Medicaid may be able to access depends on your income, family size, and which state you live in

Medicaid is not one program with one set of rules. Each state runs its own Medicaid program within federal guidelines, which means the income limit that makes you ineligible in one state may make you may be able to access in another. Your household income is the main factor — but "household income" is calculated in a specific way, and it varies by the type of coverage you are seeking (regular Medicaid, pregnancy coverage, child coverage, or coverage for seniors and people with disabilities).

The fastest way to know whether you meet the income threshold is to contact your state Medicaid office directly or use your state's online screening tool. Both will ask you your income and family size and tell you whether you likely meet the income limit. This takes minutes and costs nothing. If you do not know your state Medicaid office, call 211 or search "[your state] Medicaid" plus "apply" or "contact".

Key Takeaways

  • Income limits for Medicaid vary by state and by category (children, adults, seniors, people with disabilities), so you must check your specific state's rules.
  • Household income is counted differently than your paycheck — it includes income from all household members and is calculated before taxes.
  • Some states expanded Medicaid to cover adults earning up to 138% of the federal poverty line; others have lower limits or do not cover non-elderly adults at all.
  • Your state Medicaid office or a 211 referral can screen you in minutes and tell you whether your income likely qualifies you.
  • Even if your income is too high for regular Medicaid, you may still be covered under a special category like pregnancy, disability, or being a caregiver.

How your income is counted for Medicaid

Medicaid counts gross household income, which means income before taxes are taken out. It includes wages, self-employment income, Social Security, unemployment benefits, child support, and some other sources. It does not include food stamps, housing vouchers, or certain other assistance.

Your household includes you, your spouse (if you are married), and any children under 19 who live with you. In some states and some situations, it may also include parents or other relatives you support. Medicaid will ask you to list everyone in the household and their income.

The income limit is expressed as a percentage of the federal poverty line. For 2024, the federal poverty line for a single person is about $15,000 per year; for a family of four, about $31,000. Each state sets its own limit — often 130%, 138%, or 200% of the poverty line, depending on the category and whether the state expanded Medicaid. A state that covers adults at 138% of poverty would cover a single person earning up to roughly $20,700 per year.

Income limits by state and category

The income limit you face depends on which category you fall into. States must cover children, pregnant people, and some seniors and people with disabilities. States that expanded Medicaid also cover non-elderly, non-disabled adults. States that did not expand cover adults only in narrow circumstances — usually only if they are parents of young children or have a disability.

Because limits vary widely, here are the real steps: First, identify which category you fall into (child, pregnant person, adult, senior, person with disability). Second, contact your state Medicaid office or use your state's online tool to learn that category's income limit. Third, compare your household income to that limit. Your state Medicaid office can do this comparison for you in one conversation.

A few states use different income counting rules for different programs. For example, some states count income differently for Medicaid than for CHIP (the Children's Health Insurance Program), even though both are run by the same office. Ask your state Medicaid office which rules apply to you.

Other factors beyond income

Income is the main gate, but Medicaid also checks citizenship and immigration status. You must be a U.S. citizen or a may have access to immigrant (which includes lawful permanent residents, refugees, and some other categories). Your state Medicaid office will ask for proof — usually a birth certificate, passport, or green card.

Medicaid also checks whether you are already covered by other insurance. If you have employer health insurance or Medicare, you may not be able to get Medicaid, or you may get it only to fill gaps. Tell your state Medicaid office about any other coverage you have.

Some states also have asset limits — meaning you cannot own more than a certain amount of money or property and still be covered. Asset limits vary by state and category. Your state Medicaid office will tell you if an asset limit applies to you.

Special categories that may cover you even if your income is too high

If your income is above the regular Medicaid limit for your state, you may still be covered under a special category. These include pregnancy (most states cover pregnant people at higher income limits than non-pregnant adults), disability (if you receive SSI or SSDI, or meet your state's disability rules), being a caregiver for a child or elderly person, or being a former foster youth. Each state defines these categories differently.

Ask your state Medicaid office whether you fit any special category. Even if you do not meet the income limit for regular Medicaid, you may meet it for one of these.

How to find your state's income limits

Your state Medicaid office publishes its income limits, but they are not always easy to find on a website. The most direct route is to call your state Medicaid office and ask: "What is the income limit for [your category] in my state?" They will give you a number and can tell you whether your household income is below it.

You can also search "[your state] Medicaid income limits" or "[your state] Medicaid may be able to access" online. Most state Medicaid websites have a page listing the limits by category and family size. If you cannot find it, call 211 and ask them to direct you to your state Medicaid office or to a local organization that helps people understand Medicaid.

Some states have online screening tools where you enter your income and family size and get an immediate answer about whether you likely meet the income limit. These tools do not make a final decision — your state Medicaid office does — but they give you a quick sense of where you stand.

What happens after you know your income qualifies you

Meeting the income limit is the first step, not the last. Your state Medicaid office will also verify your citizenship, check for other insurance, and confirm the information you provided. This verification usually takes two to four weeks. During this time, keep records of the documents you submitted.

If your state approves you, you will receive a Medicaid card or a notice telling you your coverage has started. Coverage usually begins on the first day of the month after you are approved, though some states backdate coverage to the month you applied. Your state Medicaid office will tell you the exact date.

Frequently Asked Questions

Does my income include my spouse's income if we are married?

Yes. Medicaid counts the income of both spouses in a married household, even if only one spouse is applying. If you are married and your spouse has income, that income counts toward the household total. If you are separated or divorced, your ex-spouse's income does not count.

What if my income changes after I am approved?

You must report income changes to your state Medicaid office. If your income rises above the limit, your coverage may end. If your income drops, you may become newly covered or your coverage may continue. Most states require you to report changes within 10 to 30 days. Your Medicaid office will tell you how to report.

Can I be covered by Medicaid if I have a job?

Yes. Medicaid covers working people whose income is below the state limit. Your job income counts toward that limit, but having a job does not disqualify you. Many people on Medicaid work full-time or part-time.

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

Self-employment income counts as household income. Medicaid usually uses your most recent tax return or your average income over the past few months to calculate what you earn. If your income is irregular, tell your state Medicaid office — they may average it over time or use a different method to count it fairly.

Do I have to be a citizen to get Medicaid?

You must be a U.S. citizen or a may have access to immigrant. may have access to immigrants include lawful permanent residents, refugees, asylees, and some other categories. Undocumented immigrants do not meet this requirement for regular Medicaid, though some states cover emergency services for anyone. Ask your state Medicaid office about your specific immigration status.