Medicaid covers people based on income, family size, disability status, age, and pregnancy — not on employment or immigration status alone

Medicaid is a joint federal and state program that pays for medical care for people who meet specific criteria. The rules about who qualifies differ by state, but the basic categories are the same everywhere: low-income adults and children, pregnant people, people over 65, and people with disabilities. You do not have to be working, unemployed, or a citizen to be considered — but your income and household size matter most.

Each state sets its own income limits and decides which groups beyond the federal minimum it will cover. This means a person who qualifies in one state may not may have access to in another. The only way to know whether you meet your state's rules is to check with your state Medicaid office or use a screening tool designed for your state.

Key Takeaways

  • Medicaid covers low-income children, pregnant people, parents, elderly people, and people with disabilities, but income limits and covered groups vary by state.
  • You do not have to be a U.S. citizen to be covered, though some states restrict coverage for certain immigration statuses.
  • Your household income and family size are the main factors that determine whether you meet the income threshold in your state.
  • Some states expanded Medicaid to cover more working-age adults; others did not, so coverage rules differ significantly depending on where you live.
  • The fastest way to learn about you may have access to is to contact your state Medicaid office or use your state's online screening tool.

Children and parents

Medicaid covers children in every state, though the income limit varies. Federal law requires states to cover children under 19 whose household income is at or below 133 percent of the federal poverty line. Many states cover children with higher incomes than that. Some states also cover young adults up to age 26.

Parents and caretakers of children can also get Medicaid, but only if their income is low enough. The income threshold for parents is lower than for children in most states — sometimes significantly lower. A parent might earn too much to may have access to even though their child does.

Pregnant people and new parents

Pregnant people are covered in all states, regardless of whether they have children already. Coverage usually continues for 60 days after the pregnancy ends, whether the outcome is birth, miscarriage, or abortion. This is true even in states that did not expand Medicaid to other groups.

After the 60-day postpartum period ends, coverage stops unless the person qualifies under another category — such as being a parent of a child already on Medicaid, or having a disability. Some states have extended postpartum coverage beyond 60 days, but you will need to check your state's rules.

People over 65 and people with disabilities

Medicaid covers people age 65 and older who have low income, regardless of whether they are working. It also covers people under 65 who have a disability recognized by Social Security or the Railroad Retirement Board. You do not have to be receiving Social Security Disability Insurance (SSDI) payments to may have access to — being found disabled is enough.

People who are blind or have end-stage renal disease also may have access to in all states. Income limits for elderly and disabled people are usually higher than for working-age adults without disabilities, but they still exist and vary by state.

Working-age adults without disabilities

Coverage for working-age adults without disabilities depends entirely on whether your state expanded Medicaid. Thirty-eight states and Washington, D.C. have expanded Medicaid to cover adults earning up to 138 percent of the federal poverty line. Twelve states have not expanded, so in those states, working-age adults without disabilities generally cannot get Medicaid no matter how low their income is, unless they are parents or pregnant.

If you live in a non-expansion state and do not fit another category, you may still have other options — such as marketplace insurance through the Affordable Care Act, or programs run by your county or city. Your state Medicaid office can tell you what is available where you live.

Immigration status and Medicaid coverage

Federal law allows states to cover certain immigrants regardless of status. Lawful permanent residents, refugees, and asylees can get Medicaid in all states. Undocumented immigrants are barred from most Medicaid coverage under federal law, but some states use their own money to cover emergency services or pregnancy care for undocumented people.

A few states cover undocumented immigrants more broadly. California, Illinois, New York, and Washington cover undocumented adults in their Medicaid programs. If you are undocumented, ask your state Medicaid office what coverage, if any, is available to you.

Income limits and how they are calculated

Medicaid income limits are based on the federal poverty line, which changes each year. For 2024, the poverty line for a single person is about $15,000 per year; for a family of four, it is about $31,000. States set their own limits as a percentage of the poverty line — usually between 100 and 138 percent, depending on the group and whether the state expanded Medicaid.

When you apply, Medicaid counts your household income, not just your own. Household size includes you, your spouse if you are married, and any children under 19 you are responsible for. Some states count parents' income if you are under 19. The rules about what counts as income — wages, self-employment, child support, Social Security — are the same in every state, but the threshold that matters is your state's limit.

How to learn about you may have access to in your state

The fastest way is to contact your state Medicaid office directly. You can find the phone number and website on your state health department's website, or by searching "[your state] Medicaid." Many states also have online screening tools that ask questions about your income and household and tell you within minutes whether you likely may have access to.

You can also call 211 (in most states) or visit 211.org to be connected to local resources that can help you understand your state's rules and walk you through the process. These services are free and do not require you to speak English — interpreters are available.

Frequently Asked Questions

Do I have to be unemployed to get Medicaid?

No. Medicaid is based on income, not employment status. You can be working full-time and still may have access to if your income is low enough. In expansion states, working adults earning up to about 138 percent of the poverty line can get Medicaid.

Does Medicaid cover people with pre-existing conditions?

Yes. Medicaid covers pre-existing conditions and does not charge more based on health status. Once you are covered, you have access to the same benefits as anyone else on Medicaid in your state.

Can I get Medicaid if I am not a U.S. citizen?

It depends on your immigration status. Lawful permanent residents, refugees, and asylees can get Medicaid in all states. Undocumented immigrants are generally barred from Medicaid except for emergency services, though a few states cover them more broadly. Ask your state Medicaid office what applies to you.

What happens to my Medicaid if my income goes up?

Your coverage will end if your income rises above your state's limit. You will usually get a notice before coverage stops. You may then be able to buy insurance through the Affordable Care Act marketplace, sometimes with financial help based on your income.

How long does it take to learn about I may have access to?

Most states aim to make a decision within 30 days of receiving a complete application. Some states are faster. If you apply online or by phone, you may get a decision the same day or within a few days.