Medicaid requirements vary by state, but most programs look at income, household size, citizenship status, and whether you fall into a category the program covers

Medicaid is run by each state, not by the federal government, so the rules that matter to you depend on where you live. Every state must cover certain groups — children, pregnant people, parents of dependent children, and people over 65 — but the income limits and other requirements differ. Some states have expanded Medicaid to cover more working-age adults; others have not. Before you look at any specific requirement, you need to know which state's rules apply to you.

The basic things Medicaid programs check are: your income compared to the federal poverty line (adjusted for your household size), whether you are a U.S. citizen or may have access to immigrant, whether you are currently incarcerated, and whether you fit into a category the program is required or allowed to cover. You will need to report these facts when you contact your state Medicaid office or apply through your state's online portal.

Key Takeaways

  • Income limits are set by each state and are based on the federal poverty line adjusted for household size; your state Medicaid office can tell you the exact limit that applies to you.
  • You must be a U.S. citizen, national, or may have access to immigrant with a valid Social Security number or Individual Taxpayer Identification Number to be covered.
  • Medicaid covers different groups depending on your state: children, pregnant people, parents, seniors, and in some states working-age adults without dependents.
  • Your state Medicaid office is the only place that can tell you whether you meet the requirements; you can find it by searching "[your state] Medicaid" or calling 211.

Income limits and household size

Medicaid measures income against the federal poverty line, which changes each year and is different for each household size. A single person has a lower limit than a family of four. Your state takes your household's total monthly income and compares it to the poverty line for your household size. If you are below that line (or a percentage of it set by your state), you may meet the income requirement.

The exact percentage varies by state and by which group you fall into. For example, one state might cover children up to 200 percent of the poverty line but parents only up to 100 percent. Another state might cover working-age adults up to 138 percent of the poverty line if it has expanded Medicaid. You cannot know whether your income qualifies without checking with your state Medicaid office or using your state's online screening tool.

Income includes wages, self-employment earnings, Social Security, unemployment benefits, and child support. It does not include food stamps, housing assistance, or some other government benefits. Your state will ask you to report your income for the past month or the past three months, depending on the program.

Citizenship and immigration status

You must be a U.S. citizen or national to be covered by Medicaid in most cases. If you are not a citizen, you may still be covered if you are a may have access to immigrant — a term with a specific legal meaning. may have access to immigrants include people with a green card, people granted asylum, refugees, and some other categories defined by federal law. You will need to provide proof of your status, usually a green card, passport, or other immigration document.

You must also have a valid Social Security number or an Individual Taxpayer Identification Number (ITIN). If you do not have either, your state Medicaid office can tell you how to get one or whether you can apply for Medicaid while you are waiting.

Undocumented immigrants are not covered by regular Medicaid in any state, though some states offer limited coverage for emergency services only. A few states cover pregnant people or children regardless of immigration status through separate programs; check with your state Medicaid office to learn what is available where you live.

Age and family status categories

Medicaid covers different groups depending on your state. Every state must cover children under 19 whose family income is below a certain level (usually higher than the level for adults). Every state must also cover pregnant people and parents of dependent children whose income is below the state's limit, though that limit varies widely — some states set it very low.

People age 65 and older are covered if their income is low enough, regardless of whether they have worked. Blind and disabled people of any age may be covered under a separate program called SSI-related Medicaid, which has its own income and resource limits.

In states that have expanded Medicaid, working-age adults without dependent children may also be covered if their income is below 138 percent of the poverty line. In states that have not expanded, this group is usually not covered by Medicaid at all, even if their income is very low. You can find out whether your state has expanded Medicaid by calling your state Medicaid office or searching "[your state] Medicaid expansion."

Resources and assets

Most Medicaid programs do not count how much money you have in the bank or what you own, as long as your income is low enough. However, SSI-related Medicaid — the program for blind and disabled people — does have resource limits. You cannot have more than $2,000 in countable resources as a single person or $3,000 as a couple. A home you live in, a car you use, and household goods do not count toward this limit, but savings accounts and investments do.

If you are applying for regular Medicaid (not SSI-related), your state will not ask about your savings or assets. If you are applying for SSI-related Medicaid, bring documentation of your bank accounts, investment accounts, and any other money or property you own.

Citizenship verification and documentation

When you contact your state Medicaid office or apply online, you will be asked to provide proof of your identity, income, and citizenship or immigration status. Bring documents like a driver's license or passport, recent pay stubs or tax returns, and proof of citizenship (birth certificate, passport, or naturalization papers) or proof of may have access to immigrant status (green card or asylum approval letter).

Your state may verify some information electronically — for example, by checking with the Social Security Administration or the IRS — so you may not need to provide every document in person. However, if your state cannot verify something electronically, it will ask you to send or bring the document. Keep copies of everything you submit.

How to find your state's specific requirements

The fastest way to learn what you need is to contact your state Medicaid office directly. Search "[your state] Medicaid" online to find the phone number and website, or call 211 and ask for your state Medicaid office. You can also use your state's online screening tool, which will ask you questions about your income, household size, and situation and tell you whether you may be covered.

Your state Medicaid office can also tell you whether your state has expanded Medicaid, what the current income limits are, and what documents you will need to bring. Rules change, so calling or checking the official website is more reliable than information you find elsewhere.

Frequently Asked Questions

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

Not always. Your state sets its own income limit, which is usually a percentage of the poverty line. Some states cover people up to 138 percent of the poverty line; others cover only people below 100 percent. Call your state Medicaid office to learn the exact limit for your situation.

Can I get Medicaid if I have a job?

Yes. Medicaid is based on income, not on whether you work. If your wages are low enough to meet your state's income limit, you may be covered. Some states have programs that help working people keep Medicaid even as their income rises slightly.

What if I am not a citizen but have been in the U.S. for many years?

Length of time in the U.S. does not matter for Medicaid. You must be a citizen or a may have access to immigrant with valid immigration status. If you are unsure whether you are a may have access to immigrant, bring your immigration documents to your state Medicaid office and ask.

Do I have to report my savings account?

For regular Medicaid, no. Your state only looks at income. If you are applying for SSI-related Medicaid (for blind or disabled people), you must report savings and other resources, and you cannot have more than $2,000 as a single person.

Can I apply for Medicaid if I am already on Social Security?

Yes. Social Security income counts as income for Medicaid, but if your Social Security payment is low enough, you may still meet your state's income limit. Contact your state Medicaid office to find out.