Medicaid covers people based on income, family size, disability, age, and citizenship — but the exact rules vary by state

Medicaid is not one national program with one set of rules. Each state runs its own Medicaid program within federal guidelines, which means who gets coverage depends partly on where you live. That said, certain groups are covered in every state: children under 19 in households below a certain income, pregnant people, parents of dependent children, people over 65, and people with disabilities. Beyond those core groups, states have flexibility to cover more people or set different income limits.

The fastest way to know whether you might be covered is to check your state's Medicaid website directly or call your state's Medicaid office. They can tell you the exact income limit for your household size and situation. You can also use the federal government's Medicaid.gov website to find your state's program and contact information.

Key Takeaways

  • Every state covers children under 19, pregnant people, parents with dependent children, seniors over 65, and people with disabilities, but income limits vary by state.
  • Your household income and family size are the main factors — most programs use a percentage of the federal poverty level as their cutoff.
  • Some states cover more people than federal law requires, including adults without children and people with higher incomes.
  • You must be a U.S. citizen or may have access to immigrant to get Medicaid in most cases.
  • Your state's Medicaid office can tell you in one call whether you meet the income and other requirements for your situation.

Income limits and how they work

Medicaid uses household income and family size to decide who qualifies. The program compares your total household income to a percentage of the federal poverty level. The federal poverty level changes each year, and each state sets its own percentage — some states cover people at 138% of poverty, others at 100%, and some higher or lower depending on the group.

For example, in 2024, the federal poverty level for a family of three is roughly $23,000 per year. If your state covers Medicaid at 138% of poverty for that family size, the income limit would be around $31,700. If your household income is below that, you may be covered. If it is above, you would not be, unless your state has a separate program for higher-income people.

Income includes wages, self-employment earnings, Social Security, unemployment benefits, and some other sources. Different states count income differently — some exclude certain types or allow deductions — so the exact calculation depends on your state. When you contact your state's Medicaid office, they will walk through what counts as income for your household.

Who is automatically covered in every state

Children under 19 in households below the income limit are covered in every state. Most states cover children at or above the federal poverty level, and many cover them at higher income levels. A child's coverage does not depend on the parents' immigration status in most cases.

Pregnant people are covered in every state during pregnancy and for a period after birth (usually 60 days). Pregnancy-related Medicaid covers prenatal care, delivery, and postpartum care. Income limits for pregnant people are often higher than for other adults.

Parents and caretakers of dependent children are covered in every state if their income is below the state's limit. The income threshold for parents is usually lower than for children, so a parent might not be covered even if their child is.

People age 65 and older are covered if their income and assets are below the state's limits. Medicaid for seniors often works alongside Medicare to cover costs that Medicare does not.

People with disabilities are covered if they meet the state's definition of disability and income limits. Disability under Medicaid is not the same as Social Security Disability — the rules are different, and you can be found disabled by one program but not the other.

How states expand coverage beyond the federal minimum

Federal law sets a floor, but states can cover more people. Some states have expanded Medicaid to cover adults without dependent children — people who would not be covered under the basic federal rules. These states typically cover adults up to 138% of the federal poverty level, though the exact income limit varies.

Other states have created separate programs for people who earn too much for Medicaid but too little to afford private insurance. These programs may have different names and different rules, but they serve a similar purpose. Your state's Medicaid office can tell you whether such a program exists where you live.

A few states have not expanded coverage beyond the federal minimum, so adults without children, disability, or age 65+ may have no Medicaid option even at very low incomes. If you live in one of those states and do not fit the core groups, ask about other state or federal programs that might help.

Citizenship and immigration status requirements

You must be a U.S. citizen or a may have access to immigrant to get Medicaid in most cases. may have access to immigrants include people with a green card, refugees, asylees, and certain other immigration statuses. The rules are complex and vary by immigration category.

If you are not a citizen or may have access to immigrant, you may still be covered for emergency medical services in most states, even if you do not may have access to for full Medicaid. Some states also cover pregnant people and children regardless of immigration status. Contact your state's Medicaid office to ask what is available in your situation.

Disability and how it is defined

Medicaid covers people with disabilities, but the definition is strict. You must have a physical or mental condition that prevents you from working and is expected to last at least 12 months or result in death. Having a diagnosis alone is not enough — the condition must limit your ability to work.

Medicaid uses its own disability information process, separate from Social Security Disability Insurance (SSDI). You can be found disabled by one program but not the other. If you have been denied SSDI, that does not automatically mean you will be denied Medicaid, and vice versa.

To be considered for Medicaid based on disability, you will need medical records showing your condition and how it limits your work. Your state's Medicaid office can explain what documentation they need and how long the review takes.

Assets and resource limits

Most Medicaid programs have resource limits — a cap on how much money or property you can own and still be covered. For working-age adults and children, the limit is often $2,000 in countable resources for an individual and $3,000 for a couple, though this varies by state and program.

Not all assets count toward the limit. Your primary home, one vehicle, and certain retirement accounts are usually excluded. Cash, bank accounts, stocks, and second properties typically do count. If you are close to the limit, ask your state's Medicaid office which specific assets count in your situation.

For seniors and people with disabilities, resource rules can be different and sometimes more complex, especially if they are receiving long-term care. Contact your state's program to understand how resources are counted for your group.

How to learn about you meet your state's requirements

The most direct route is your state's Medicaid office. You can find the phone number and website on Medicaid.gov by selecting your state. When you call, have your household income, family size, and any relevant information about disability or age ready to share.

Many states also have online screening tools that ask basic questions and give you an immediate answer about whether you might be covered. These tools are not official determinations, but they can tell you whether it is worth applying. Some states use a single application for Medicaid and other benefits, which you can often start online.

If you are applying for the first time, you will need to provide proof of income, citizenship or immigration status, and family relationships. Your state's office will tell you what documents to bring or submit. The process usually takes 30 to 45 days, though some states are faster.

Frequently Asked Questions

Can I get Medicaid if I work full-time but earn low wages?

It depends on your state and household size. Many states cover working adults if their income is below the state's limit, which is often around 138% of the federal poverty level. Some states have lower limits or do not cover working adults without children. Contact your state's Medicaid office with your income and family size to find out.

What if my income changes after I am covered?

You must report income changes to your state's Medicaid office. If your income rises above the limit, your coverage will end, usually at the end of the month in which you reported the change. If your income drops, you may become newly covered or your coverage may continue. Rules vary by state.

Does having a job disqualify me from Medicaid?

No. Medicaid is based on income, not employment status. If you work but earn below your state's income limit, you can be covered. Some states have special programs for working people with disabilities that allow higher income and resource limits.

Can I be denied Medicaid because of a pre-existing condition?

No. Medicaid cannot deny you based on health status or pre-existing conditions. If you meet the income, citizenship, and other requirements for your state, you cannot be turned down because of a medical diagnosis or past health problems.

What happens if I am denied — can I appeal?

Yes. Every state has an appeal process. If you are denied, the notice will explain why and how to request a hearing. You have the right to present additional information and argue your case. Contact your state's Medicaid office for details on how to file an appeal in your state.