Medicaid covers people based on income, family size, citizenship, and sometimes disability or age

Medicaid is not one program with one set of rules. Each state runs its own Medicaid program within federal guidelines, so who gets covered depends partly on where you live. That said, most states follow similar categories: people below a certain income level, families with children, pregnant people, people over 65, and people with disabilities. Your state might cover you through one category but not another, or it might have expanded the program to cover more people than the federal minimum requires.

The first thing Medicaid checks is your household income. Each state sets its own income limit, but it is usually between 100% and 200% of the federal poverty line. For 2024, 100% of the poverty line for a single person is roughly $15,000 per year; for a family of four, roughly $31,000. Some states go higher, especially for children or pregnant people. Your income is measured before taxes, and it includes wages, Social Security, child support, and some other sources — but not food stamps or housing assistance.

You also have to be a U.S. citizen or a may have access to immigrant. may have access to immigrants include people with a green card, people granted asylum, and some other statuses. Undocumented immigrants do not may have access to for regular Medicaid in most states, though some states cover emergency services or pregnancy care regardless of status.

Key Takeaways

  • Income limits vary by state and by category (children, pregnant people, adults, seniors, disabled people), so you may may have access to in one state but not another.
  • You must be a U.S. citizen or a may have access to immigrant; most undocumented immigrants do not may have access to for regular Medicaid.
  • Household size matters: the same income might may have access to a family of four but not a single person, depending on your state's limits.
  • Some states expanded Medicaid to cover adults earning up to 138% of the poverty line; others did not, creating a gap where some people earn too much for Medicaid but too little for marketplace insurance.

Income limits by category and state

Medicaid has different income thresholds for different groups. Children often have the highest limits — many states cover children up to 200% of the poverty line or higher. Pregnant people and parents of young children usually have limits between 130% and 200% of poverty. Adults without children or disabilities have much lower limits in non-expansion states, sometimes as low as 0% to 10% of poverty, meaning they earn almost nothing and still do not may have access to.

In 2020, some states chose to expand Medicaid under the Affordable Care Act. Expansion states cover most adults earning up to 138% of the poverty line. Non-expansion states do not, which creates a coverage gap: you might earn too much for Medicaid but not enough to afford marketplace insurance without a subsidy. As of 2024, about 38 states have expanded Medicaid, but this number changes as states make policy decisions.

To find your state's exact income limits, contact your state Medicaid office or use the Medicaid.gov website, which lists each state's rules. Do not assume your income disqualifies you — the math is specific to your household size and your state.

Citizenship and immigration status requirements

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 resident), people granted asylum, refugees, people with a U visa (crime victim visa), people with a T visa (human trafficking victim visa), and some other statuses. If you have one of these statuses, you can usually get Medicaid the same way anyone else does.

Undocumented immigrants do not may have access to for regular Medicaid in most states. However, some states cover emergency medical services for undocumented people, and some cover pregnancy care or care for children regardless of status. A few states (California, Illinois, New York, and others) have expanded coverage to undocumented immigrants in certain age groups or categories. Check your state's rules directly, because this varies widely.

If you are not sure of your immigration status or how it affects your coverage, contact your state Medicaid office or a local legal aid organization. They can explain your options without reporting you to immigration authorities.

Age, disability, and other may have access to categories

Medicaid covers people over 65 automatically if they meet the income limit, regardless of disability status. People under 65 with a disability recognized by Social Security also may have access to in most states, even if their income is higher than the regular adult limit. You do not have to be receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) to may have access to on disability grounds — you just have to have a disability that Social Security would recognize.

Pregnant people and people in the postpartum period (usually up to 60 days after delivery, though some states extend this) may have access to in all states, with income limits that are usually higher than for other adults. Parents and caretakers of children under 18 may have access to in most states, with income limits that vary. Some states also cover people transitioning out of foster care, people leaving the criminal justice system, or people experiencing homelessness under special categories.

The category you fall into affects not just whether you may have access to, but sometimes what services you receive. For example, some states cover dental care for children but not adults, or cover vision care for seniors but not working-age adults.

How household size and income are counted

Your household includes you, your spouse if you are married, and your children under 19 (or sometimes 21, depending on the state). It does not usually include adult children, parents, or siblings, even if they live with you. Some states count income from all household members; others count only the income of the person applying and their spouse.

Income includes wages, self-employment income, Social Security, pensions, child support, and alimony. It does not include food stamps, housing assistance, or Supplemental Security Income (SSI). Some income is excluded entirely — for example, the first $65 per month of earned income is often not counted. If you are self-employed, your income is your gross revenue minus business expenses.

If your income fluctuates, Medicaid usually uses your income from the last month or the last three months, depending on your state. If you recently lost a job or had a major change in income, tell the Medicaid office — they may use a different time period or average.

Medicaid expansion and the coverage gap

Before the Affordable Care Act, Medicaid covered only certain groups: children, pregnant people, parents, seniors, and people with disabilities. In 2014, states were given the option to expand Medicaid to cover most adults earning up to 138% of the poverty line. This was optional, so some states did and some did not.

If you live in an expansion state and you are an adult earning up to 138% of poverty, you likely may have access to for Medicaid. If you live in a non-expansion state and you are an adult without children or a disability, you might not may have access to for Medicaid even if your income is very low. This is called the coverage gap. If you fall in the gap, you may be able to get a subsidy for marketplace insurance through Healthcare.gov, but the subsidy is only available if your income is above the Medicaid limit in your state.

As of 2024, the expansion states are: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, and Wyoming. This list changes as states make policy decisions.

Special situations: recent changes and temporary coverage

Medicaid has special rules for certain situations. If you recently lost your job or had a major drop in income, you may may have access to even if you would not normally. If you are experiencing homelessness, some states have expedited processes or waived documentation requirements. If you are leaving the foster care system, you may have extended coverage until age 26 in some states.

During the COVID-19 pandemic, states were required to keep people on Medicaid even if their income changed. This ended in 2023, and many people lost coverage. If you lost Medicaid coverage recently, check whether you still may have access to under your state's current rules — your income or family situation may have changed, or your state may have changed its rules.

Some states also offer Medicaid to people who are working but earning low wages, or to people with certain chronic conditions like HIV or tuberculosis, regardless of income. These programs have different names in different states. Contact your state Medicaid office to ask whether you may have access to for any special category.

Frequently Asked Questions

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

No. Most states set their income limits higher than the poverty line — often between 130% and 200% of poverty for children and pregnant people. Some expansion states cover adults up to 138% of poverty. Your state's specific limit depends on your age, family status, and whether your state expanded Medicaid.

If I am married, does my spouse's income count?

Yes. Medicaid counts your spouse's income as part of your household income, even if you file taxes separately. If you are applying for Medicaid and your spouse is not, their income still counts toward your household total.

Can I get Medicaid if I have a job?

Yes. Medicaid is based on income, not employment status. If your job pays low wages and your household income is below your state's limit, you can get Medicaid. Some states also have special programs for working people with disabilities or chronic conditions.

What happens if my income goes up after I get Medicaid?

If your income rises above your state's limit, you will lose Medicaid coverage. Most states give you a grace period of one or two months to report the change. After that, you may be able to get marketplace insurance with a subsidy, depending on your new income.

Do I have to be a permanent resident to get Medicaid?

No. You can be a refugee, asylee, or have a U visa or T visa and still may have access to. You do have to be a may have access to immigrant or a citizen. Undocumented immigrants do not may have access to for regular Medicaid in most states, though some states cover emergency services or pregnancy care.