Medicaid requirements depend on your state, income, family size, and sometimes your age or disability status

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. The federal government sets a floor — states cannot go below it — but most states have set their own higher limits. Your state's Medicaid office is the only source that can tell you whether you meet that state's specific requirements.

The most common factors are income and family size. Most states use the federal poverty level as a starting point and then set their own percentage of it. A family of three in one state might may have access to at 138% of the federal poverty level, while another state uses 100%. Some states have expanded Medicaid to cover adults earning up to 138% of poverty; others have not. Your state's website will list its current income limits, usually broken down by family size.

Beyond income, you may also meet the requirements if you are pregnant, under 19, over 65, blind, or disabled. These categories often have different income limits than the general adult population. Some states cover pregnant people at higher income levels than they cover other adults. Children often have higher income thresholds than their parents.

Key Takeaways

  • Income limits and rules are set by your state, not by the federal government, so you must check your state's Medicaid office website or call their number to learn your state's specific requirements.
  • Most states use a percentage of the federal poverty level as the income cutoff, and that percentage varies widely — from 100% in some states to 138% or higher in others.
  • Pregnancy, age under 19, age over 65, blindness, and disability status can make you meet the requirements even if your income is above the general adult limit.
  • Citizenship or immigration status requirements vary by state; some states cover certain non-citizens while others do not.
  • Your state's Medicaid office can tell you in one conversation whether you meet the requirements based on your specific situation.

How income limits work and why they differ by state

The federal poverty level for 2024 is $14,580 per year for a single person and $30,000 for a family of four. Most states use this as a reference point but then multiply it by a percentage. A state that covers people at 138% of poverty would cover a single person earning up to about $20,120 per year. A state at 100% would cover only those earning up to $14,580.

States that have expanded Medicaid — which is optional under federal law — typically cover adults earning up to 138% of the federal poverty level. States that have not expanded cover a much narrower group, often only children, pregnant people, parents of young children, and people who are elderly or disabled. This means a working adult with no children might have no path to Medicaid in a non-expansion state, even at a low income.

Income is usually calculated as your household's gross monthly income before taxes. Some states count only earned income (wages); others count unearned income too (Social Security, child support, rental income). Some states have resource limits — meaning you cannot own more than a certain amount in savings or assets — while others do not. Your state's rules determine what counts and what does not.

Age and disability categories with their own income rules

If you are under 19, most states cover you at a higher income level than they cover adults. Some states cover children up to 200% or even 300% of the federal poverty level, even though the adult limit is much lower. This is a federal requirement: states must cover children in families earning up to at least 133% of poverty.

If you are pregnant, you may be covered at a higher income level than the general adult population in your state. Federal law requires states to cover pregnant people, but the income threshold varies. Some states cover pregnant people up to 185% of poverty; others use a lower percentage.

If you are 65 or older, blind, or disabled, you may meet the requirements under a separate category. These groups often have different income and resource limits than the general population. Disability is defined by Social Security standards in most states — meaning you must have a condition expected to last at least 12 months or result in death, and it must prevent you from working. You do not need to be receiving Social Security Disability Insurance (SSDI) to meet this definition, but the medical criteria are similar.

Citizenship and immigration status requirements

Federal law requires that you be a U.S. citizen or may have access to non-citizen to receive Medicaid in most cases. may have access to non-citizens include lawful permanent residents (green card holders), refugees, asylees, and certain other categories defined by immigration law. The rules are complex and vary by immigration status.

Some states have chosen to cover certain non-citizens using their own funds, beyond what federal Medicaid covers. A few states cover undocumented immigrants for emergency services or limited services. Your state's Medicaid office can tell you whether your immigration status makes you ineligible or whether your state has chosen to cover your category.

You will need to provide proof of citizenship or may have access to non-citizen status when you apply. This can be a birth certificate, passport, naturalization certificate, or other document. If you do not have proof, some states allow you to sign a declaration under penalty of perjury.

How to find your state's specific income limits and requirements

Your state's Medicaid office publishes its income limits and requirements on its website. Search for "[Your State] Medicaid income limits" or "[Your State] Medicaid requirements." Most state websites list the limits by family size and sometimes by category (children, pregnant people, elderly, disabled).

If you cannot find the information online, call your state's Medicaid office directly. The number is usually on the state health department website. Be ready to tell them your family size and ask whether you meet the income requirement for your state. They can also tell you about any special categories you might fall into — for example, if you are pregnant or disabled.

You can also contact 211, a free referral service, by dialing 2-1-1 from any phone or visiting 211.org. They can tell you your state's requirements and help you understand whether your situation might may have access to you.

What happens after you meet the income and category requirements

Meeting the income and category requirements is the first step, but it is not the only step. You will also need to provide proof of your income, family size, and citizenship or immigration status. Most states ask for recent pay stubs, tax returns, or a letter from your employer. If you receive benefits like Social Security or unemployment, you will need documentation of those.

Some states also check whether you have access to other insurance — for example, through an employer. If you do, you may be required to use that insurance first, or you may be ineligible for Medicaid. The rules vary by state and by the type of insurance.

Once you have submitted your information, your state's Medicaid office will make a information. This usually takes 30 to 45 days, though some states are faster. If you are found to meet the requirements, your coverage typically begins on the first day of the month in which you applied, or sometimes the first day of the following month.

Special situations: pregnancy, disability, and emergency coverage

If you are pregnant, you may be able to get coverage quickly even if you do not normally meet the income requirement. Many states have expedited processes for pregnant people. Some states cover pregnancy-related care even for people who do not meet other Medicaid requirements. Call your state's Medicaid office and mention that you are pregnant; they can tell you what is available.

If you are disabled but have not yet been approved for Social Security Disability Insurance, you can still apply for Medicaid under the disability category. You will need medical evidence of your condition, but you do not need to wait for a Social Security decision. Some states have programs specifically for working people with disabilities that allow you to earn more than the usual limit.

If you are in a medical emergency, some states cover emergency services through Medicaid even if you do not meet the regular requirements. This is called emergency Medicaid and is limited to the emergency itself, but it can prevent medical debt from an unexpected crisis. Ask your hospital or emergency room whether you are may be able to access.

Frequently Asked Questions

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

No. Most states cover people earning above the federal poverty level. Many states cover people up to 138% of poverty or higher. The exact threshold depends on your state and your family size. Check your state's Medicaid website or call their office to learn the specific limit.

If I work part-time, will I still may have access to?

It depends on how much you earn. Your income is what matters, not whether you work full-time or part-time. If your total household income is below your state's limit, you may may have access to. Some states also have work incentive programs that let you earn more and still keep Medicaid if you have a disability.

What if my income changes after I get Medicaid?

You must report changes in income to your state's Medicaid office. If your income rises above the limit, your coverage may end. If it drops, you may become may be able to access if you were not before. Most states allow you to report changes online, by phone, or by mail. The timing of when your coverage ends or begins depends on your state's rules.

Can I get Medicaid if I am not a U.S. citizen?

It depends on your immigration status. Lawful permanent residents, refugees, and asylees can usually get Medicaid if they meet the income requirement. Other non-citizens may not be may be able to access for federal Medicaid, though some states cover certain groups with state funds. Contact your state's Medicaid office with your immigration status to learn what you can access.

How do I prove my income when I apply?

Most states ask for recent pay stubs (usually the last two months), tax returns from the previous year, or a letter from your employer. If you receive benefits like unemployment or Social Security, bring documentation of those. If you are self-employed, bring tax returns and business records. Your state's Medicaid office will tell you exactly what documents they need.