Medicaid looks at your income, household size, citizenship status, and state of residence

Medicaid does not have a single set of rules. Each state runs its own program within federal guidelines, which means the income limit in one state may be much higher or lower than in another, and some states cover groups of people that others do not. To find out whether you meet your state's requirements, you need to know three things: your household income, how many people depend on that income, and which state you live in.

Most states use Modified Adjusted Gross Income (MAGI) to calculate whether you may have access to. MAGI is roughly your income from work, minus certain deductions. Some states use a different method called SSI-related rules, which apply mainly to elderly people and people with disabilities. The method your state uses affects what counts as income and what does not.

You must be a U.S. citizen or a may have access to immigrant to get Medicaid in most states. may have access to immigrants include people with a green card, refugees, asylees, and certain other visa holders. Undocumented immigrants are not covered by regular Medicaid in any state, though some states offer limited coverage for emergency care only.

Key Takeaways

  • Income limits vary by state and household size; a family of three might may have access to in one state but not another 50 miles away.
  • You must be a U.S. citizen or may have access to immigrant; most undocumented immigrants cannot get regular Medicaid coverage.
  • Your state counts income differently depending on whether you are applying as a working adult, a parent, a child, or a person with a disability.
  • The fastest way to learn your state's exact rules is to contact your state Medicaid office or use the federal finder at Healthcare.gov.
  • Income limits change each year, so a program that rejected you last year may cover you now.

How your state calculates income and sets the limit

Each state sets its own income threshold, expressed as a percentage of the Federal Poverty Level (FPL). The FPL changes every year. For 2024, the federal poverty line for a single person is roughly $15,000 per year; for a family of four, roughly $31,000. But your state's Medicaid limit might be 130% of the FPL, or 200%, or some other percentage — and it depends on which group you belong to.

A parent with children might may have access to at 138% of FPL in one state and 100% in another. A childless adult might may have access to at 138% in a state that expanded Medicaid under the Affordable Care Act, or not may have access to at all in a state that did not expand. A child might may have access to at 200% of FPL. An elderly person or someone with a disability might have a different limit altogether.

Income includes wages, self-employment earnings, Social Security, unemployment benefits, and some other sources. It does not include food stamps, housing assistance, or certain other benefits. Your state's Medicaid office can tell you exactly what counts in your situation.

Citizenship and immigration status requirements

To get Medicaid, you must be either a U.S. citizen or a may have access to immigrant. may have access to immigrants include people with a green card (lawful permanent residents), refugees, asylees, people granted withholding of removal, and certain other visa holders. If you are not sure whether your status qualifies, your state Medicaid office or a legal aid organization can tell you.

Some states offer limited Medicaid coverage to undocumented immigrants for emergency services only. California, Illinois, New York, and a few others cover emergency care, pregnancy-related care, or dialysis for undocumented residents. These programs have different names and different income rules. If you are undocumented, contact your state Medicaid office to ask what is available where you live.

How household size affects your income limit

Medicaid counts your household to calculate whether your income is low enough. Household usually means you and anyone you claim as a dependent on your tax return, plus your spouse if you are married. It does not include adult children who file their own taxes, roommates, or other unrelated people living with you.

The larger your household, the higher your income can be and still may have access to. A single person might have a limit of $18,000 per year, while a family of four might have a limit of $37,000. Your state publishes these limits each year. When you contact your state Medicaid office or use an online screening tool, you will enter your household size and income, and the tool will tell you whether you fall below the limit.

Different rules for different groups

Medicaid has separate income rules depending on who you are. Children often may have access to at higher income levels than adults — sometimes up to 200% of FPL or more. Parents and caretakers have one set of rules. Childless adults have another. Elderly people and people with disabilities may use SSI-related rules instead of MAGI rules, which can change what counts as income.

Pregnant people are treated as a separate group in most states and often have higher income limits than other adults. If you are pregnant, mention that when you contact your state Medicaid office, because you may may have access to even if you would not otherwise.

Some states have special programs for specific groups — for example, breast and cervical cancer screening programs, or coverage for people with HIV. Your state Medicaid office can tell you whether you fit into any of these categories.

How to find your state's specific rules

The fastest way to learn whether you meet your state's requirements is to contact your state Medicaid office directly. You can find the phone number and website through the federal Medicaid website at Medicaid.gov, which has a link to every state program. Many states also let you check your situation online without submitting a full form.

You can also use the federal screening tool at Healthcare.gov. Enter your state, household size, and income, and the tool will tell you whether you may be covered and direct you to your state program. This tool is free and does not require you to create an account.

If you need help understanding your state's rules or filling out forms, contact your local community health center or a legal aid organization. Many offer free help with Medicaid questions.

What happens after you provide your information

When you contact your state Medicaid office — by phone, mail, or online — you will be asked to provide proof of your income, citizenship, and household size. Proof of income might be recent pay stubs, a tax return, or a letter from your employer. Proof of citizenship might be a birth certificate, passport, or naturalization papers. Proof of household size is usually a list of names and dates of birth.

Your state will review this information and tell you whether you meet the income, citizenship, and other requirements. If you do, you will be told when your coverage starts. If you do not, you will be told why and what options may be available to you — for example, whether you can get coverage through your employer's plan or through the health insurance marketplace.

Income limits change every year, usually in January. If you were turned down in the past, you may now may have access to. It is worth checking again each year, especially if your income has changed.

Frequently Asked Questions

Does my income have to be below the poverty line to get Medicaid?

No. Most states set their Medicaid income limit higher than the federal poverty line — often at 130% to 200% of the poverty line, depending on your state and which group you belong to. A family of four might may have access to even if their income is $40,000 or more per year, depending on the state.

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

Self-employment income counts toward Medicaid. Your state will usually ask for your last tax return or profit-and-loss statement. If your income varies month to month, your state may average it over several months or use your most recent month as a snapshot. Ask your state Medicaid office how they handle variable income in your situation.

Do I have to be working to get Medicaid?

No. Medicaid is available to people who are not working, as long as their income is low enough. This includes children, elderly people, people with disabilities, and unemployed adults (in states that expanded Medicaid). You do not have to be looking for work or in a work program.

Can I get Medicaid if I have a green card but am not yet a citizen?

Yes. A green card holder is a may have access to immigrant and can get Medicaid if you meet your state's income and other requirements. You do not have to wait to become a citizen. Some states have a five-year waiting period for certain immigrants, but green card holders are usually exempt from this rule.

What if my state did not expand Medicaid?

In states that did not expand Medicaid, childless adults with no disabilities may not may have access to no matter how low their income is. You may be able to get coverage through the health insurance marketplace instead, where you might be able to get a subsidy to lower your monthly premium. Check Healthcare.gov to see what is available in your state.