Medicaid covers people based on income, family size, citizenship, and sometimes disability or age — but the exact rules depend on which state you live in

Medicaid is not one national program with one set of rules. Each state runs its own Medicaid program within federal guidelines, which means who can get coverage varies significantly by location. A person who qualifies in one state may not may have access to in another, even if their income and family situation are identical. Before you assume you do not may have access to, you need to check your specific state's rules.

The broadest categories are income-based coverage (for people below a certain income threshold), categorical coverage (for children, pregnant people, seniors, or people with disabilities), and coverage tied to specific life events like losing a job or having a baby. Most people get Medicaid through one of these routes, but the income limits and which groups are covered differ by state.

Key Takeaways

  • Income limits for Medicaid vary by state and family size; some states cover people earning up to 138% of the federal poverty line, while others stop at 100% or lower.
  • Children, pregnant people, and seniors often have separate income thresholds that are higher than the general adult limit in the same state.
  • You must be a U.S. citizen or may have access to immigrant to get Medicaid in most states, though a few states cover certain undocumented immigrants.
  • Disability status, age 65 or older, or recent job loss can make you may be able to access even if your income is above the standard limit in some states.
  • The only way to know if you may have access to is to check your state's Medicaid program directly, because rules change and vary too much to predict.

Income thresholds and how they work by state

Medicaid income limits are set as a percentage of the federal poverty line, which changes each year. The federal poverty line for 2024 is roughly $15,000 for a single person and $31,000 for a family of four, but Medicaid programs use percentages of this line rather than the exact dollar amount.

Some states cover people up to 138% of the federal poverty line (this is the standard for states that expanded Medicaid under the Affordable Care Act). Other states cover only up to 100% of the poverty line, and a few cover even less. For example, in a state with a 138% limit, a single person earning up to roughly $20,700 per year might may have access to, while in a 100% state, the limit would be around $15,000. Your state's Medicaid office publishes its current income limits, and they are the only source you should trust.

Income is calculated differently depending on your situation. If you are self-employed, Medicaid counts your net business income. If you receive unemployment benefits, child support, or Social Security, those count as income. Some types of income — like certain student loan disbursements or Supplemental Security Income (SSI) — may be treated differently, so ask your state program how they count your specific income sources.

Coverage for children and pregnant people

Children and pregnant people often have higher income limits than other adults in the same state. Many states cover children up to 200% or 300% of the federal poverty line, meaning a child in a family earning significantly more than the adult limit might still may have access to. Pregnant people typically have their own threshold, often higher than the general adult limit but lower than the child limit.

These higher thresholds exist because federal law requires states to cover children and pregnant people more broadly than other groups. If you have children or are pregnant, always check the specific income limit for that category in your state — it may be substantially different from the limit for a childless adult.

Citizenship and immigration status requirements

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, people granted asylum, refugees, and people with certain other immigration statuses. The specific list is long and technical, and immigration status changes frequently, so your state Medicaid office can tell you whether your status qualifies.

A small number of states cover certain undocumented immigrants — usually pregnant people, children, or seniors — but this is rare and state-specific. If you are undocumented, ask your state program directly rather than assuming you are ineligible; some states have separate programs for uninsured immigrants that may help you access care.

Disability and age-based coverage

People age 65 and older are covered by Medicare (the federal program for seniors), but Medicaid can pay some Medicare costs for low-income seniors. People under 65 with a disability recognized by Social Security may may have access to for Medicaid even if their income exceeds the standard limit, depending on the state. Blindness and certain other conditions also have their own coverage pathways in some states.

If you receive Supplemental Security Income (SSI) — a federal payment for people who are elderly, blind, or disabled and have very low income — you are automatically may be able to access for Medicaid in most states. If you receive Social Security Disability Insurance (SSDI) but not SSI, your state's rules determine whether you may have access to based on income and other factors.

Coverage tied to life changes

Some states cover people temporarily when they experience specific life events, even if they would not normally may have access to. Losing a job, having a baby, getting married or divorced, or losing other health insurance can trigger coverage in certain states. These pathways are called medically needy or spend-down programs in some states, meaning you can become may be able to access by incurring medical expenses that reduce your countable income.

The availability and rules for these programs vary widely. Some states have robust medically needy programs; others have none. If your income is slightly above your state's limit, ask whether your state has a spend-down program or whether a recent life change might make you may be able to access through a different pathway.

How to find your state's specific rules

The only reliable way to learn whether you may have access to is to contact your state's Medicaid program directly. You can find your state program through the Centers for Medicare & Medicaid Services (CMS) website, which lists each state's Medicaid office and phone number. Many states also have online screening tools that ask about your income, family size, and citizenship, and give you an answer in minutes.

When you contact your state program, have ready: your income from the past month or two, your family size, your citizenship or immigration status, and any information about disability or age. The staff can tell you whether you may have access to and what documents you need to provide. If you are told you do not may have access to, ask whether your state has other programs — some states have separate coverage for people just above the Medicaid limit, or for specific groups like pregnant people or children.

Frequently Asked Questions

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

No. Most states cover people earning above the poverty line — often up to 138% of it. The exact limit depends on your state and your family size. Check your state's program to learn the specific threshold.

If I work part-time, does that disqualify me?

No. Medicaid counts your total income, not your employment status. If your income from part-time work is below your state's limit, you can may have access to. Some states also have work incentive programs that let you earn a bit more and still keep coverage.

Can I get Medicaid if I am undocumented?

Most states do not cover undocumented immigrants through regular Medicaid, but a few cover pregnant people, children, or seniors regardless of status. Some states have separate programs for uninsured immigrants. Ask your state Medicaid office what options exist in your location.

What happens to my Medicaid if my income goes up?

If your income rises above your state's limit, you will lose Medicaid coverage. Most states give you a grace period or a month's notice before ending coverage. Some states have programs that let you keep partial coverage or transition to a different plan if your income increases slightly.

Do I have to reapply every year?

Yes, in most states. Medicaid requires annual renewal to confirm you still meet the income and other requirements. Your state will send you a renewal form, usually by mail or through an online portal. If you do not respond, your coverage ends, even if you still may have access to.