Medicaid covers people based on income, family size, disability, age, and citizenship — 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 a person who qualifies in one state might not in another, and income limits change year to year. The federal government sets a floor — states cannot make their programs more restrictive than that floor — but most states have chosen to go further and cover more people.

The main categories are: people under 65 with income below a certain threshold, parents and caregivers, children, pregnant people, people over 65, and people with disabilities. Within each category, your state's specific income limit, asset rules, and citizenship requirements determine whether you may have access to. You will need to report your actual household income, family size, and sometimes assets to find out.

Key Takeaways

  • Income limits vary by state and change each year, so you cannot assume you do not may have access to based on what you earned last year or what a neighbor was told.
  • Medicaid covers children in most states up to a higher income threshold than it covers adults, and covers pregnant people separately from other adults.
  • Some states expanded Medicaid to cover all adults under 65 with income below 138% of the federal poverty line; others did not, creating a gap where some people earn too much for Medicaid but too little for subsidized marketplace insurance.
  • You must be a U.S. citizen or may have access to immigrant to get Medicaid, though the definition of "may have access to immigrant" is broader than many people think.
  • The only way to know if you may have access to is to contact your state Medicaid office or use your state's online screening tool, because income limits and rules change and vary too much to estimate.

Income Thresholds and How They Work

Medicaid uses your household's gross monthly income and compares it to a percentage of the federal poverty line. The federal poverty line itself changes each year — for 2024, the poverty line for a single person is around $14,600 annually, and for a family of four around $30,000, though these figures shift annually. Your state then applies its own percentage to that line to set its income limit.

For example, a state might say "we cover adults up to 138% of the federal poverty line" or "we cover children up to 200% of the federal poverty line." That means a child in a family earning twice the poverty line might may have access to even though an adult in the same family would not. Income limits are almost always higher for children and pregnant people than for other adults.

Income includes wages, self-employment earnings, Social Security, unemployment benefits, and some other sources. It does not include certain things like child support received or some types of assistance. Your state's Medicaid office can tell you exactly what counts as income for their program.

Who Qualifies by Family Status and Age

Medicaid covers children in every state up to at least 138% of the federal poverty line, and most states go higher — many cover children up to 200% or 250% of the poverty line. This means a child can may have access to even when their parents do not.

Pregnant people are covered in all states, usually with income limits higher than for other adults. Coverage typically continues for 60 days after the pregnancy ends, whether the pregnancy resulted in birth or not.

Parents and other caretakers of children are covered, but the income limit is usually lower than for children. In states that expanded Medicaid, the limit is often 138% of the poverty line. In states that did not expand, the limit can be much lower — sometimes 50% of the poverty line or less — which means a parent can earn too much for Medicaid but still not earn enough to afford marketplace insurance without a subsidy.

People over 65 are covered if they meet income and asset limits, which are typically lower than for younger adults. People with disabilities can may have access to regardless of age if they meet income and asset limits and have a may have access to disability.

The Medicaid Expansion Gap

In 2014, the Affordable Care Act allowed states to expand Medicaid to cover all adults under 65 with income up to 138% of the federal poverty line. Some states did; others did not. This created what is sometimes called the "coverage gap" — a group of people who earn too much to may have access to for Medicaid in their state but too little to may have access to for subsidized marketplace insurance.

If you live in a state that expanded Medicaid, you may may have access to as an adult even if you have no children and no disability, as long as your income is below the threshold. If you live in a state that did not expand, you will need to fall into one of the traditional categories — parent, child, pregnant person, over 65, or disabled — to may have access to.

You can find out whether your state expanded Medicaid by contacting your state Medicaid office or by searching your state's name plus "Medicaid expansion" online.

Citizenship and Immigration Status

You must be a U.S. citizen or a may have access to immigrant to get Medicaid. may have access to immigrants include lawful permanent residents (green card holders), refugees, asylees, and some other categories. Undocumented immigrants do not may have access to for regular Medicaid, though some states offer limited emergency or pregnancy-related coverage through separate programs.

If you are a may have access to immigrant, there is usually a five-year waiting period before you can get Medicaid — with some exceptions. Refugees and asylees are exempt from the five-year wait. Lawful permanent residents who have worked in the U.S. for at least 40 quarters (10 years) are also exempt. Your state Medicaid office can tell you whether your specific immigration status qualifies you and whether any waiting period applies.

Assets and Resource Limits

Most Medicaid programs do not count assets or resources when deciding whether you may have access to based on income alone. However, if you are over 65 or have a disability, your state may have asset limits — meaning you cannot own more than a certain amount in savings, investments, or property (though your home usually does not count).

Asset limits vary by state. Some states have no asset limit at all; others limit you to $2,000 in countable resources for an individual or $3,000 for a couple. If you think asset limits might affect you, ask your state Medicaid office what the limit is and what counts as an asset.

How to learn about You may have access to

The only reliable way to know whether you may have access to is to contact your state Medicaid office directly or use your state's online screening tool. Every state has a Medicaid website where you can either apply online or find the phone number to call. You can also call 211 (a free helpline) and ask for your state Medicaid office's contact information.

When you contact them, have ready: your household size, your household's gross monthly income, your citizenship or immigration status, and the ages of anyone in your household. They will tell you whether you may have access to and what documents you need to provide to complete the process.

If your income is close to the limit or changes frequently, it is worth checking even if you think you might not may have access to. Income limits are higher than many people expect, especially for children and pregnant people.

Frequently Asked Questions

Does my income from a side job or gig work count toward the Medicaid limit?

Yes. Medicaid counts all household income, including wages from a job, self-employment earnings, gig work, and other sources. Report your actual income, not what you think you should earn. If your income varies month to month, your state will usually average it over a period of time or ask you to estimate what you expect to earn in the coming months.

If I am married but file taxes separately, does my spouse's income count?

Yes. Medicaid counts the income of your spouse even if you file taxes separately. Household income includes all income earned by people living in your home who are related to you by blood, marriage, or adoption, with limited exceptions.

Can I get Medicaid if I am a student?

Yes, if you meet the income and other requirements for your state. Being a student does not disqualify you. If you live in student housing and your parents support you financially, your parents' income may count toward your household income depending on your age and your state's rules.

What happens to my Medicaid if my income goes up?

You are required to report changes in income to your state Medicaid office. If your income rises above the limit, your coverage will end, usually at the end of the month in which the change occurred. Some states have a grace period or allow you to keep coverage for a short time after income increases. Contact your state office to understand the rules in your state.

Can I have Medicaid and marketplace insurance at the same time?

No. If you may have access to for Medicaid, you cannot enroll in a marketplace plan. If you are already enrolled in a marketplace plan and then may have access to for Medicaid, you should cancel the marketplace plan to avoid paying premiums you do not need to pay.