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

Medicaid is not a single national program with one set of rules. Each state runs its own Medicaid program within federal guidelines, which means who gets covered varies significantly by location. A person who qualifies in one state may not may have access to in a neighbouring state. The federal government sets a floor — a minimum income level below which states must cover people — but most states have set their own higher income limits, and some have added their own categories of people they will cover.

The broadest categories are: children under 19, pregnant people, parents and caretakers of children, people over 65, people who are blind or disabled, and people in long-term care facilities. Within each category, income and asset limits apply. Some states also cover people who do not fit these categories if their income is low enough — this is called the "optional expansion" population, and whether your state covers them is a state choice.

Key Takeaways

  • Medicaid rules are set by each state, so your income limit, covered services, and whether you may have access to at all depend on where you live.
  • Children, pregnant people, parents, seniors, and people with disabilities are the main groups Medicaid covers, but income thresholds vary widely by state.
  • Some states have expanded Medicaid to cover adults with no children and no disability if their income is low enough; others have not.
  • You can find your state's specific income limits and rules on your state Medicaid office website or by calling 211.

Income limits vary by state and family size

Federal law requires states to cover people whose income falls below a certain percentage of the federal poverty line. For 2024, the federal poverty line for a single person is around $15,000 per year, and for a family of four around $31,000. However, states can and do set their own limits higher than the federal minimum.

Some states cover parents of children if their income is up to 200% of the poverty line (roughly $30,000 for a single person). Others set the limit at 100% of poverty or lower. A few states have set limits as high as 400% of poverty for certain groups. Your state's Medicaid office publishes its current income limits by household size and category — these change periodically and are not the same across all states.

Income is counted differently depending on your situation. Earned income (wages) is usually counted in full. Unearned income (Social Security, pensions, child support) is also counted. Some income sources are excluded — for example, the first $65 per month of earned income may not count, or certain disability benefits may be excluded. Your state's rules determine what counts and what does not.

Children and pregnant people have the broadest coverage

Medicaid must cover all children under 19 whose family income is at or below 133% of the federal poverty line. Most states cover children at higher income levels than this federal minimum. Some states cover children in families earning up to 200% or 300% of poverty. A few cover all children regardless of income.

Pregnant people are covered in all states if their income is at or below 133% of poverty. Many states cover pregnant people at higher income levels. Medicaid covers pregnancy, delivery, and 60 days of postpartum care in all states, regardless of immigration status (with narrow exceptions). This is one of the few Medicaid benefits that does not depend on your state's choices.

Children and pregnant people also have fewer asset limits than other groups. Most states do not count assets at all for children or pregnant people — only income matters. This makes these categories easier to enter than categories based on disability or age.

Parents and caretakers face stricter income limits

States must cover parents and caretakers of children if their income is at or below the state's TANF (Temporary Assistance for Needy Families) income limit. TANF is a separate cash assistance program, and Medicaid uses its income threshold as a floor. However, TANF income limits are often very low — in some states, a parent of two children earning more than $500 per month does not may have access to.

Many states have chosen to cover parents at higher income levels than their TANF limit, but not all. If your state has not expanded Medicaid (see below), parents may have very limited options. Some states cover only parents earning below 50% of poverty, which means a single parent earning more than $8,000 per year would not may have access to.

Caretakers of children — grandparents, aunts, or other relatives raising a child — are covered in some states but not others. If your state does cover caretakers, the income limit is usually the same as for parents. Check your state's rules directly, as this category is not federally required and varies widely.

Seniors and people with disabilities have asset limits

Medicaid must cover people over 65 and people who are blind or disabled if their income is at or below 74% of the federal poverty line (roughly $11,000 per year for a single person). However, most states have chosen to cover seniors and disabled people at higher income levels — some at 100% of poverty, some higher.

Unlike children and pregnant people, seniors and disabled people have asset limits. Medicaid counts your savings, property, vehicles, and other resources. The federal limit is $2,000 for a single person and $3,000 for a couple, but states can set higher limits. Some states use the federal limit; others allow more. Certain assets do not count — your primary home usually does not count, and one vehicle usually does not count.

If you are disabled and under 65, you may also may have access to through SSI (Supplemental Security Income), which is a separate federal program. If you receive SSI, you automatically may have access to for Medicaid in most states. If you do not receive SSI but have a disability, you can still apply for Medicaid directly through your state.

Medicaid expansion changed who qualifies in some states

In 2014, states were given the option to expand Medicaid to cover adults earning up to 138% of the federal poverty line, regardless of whether they have children, are disabled, or are over 65. This is called the "optional expansion" or "adult expansion." As of 2024, 39 states and Washington, D.C. have chosen to expand. Eleven states have not.

In expansion states, a single adult earning up to roughly $20,000 per year can may have access to for Medicaid. In non-expansion states, a single adult with no children and no disability typically cannot may have access to for Medicaid at all, no matter how low their income is. This creates a coverage gap: people earning too much for their state's existing categories but too little to afford private insurance.

If you live in a non-expansion state and do not fit an existing category (child, pregnant person, parent, senior, or disabled person), you do not may have access to for Medicaid. Your options may include the Affordable Care Act marketplace, where you may be able to find subsidized coverage, or programs like CHIP (Children's Health Insurance Program) if you have children.

Immigration status affects Medicaid coverage

Medicaid is generally available only to U.S. citizens and certain may have access to immigrants. Lawful permanent residents (green card holders) can may have access to for Medicaid in most states. Refugees and asylees can may have access to. Undocumented immigrants cannot may have access to for most Medicaid services in most states.

However, all states must cover emergency services for anyone, regardless of immigration status. Some states have chosen to cover additional services for undocumented immigrants — for example, some states cover prenatal care and delivery for undocumented pregnant people, or cover children regardless of immigration status. A few states cover undocumented adults in certain categories. These state choices vary widely.

If you are unsure about your immigration status and Medicaid, contact your state Medicaid office or a local legal aid organization. Immigration status is sensitive information, and you have the right to speak with someone who understands both Medicaid and immigration law.

How to find your state's specific rules

Your state Medicaid office publishes income limits, asset limits, and covered categories on its website. The website address usually follows the pattern medicaid.state.gov or your-state.gov/medicaid. You can also call 211 (a free referral line) and ask for your state's Medicaid income limits and rules for your situation.

When you contact your state, have ready: your household size, your monthly income (or recent pay stubs), and your situation (are you pregnant, a parent, disabled, over 65, or none of these). Your state can tell you whether you meet the income and category requirements. If you do not meet current limits, ask whether your state has plans to change them or whether other programs might help.

Frequently Asked Questions

Does Medicaid cover everyone below the poverty line?

No. Medicaid covers people below certain income thresholds, but those thresholds vary by state and by category. In non-expansion states, a single adult earning below the poverty line may not may have access to if they have no children, disability, or age. In expansion states, most people below 138% of poverty may have access to. Your state's specific rules determine coverage.

If I move to a different state, does my Medicaid coverage move with me?

No. Medicaid is state-based, so your coverage ends when you move. You must apply in your new state. Your new state will use its own income limits and rules. If you may have access to in your old state but not your new state, you will lose coverage. If you do not may have access to in your old state but do in your new state, you can apply immediately after moving.

Can I have Medicaid and Medicare at the same time?

Yes. People over 65 or with certain disabilities can may have access to for both. If you have both, you are called "dual may be able to access." Medicare is federal; Medicaid is state. Medicaid covers services Medicare does not, like long-term care and dental care in some states. Having both usually means better coverage than either alone.

What if my income changes after I get Medicaid?

You must report income changes to your state Medicaid office. If your income rises above your state's limit, your coverage will end. The timing depends on your state — some end coverage immediately, others give you a grace period. If your income drops, you may may have access to for a different category or remain covered. Always report changes; not reporting can result in overpayment that you may owe back.

Do I have to be a citizen to get Medicaid?

No, but you must be a U.S. citizen or a may have access to immigrant. Lawful permanent residents, refugees, and asylees can may have access to in most states. Undocumented immigrants cannot may have access to for regular Medicaid in most states, though some states cover emergency services or specific services like prenatal care for undocumented people. Contact your state Medicaid office or a legal aid organization for your state's specific rules.