How Medicaid may be able to access works

Medicaid is a joint federal and state program, which means each state sets its own income limits, asset rules, and coverage categories. There is no single national threshold. A person who meets Medicaid rules in one state may not meet them in another. You need to check your specific state's rules, not a general national standard.

Most states use income as the primary measure. They compare your household income to the federal poverty level and set a percentage — often 138% of poverty for adults, though some states go lower and a few go higher. Some states also count assets (savings, property, vehicles) and look at family size, age, disability status, or pregnancy. A few states have different rules for different groups of people within the same state.

The fastest way to learn whether you meet your state's rules is to contact your state Medicaid office directly or use your state's online screening tool. Both can tell you in minutes whether your income and household situation fit. Many states also accept phone calls and mail applications.

Key Takeaways

  • Each state sets its own Medicaid income limits and rules, so you must check your state's specific requirements, not national averages.
  • Most states use household income compared to the federal poverty level, but some also count savings, property, and other assets.
  • Your state Medicaid office or your state's online screening tool can tell you in minutes whether you meet the income and asset rules.
  • Medicaid covers different groups — children, pregnant people, parents, elderly people, and people with disabilities — and each group may have different income limits in your state.
  • If your income changes or you lose a job, you may become newly covered, and you can report the change at any time during the year.

Income limits vary by state and by category

The federal poverty level for 2024 is roughly $15,000 per year for a single person and $31,000 for a family of four, though these figures change yearly. Most states cover adults at 138% of that level, which would be about $20,700 for one person. But some states cover adults at only 100% of poverty, and a handful cover at higher percentages. Texas, Florida, and Georgia have some of the lowest income limits in the country; Vermont, New York, and California have some of the highest.

Within a single state, different groups often have different limits. A state might cover children up to 200% of poverty, pregnant people up to 185%, and non-disabled adults with no children at only 100%. Elderly people and people with disabilities may have separate income rules. You need to know which category you fall into and what that category's limit is in your state.

Your state Medicaid office publishes these limits and updates them yearly. You can find them on your state health department website or by calling your state Medicaid line. Many states also have online income calculators that let you enter your household size and income and see instantly whether you fall below the limit.

Asset limits and what counts as income

Some states count not just income but also assets — money in the bank, property you own, vehicles, and investments. Asset limits vary widely. Some states have no asset limit at all. Others set a limit of $2,000 for an individual or $3,000 for a couple. A few states have higher limits. Your state Medicaid office can tell you whether your state counts assets and what the limit is.

Income itself is defined narrowly. Wages, salary, and self-employment income count. So do Social Security, unemployment benefits, child support, and alimony. But not all money counts as income. Gifts, tax refunds, and money from selling an asset usually do not. Some states exclude the first $20 or $65 of monthly income. If you receive irregular income or have questions about whether a specific payment counts, ask your state Medicaid office before you report it.

Household size matters too. If you live with a spouse or dependent children, their income counts toward your household total. If you live alone, only your income counts. Some states count income from adult children or parents living in the home; others do not. Your state office can clarify who counts as part of your household for Medicaid purposes.

Special rules for children, pregnancy, and disability

Children often have higher income limits than adults. Many states cover children in households earning up to 200% of poverty, even if the adult limit is lower. Pregnant people are usually covered at a higher threshold than non-pregnant adults. Some states cover pregnant people at 185% or 200% of poverty regardless of other circumstances.

People who are blind, disabled, or over 65 may have different income and asset rules than working-age adults without disabilities. Some states use a higher income limit for these groups. Others use the same limit but count assets differently or allow certain assets not to count — for example, a home or a vehicle used for work. If you are disabled or elderly, tell your state Medicaid office when you report your income, because you may may have access to under a separate category with better terms.

Parents and caretakers of children may also have a separate category with its own income limit. If you are raising a child and your income is below your state's parent limit, you may be covered even if you would not be covered as a single adult. Again, your state office can explain which category applies to you.

How to find your state's specific rules

Your state Medicaid office is the authoritative source. You can find it by searching "[Your State] Medicaid" or by visiting your state health department website. Most state offices have a phone line, a mailing address, and an online portal. Some states use a single statewide office; others route applications through county offices. The state website will tell you which.

Many states offer an online screening tool. You enter your household size, income, and age, and the tool tells you whether you likely meet the income limit. This is not a formal information, but it gives you a quick answer. If the tool says you may be covered, you can then submit a full report to your state office.

You can also call 211 (a free helpline in most states) and ask for your state Medicaid office contact information. 211 staff can also answer basic questions about your state's rules and may be able to help you start the process. Some community health centers and legal aid offices also have staff who know your state's Medicaid rules and can answer questions over the phone.

What happens after you report your income

Once you report your income and household information to your state Medicaid office, they will compare it to your state's limit for your category. If you are below the limit, you will be covered. If you are above it, you will not be, unless your state has a waiver or special program that covers people at higher income levels. Your state office will send you a written notice explaining the decision.

If you are covered, your state will issue you a Medicaid card or number. You can use it at any doctor, hospital, or pharmacy that takes Medicaid in your state. Coverage usually starts on the first day of the month in which you reported, though some states backdate coverage a few months if you were may be able to access earlier and did not know.

If your income changes — you get a job, lose a job, get a raise, or have a major life change — you can report the change to your state Medicaid office at any time. If your new income is lower, you may become covered or stay covered. If your new income is higher, you may lose coverage, but your state will give you advance notice before ending it.

Frequently Asked Questions

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

Yes, in most states. Your spouse's income is counted as part of your household income, even if your spouse does not report it separately. If you are applying for Medicaid, you will need to report your spouse's income too. Some states have different rules for elderly or disabled people; ask your state office if you are in that category.

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

Self-employment income counts toward your Medicaid income limit. Your state will usually ask you to report your net income (income minus business expenses) from the past year or an average of recent months. If your income is very irregular, ask your state office how they calculate it — some average over several months, others use the most recent month, and practices vary by state.

Can I be covered if I am undocumented?

Most states do not cover undocumented immigrants under regular Medicaid, with a few exceptions. Some states cover emergency services only. A small number of states cover undocumented immigrants at state expense. Your state Medicaid office can tell you what your state covers. Immigration status is separate from income and asset rules.

What if I do not have proof of my income?

Your state Medicaid office can work with you if you do not have pay stubs or tax returns. You can provide a signed statement about your income, ask your employer to write a letter, or show bank deposits. Some states accept a verbal statement if you sign a form saying it is true. Contact your state office to ask what proof they will accept for your situation.

If I am denied, can I appeal?

Yes. Your state will send you a written notice explaining why you were denied and how to appeal. You have a right to request a hearing where you can present more information. The appeal process and timeline vary by state, but you usually have 30 to 60 days to request one. Your state Medicaid office notice will explain the deadline and how to request a hearing.