Medicaid covers people in specific groups, and which groups your state covers depends on state law

Medicaid is not one program — it is a joint federal and state program, which means your state decides who it covers within federal guidelines. Every state must cover certain groups: children under 19, pregnant people, parents of dependent children, elderly people with low income, and people with disabilities. Beyond those groups, states vary widely. Some states cover childless adults with low income; others do not. Some cover people earning up to 138 percent of the federal poverty line; others stop at 100 percent or lower.

The only way to know whether you fall into a group your state covers is to check your state's Medicaid rules directly or contact your state Medicaid office. Income limits, asset limits, and citizenship rules all differ by state. A person who qualifies in one state may not may have access to in another, even if their income and family situation are identical.

Key Takeaways

  • Every state must cover children under 19, pregnant people, parents of dependent children, elderly people with low income, and people with disabilities, but income and asset limits vary by state.
  • Many states also cover childless adults with low income, but not all — your state's rules determine whether you fall into a covered group.
  • Your state Medicaid office or your state's Medicaid website is the only source that can tell you whether you meet your state's rules.
  • Medicaid covers inpatient hospital care, outpatient services, doctor visits, prescription drugs, and long-term care, though which services are covered and how much you pay varies by state.

The groups every state must cover

Federal law requires every state to cover children under 19 whose family income is at or below 133 percent of the federal poverty line. Most states cover children at higher income levels than that. A state may also cover children in foster care and children adopted from foster care.

Pregnant people are covered through the end of the month after the pregnancy ends, regardless of whether the pregnancy resulted in a live birth. Income limits for pregnant people are often higher than for other adults in the same state.

Parents and caretakers of dependent children are covered if their income falls below their state's limit. That limit varies: some states set it at 100 percent of the federal poverty line, others at 200 percent or higher. If you are the parent or legal guardian of a child under 18 or 19 (depending on your state), you may fall into this group.

Elderly people — usually defined as 65 and older — are covered if their income and assets fall below state limits. Asset limits are typically low: many states allow no more than $2,000 in countable assets for a single person, though the rules for what counts as an asset are complex.

People with disabilities are covered if they receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), or if they meet your state's separate disability rules. Some states use SSI income and asset limits; others are more generous. Blindness and specific medical conditions may also may have access to you.

Groups your state may choose to cover

States have the option to cover other groups beyond the federally required ones. The most common optional group is childless adults with low income. As of 2024, most states have chosen to cover this group, but not all. If you are an adult without dependent children and your income is low, you need to check whether your state covers you.

Some states also cover people who are medically needy — people whose income is above the limit but whose medical bills are high enough that they spend down to the limit. The rules for medical need are state-specific and often complicated.

A few states cover transitional groups — for example, people who recently lost Medicaid because their income rose slightly, or people leaving the foster care system. These programs exist in some states but not others.

What services Medicaid covers

Every state Medicaid program must cover certain core services: inpatient hospital care, outpatient hospital services, emergency services, physician services, laboratory and X-ray services, and family planning services. Most states also cover prescription drugs, though the list of covered drugs and any copayments you owe vary by state.

Many states cover additional services that are not federally required: dental care, vision care, hearing aids, mental health services, substance use treatment, and physical therapy. Some states cover these services for all Medicaid members; others cover them only for certain groups, such as children or pregnant people.

Long-term care — nursing home care or home and community-based services for elderly people and people with disabilities — is covered by Medicaid in every state, but the rules for who qualifies and how much you must pay toward your care vary significantly. Some states have waiting lists for home and community-based services.

Income and asset limits vary by state and by group

Medicaid income limits are expressed as a percentage of the federal poverty line, which changes each year. For 2024, the federal poverty line for a single person is approximately $14,600 per year; for a family of three, approximately $30,000. Your state's limit might be 100 percent of that line, 133 percent, 200 percent, or another figure entirely, depending on which group you fall into and which state you live in.

Asset limits — the amount of money and property you can own and still may have access to — also vary. For elderly people and people with disabilities, many states allow $2,000 in countable assets for a single person and $3,000 for a couple. However, certain assets do not count: your home, your car, household goods, and life insurance policies typically do not count toward the limit. The rules for what counts are complex and state-specific.

Income and assets are counted differently depending on your situation. If you are married, your spouse's income may or may not count, depending on your state and your circumstances. If you receive Social Security, part of it may be excluded from your income count. If you have a job, some of your earnings may be excluded. You cannot determine whether you meet the limit without checking your state's specific rules.

Citizenship and immigration status requirements

Medicaid is available only to U.S. citizens and certain immigrants. U.S. citizens and nationals are always covered if they meet the other rules for their group. Lawful permanent residents (green card holders) are covered in most states. Refugees and asylees are covered for their first year in the United States, and many states cover them longer.

Undocumented immigrants are not covered by regular Medicaid in most states, though some states cover emergency services only. A few states cover undocumented immigrants more broadly. If you are unsure of your immigration status or how it affects your coverage, contact your state Medicaid office.

How to find out whether your state covers you

Your state Medicaid office maintains a website with income limits, asset limits, and covered groups for your state. You can find your state office through the Centers for Medicare & Medicaid Services (CMS) website, which lists contact information and links for all 50 states. Your state's website will also explain how to report your income and assets if you think you meet the rules.

You can also contact your state Medicaid office by phone or in person. Many states have local offices in each county. If you are unsure whether you meet the rules, the office can walk you through the process and tell you what information you will need to provide.

Frequently Asked Questions

Does Medicaid cover my spouse if I am covered?

Not automatically. Your spouse must meet the rules for a covered group in your state. If your spouse is a parent of your dependent child, they may may have access to as a parent/caretaker. If they are elderly or disabled, they may may have access to under those groups. If they are a childless adult and your state does not cover that group, they would not be covered even though you are.

If my income goes up, do I lose Medicaid immediately?

No. Most states have a process called a "continuous may be able to access period" during which you stay covered even if your income rises, usually for 12 months. After that period ends, your coverage is reviewed. The exact rules depend on your state and which group you are in, so check with your state office about your situation.

Can I have Medicaid and Medicare at the same time?

Yes. People who are elderly or disabled may may have access to for both. When you have both, Medicare is your primary insurance and Medicaid covers some costs Medicare does not, such as long-term care and some copayments. You are sometimes called a "dual may be able to access."

Does Medicaid cover people who are homeless?

Medicaid does not have a separate homeless category, but homeless people can may have access to under the same groups as anyone else — as a parent, elderly person, person with a disability, or childless adult if your state covers that group. Homelessness itself does not disqualify you, and some states have outreach programs to help homeless people understand their options.

What if I am a student — does that affect my Medicaid coverage?

Being a student does not disqualify you. If you are under 19, you are covered under the child group if your family income meets the limit. If you are an adult, you may have access to under whichever group applies to you — parent, elderly, disabled, or childless adult if your state covers it. Your student status does not change the income or asset rules.