Medicaid may be able to access depends on your income, household size, and which state you live in — there is no single national rule

Whether you meet Medicaid's requirements is determined by your state's Medicaid program, not by a federal standard. Each state sets its own income limits, decides which groups of people it covers, and chooses whether to expand the program beyond the federal minimum. This means two people with identical income and family size may have different results depending on whether they live in a state that expanded Medicaid or one that did not.

The fastest way to find out what your state requires is to contact your state Medicaid office directly or use your state's online screening tool. Most states have a website where you can enter your income and household information and get an immediate answer about whether you may be covered. Your state's name plus "Medicaid" in a search engine will take you to the right office.

Key Takeaways

  • Income limits vary by state and household size; a single person's limit in one state may be much higher or lower than in another.
  • Medicaid expansion, which your state chose or did not choose to adopt, determines whether working adults without children can be covered.
  • Your state Medicaid office or your state's online screening tool can tell you in minutes whether your income and household situation fit your state's rules.
  • Citizenship and immigration status requirements exist in every state, though the rules differ by immigration category.
  • Some states cover pregnant people, children, seniors, and people with disabilities under different income limits, so your category matters.

How income limits work and why they differ by state

Medicaid income limits are set as a percentage of the federal poverty line. A state might say "we cover individuals at 138 percent of the poverty line" or "we cover families at 200 percent." Because the poverty line itself changes each year and varies by household size, the actual dollar amount you need to earn to stay under the limit changes too.

States that expanded Medicaid under the Affordable Care Act generally cover adults earning up to 138 percent of the federal poverty line. States that did not expand cover much lower income levels — sometimes only 50 or 60 percent of the poverty line for working adults without children. This is the single largest difference between states. If you live in a non-expansion state and earn more than your state's limit, you will not be covered even if you would be in an expansion state.

Your state Medicaid office publishes its current income limits each year. You can find them on your state's Medicaid website, usually in a table organized by household size and category (children, pregnant people, adults, seniors, people with disabilities). Income is usually counted as gross monthly income before taxes.

What "household size" means and how it affects your limit

Medicaid counts household size as the people living with you who are related to you by blood, marriage, or adoption, plus any children you are legally responsible for. This is not the same as tax household, and it is not the same as who you claim as dependents on your taxes. Medicaid has its own definition, and it matters because a larger household usually means a higher income limit.

If you live alone, your household size is one. If you live with a spouse and two children, your household size is four. If you live with a roommate who is not related to you, they do not count toward your household size. If you are pregnant, some states count the unborn child as a household member starting at a certain point in pregnancy; others do not. Your state Medicaid office can clarify how your specific living situation counts.

Medicaid expansion and what it means for working adults

In 2014, states were given the option to expand Medicaid to cover working adults earning up to 138 percent of the federal poverty line, regardless of whether they have children or disabilities. Some states chose to expand; others did not. As of now, about 40 states have expanded Medicaid, but the list changes occasionally as states make new decisions.

If you live in an expansion state and are a working adult without children, you may be covered even if your income is too high for your state's traditional Medicaid program. If you live in a non-expansion state, working adults without children are generally not covered unless they fall into another category — such as pregnant, disabled, or caring for a child.

You can find out whether your state expanded Medicaid by searching "[your state name] Medicaid expansion" or by asking your state Medicaid office directly. This single fact often determines whether you are covered or not.

Citizenship and immigration status requirements

Every state requires proof of citizenship or a may have access to immigration status to receive Medicaid. U.S. citizens are always covered. Lawful permanent residents (green card holders) are covered in most states. Refugees and asylees are covered. Undocumented immigrants are not covered in most states, though a few states cover emergency services or pregnancy-related care regardless of status.

If you are in the country on a visa (such as H-1B, F-1, or tourist visa), you are generally not covered by Medicaid. If you are in removal proceedings or have a pending asylum case, your status may affect your coverage. Your state Medicaid office can tell you which immigration statuses may have access to in your state and what documents you will need to prove your status.

Special categories with different income limits

Most states have separate income limits for different groups. Children often have a higher limit than working adults. Pregnant people usually have a higher limit than non-pregnant adults. Seniors (age 65 and older) and people with disabilities may have different limits than working-age adults without disabilities. Some states cover children up to 200 or 300 percent of the poverty line while covering working adults at only 138 percent.

If you fall into more than one category — for example, you are both pregnant and a working adult — your state will use whichever category gives you the best chance of being covered. You do not have to choose; the state determines which rule applies to you.

How to find your state's specific rules

Your state Medicaid office maintains a website with current income limits, citizenship requirements, and the list of covered groups. You can usually find it by searching "[your state] Medicaid income limits" or "[your state] Medicaid may be able to access." Most state sites have an online screening tool where you enter your income and household information and get an answer in real time.

If you cannot find the information online or need to speak to someone, call your state Medicaid office. The number is usually on the state website. You can also call 211 (a national referral service) and ask for your state Medicaid office's contact information. Have your income, household size, and immigration status ready when you call.

Frequently Asked Questions

Does my income have to stay below the limit every month, or just when I apply?

Most states check your income at the time you apply and then again when your coverage renews (usually once a year). If your income changes after you are approved, you should report it to your state Medicaid office, but a temporary increase usually does not end your coverage immediately. Some states allow your income to go slightly over the limit without losing coverage, while others do not. Ask your state office what happens if your income changes.

What counts as income for Medicaid?

Medicaid counts wages, self-employment income, Social Security, unemployment benefits, child support, and some other sources. It does not count certain things like food stamps (SNAP), housing assistance, or some types of financial aid. Your state Medicaid office has a full list of what counts and what does not. If you are unsure whether a specific source of money counts, ask before you apply.

Can I be covered if I am unemployed?

Yes, if your household income (including any income from other household members) is below your state's limit. Unemployment benefits count as income. If you have no income at all and live alone, you will likely be covered in an expansion state. In a non-expansion state, you may only be covered if you are pregnant, disabled, a child, or a senior.

What if I do not know my exact income?

Use your most recent pay stubs or tax return to estimate your monthly income. If your income varies (for example, you are self-employed or work seasonal jobs), average it over the past three months or the past year, depending on what your state asks for. Your state Medicaid office can tell you which method to use. You do not need exact figures to start the process; estimates are fine.

Do I have to be a U.S. citizen to be covered?

No, but you must have a may have access to immigration status. Lawful permanent residents, refugees, asylees, and some other statuses may have access to. Undocumented immigrants do not may have access to in most states. If you are unsure whether your status qualifies, contact your state Medicaid office or a local immigration legal aid organization.