigrants who do not may have access to for regular Medicaid, so it is worth asking.

How to find out what your state requires

The most direct way to learn your state's requirements is to contact your state Medicaid office. You can find the phone number and website through the federal Medicaid website, which has a state-by-state directory. When you call, have your household size and recent income information ready. The staff can tell you in one call whether you meet your state's income and other requirements.

You can also visit a local community health center, hospital, or social services office. Staff there often know your state's Medicaid rules and can point you toward the right application process. Some community organizations also help people understand whether they meet their state's requirements and guide them through the next steps.

Frequently Asked Questions

Does Medicaid cover everyone below the poverty line?

No. Medicaid covers certain groups — children, pregnant people, parents, seniors, and people with disabilities — but not all low-income people. Even within those groups, income limits vary by state. Some states cover adults earning up to 138% of the poverty level; others only cover parents earning much less. Your state's specific rules determine who is covered.

What if my income is just above my state's limit?

If your income is slightly above the limit, you may still have other options. Some states have programs for people just above the Medicaid limit, or you may be able to reduce your countable income by deducting certain expenses. Contact your state Medicaid office to ask whether there are other programs you might may have access to for or whether any deductions could lower your countable income.

Do I have to be unemployed to may have access to?

No. Medicaid is based on income level, not employment status. You can be working full-time and still may have access to if your income is below your state's limit. Self-employed people, part-time workers, and full-time workers all can may have access to depending on their total household income and their state's rules.

How long does it take to learn about I may have access to?

Contacting your state Medicaid office by phone usually gives you an answer in one call if you have your income information ready. The formal application process typically takes 30 to 45 days, but you can get a preliminary answer much faster by calling or visiting in person.