Key Takeaways
- Income limits for Medicaid vary by state and by category — a parent, a child, and a disabled adult in the same household may have different thresholds.
- Most states cover children up to age 19 at higher income levels than they cover adults, and some cover pregnant people regardless of income.
- Disability status, age over 65, and citizenship or immigration status all affect whether you can get Medicaid in your state.
- Your state Medicaid office or a 211 referral can tell you in minutes whether your household meets your state's rules.
Income Thresholds Vary Sharply by State and Category
Medicaid has no single national income limit. The federal government sets a floor — states must cover certain groups at or below specific percentages of the federal poverty line — but most states set their own limits higher. A parent in one state might may have access to at 138% of the federal poverty line, while a parent in another state qualifies only at 100%. A child might may have access to at 200% or 300% of poverty in the same state where a parent qualifies at 100%.
Your household income is calculated by adding up wages, self-employment income, Social Security, unemployment benefits, and certain other sources. The program counts your household size as everyone living with you who you claim as a dependent on your taxes, plus your spouse if you are married. Some states count income differently for different groups — for instance, they may not count certain deductions for a parent but will count them for a disabled person.
Because limits change and vary so widely, the only reliable way to know your state's threshold is to contact your state Medicaid office directly or use your state's online screening tool. Your state's website will have a link to both.
Children and Pregnant People Often Have Higher Income Limits
Most states cover children at much higher income levels than they cover adults. A state might cover a child whose family earns up to 200% of the federal poverty line but cover a parent only up to 100%. This means a child in the household might be covered while a parent is not, even though they share the same income.
Pregnant people are covered in most states regardless of income, though the coverage usually ends 60 days after the pregnancy ends. Some states also cover postpartum people for a longer period — up to 12 months in a growing number of states — but this varies. Check your state's rules if you are pregnant or recently gave birth.
Age, Disability, and Immigration Status Also Matter
Everyone age 65 and older is covered by Medicare, the federal program for seniors, but some older people also may have access to for Medicaid to help pay Medicare costs. Your state sets its own income limit for this group, which is often higher than the limit for working-age adults.
People who are blind, disabled, or both may have higher income limits than other adults in the same state. Disability is defined narrowly — it usually means you cannot work due to a medical condition expected to last at least 12 months or result in death. Having a disability diagnosis alone does not may provide coverage; your state will review medical records to decide whether the condition meets its definition.
Citizenship and immigration status affect coverage in most states. U.S. citizens and nationals are covered. Lawful permanent residents (green card holders) are usually covered, though some states have waiting periods. Undocumented immigrants are generally not covered by regular Medicaid, though some states cover emergency services or pregnancy care regardless of status. A few states cover all low-income immigrants. Ask your state Medicaid office about your specific immigration status.
How to learn about Your State Covers Your Situation
The fastest way is to call your state Medicaid office directly. You can find the number on your state's health department website or by calling 211 (a free referral line available in all states). Have your household income, family size, and any disability or pregnancy information ready.
Many states also have online screening tools on their Medicaid websites. You enter your income and household information, and the tool tells you whether you likely meet your state's rules. These tools do not make a final decision — you still have to provide documents to your state office — but they give you an answer in minutes.
If you are applying, your state will ask for proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of household size (birth certificates or school records for children), and proof of citizenship or immigration status (a passport, birth certificate, or green card). Keep these documents ready before you contact your state office.
What Happens After You Meet the Income Test
Meeting your state's income limit is the first step, but it is not the only one. Your state will also check whether you meet other rules — for instance, whether you are a resident of that state, whether you are a U.S. citizen or have the right immigration status, and whether you are already covered by another insurance program.
If you pass all the checks, your state will send you a Medicaid card or tell you how to access your coverage online. Coverage usually starts on the first day of the month after your state approves you, though some states backdate coverage to the month you applied. Ask your state office when your coverage will begin.
Rules Change When Your Income or Household Changes
Medicaid coverage is not permanent. If your income rises above your state's limit, you will lose coverage. If your household size changes — a child turns 19, someone moves out, or you have a baby — your income limit may change too. Some states let you keep coverage for a few months even if your income rises slightly, but most do not.
You are required to report major changes to your state Medicaid office within 30 days. Major changes include a new job, a raise, a job loss, a move, a birth, or a marriage. If you do not report and your state discovers you were no longer may be able to access, you may have to repay benefits you received. Contact your state office as soon as a change happens.
Frequently Asked Questions
Can I get Medicaid if I am working?
Yes. Medicaid is based on income, not employment status. If your wages are below your state's limit for your household size and category, you can be covered while working. Some states have special programs that let you keep Medicaid even if your income rises slightly after you start a job.
Does my immigration status automatically disqualify me?
Not necessarily. Lawful permanent residents are usually covered in most states. Undocumented immigrants are generally not covered by regular Medicaid, but some states cover emergency services or pregnancy care without regard to status. Call your state Medicaid office with your specific status to find out.
What if I was denied Medicaid — can I appeal?
Yes. Your state must send you a written notice explaining why you were denied and telling you how to request a hearing. You have a set number of days (usually 30 to 90, depending on your state) to ask for an appeal. Contact your state Medicaid office for the appeal process and deadline.
Do I have to report changes in my income or household?
Yes. You must report major changes — a new job, a raise, a job loss, a move, a birth, or a marriage — within 30 days. If you do not report and your state finds out you were no longer may be able to access, you may have to repay benefits. Contact your state office immediately when a change happens.
What if my state did not expand Medicaid?
Some states have not expanded Medicaid to cover all low-income adults. In those states, the income limits for working-age adults without disabilities are much lower — often around 50% of the federal poverty line. You may still may have access to if you are a parent, a child, pregnant, disabled, or over 65. Check your state's specific rules.