Medicaid eligibility depends primarily on your income, household size, and which state you live in. In states that have expanded Medicaid under the Affordable Care Act, most adults qualify if their household income falls below 138% of the federal poverty level, which works out to about $15,650 a year for an individual or $26,650 for a family of three in 2025. In states that haven’t expanded, the rules are more restrictive, and you typically need to fall into a specific category beyond just having low income.
Income Limits and How They’re Calculated
Medicaid uses a figure called Modified Adjusted Gross Income (MAGI) to measure whether you financially qualify. MAGI starts with your adjusted gross income from your tax return, then adds in three things if they apply to you: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. Notably, Supplemental Security Income (SSI) payments are not counted as part of your MAGI.
In the 40 states (plus Washington, D.C.) that have expanded Medicaid, income is the main test. If your MAGI falls below 138% of the federal poverty level, you qualify regardless of whether you have children, a disability, or any other special circumstance. For 2025, that translates to roughly $15,650 for a single person and $26,650 for a family of three.
In the remaining states that haven’t expanded Medicaid, adults without children often can’t qualify at all, no matter how low their income is. Parents with dependent children may qualify, but the income cutoff varies dramatically from state to state. Some set the threshold well below the poverty line, meaning you might earn very little and still not qualify. If you’re in a non-expansion state, you’ll need to check your state’s specific limits through your local Medicaid office or HealthCare.gov.
Who Qualifies Beyond Income
Even in states with stricter rules, certain groups have broader access to Medicaid. Children generally qualify at higher income levels than adults, and pregnant women also benefit from expanded thresholds in most states. People aged 65 and older, and those who are blind or have a certified disability, can qualify through separate pathways that use different income and asset rules.
If you receive Supplemental Security Income (SSI), you may get Medicaid automatically. In 35 states and Washington, D.C., your SSI application doubles as your Medicaid application, and coverage starts the same month your SSI benefits begin. Eight additional states (Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, Utah, and the Northern Mariana Islands) use the same eligibility rules as SSI but require you to file a separate Medicaid application. Nine states, including Connecticut, Illinois, Minnesota, Missouri, and Virginia, set their own disability-related Medicaid rules that differ from SSI standards, so qualifying for SSI in those states doesn’t guarantee Medicaid eligibility.
Residency and Citizenship Requirements
You must be a resident of the state where you’re applying. There’s no minimum time you need to have lived there, but you do need to be living there with the intent to stay.
U.S. citizens and nationals are eligible if they meet the financial requirements. For non-citizens, the rules get more complex. “Qualified” non-citizens, a legal term that includes green card holders, refugees, asylees, trafficking victims, and certain military veterans and their families, can qualify for Medicaid. However, most green card holders must wait five years after receiving their status before they become eligible for federal Medicaid funding. Refugees, asylees, Cuban and Haitian entrants, trafficking victims, and military-connected families are exempt from that five-year waiting period.
Many states have opted to cover lawfully residing children and pregnant women without any waiting period, regardless of when they entered the country. Undocumented immigrants are not eligible for regular Medicaid, though federal law does allow payment for emergency medical services.
Asset Limits for Seniors and Long-Term Care
If you’re applying for Medicaid to cover nursing home care or other long-term services, most states look at your assets in addition to your income. These asset tests don’t apply to most working-age adults qualifying through the expansion, but they matter significantly for older adults and people needing institutional care.
Asset limits vary by state. In Minnesota, for example, the limit is $3,000 for an individual and $6,000 for a couple, plus $200 per dependent. That sounds extremely low, but several major assets don’t count toward the limit: your home (as long as the equity is under $730,000 as of 2025), one vehicle regardless of its value, household goods, personal effects, prepaid burial arrangements, and business assets needed to earn income.
When one spouse needs long-term care and the other continues living at home, a spousal protection process kicks in. The spouse living in the community can retain assets up to a federal maximum of $157,920 in 2025. The spouse entering long-term care must reduce their countable assets to the individual limit. This prevents the community spouse from being impoverished by the cost of a partner’s care.
What If Your Income Is Slightly Too High
Some states offer a “spend-down” or “medically needy” pathway for people whose income exceeds the Medicaid limit but who face high medical expenses. This works like a deductible: if your monthly income is, say, $400 over the Medicaid limit, you need to show $400 in medical bills for that month. Once you hit that threshold, Medicaid covers additional medical costs for the rest of the month.
To use this pathway, you typically must fall into a qualifying category: under 21, 65 or older, certified blind or disabled, pregnant, or a parent of a child under 21. Qualifying medical expenses include doctor and dental visits, prescriptions, lab tests, therapy, home health aides, and even transportation costs to medical appointments. You’ll need to contact your local department of social services to enroll and learn your specific excess income amount. Not every state offers a medically needy program, so this option depends on where you live.
How to Apply and What You’ll Need
You can apply for Medicaid through your state’s Medicaid agency, through HealthCare.gov (which will route you to your state), by phone, by mail, or in person at a local office. The application asks about your household size, income, citizenship or immigration status, and residency.
The documents you’ll need depend on what the agency needs to verify. For income, your most recent tax return or W-2s work if your income hasn’t changed. If you’ve switched jobs or expect your income to change, recent pay stubs or documentation of new wages are more appropriate. For citizenship, a U.S. passport, birth certificate, or naturalization certificate is standard. Non-citizens will need immigration documents showing their status. You may also need proof of residency, such as a utility bill or lease agreement, and identification like a state-issued ID or driver’s license.
Most states process applications within 45 days, or 90 days if the application involves a disability determination. In many cases, Medicaid can cover medical bills retroactively for up to 90 days before your application date, though some states have limited this retroactive coverage. In Florida, for instance, retroactive eligibility is now restricted to pregnant women and children under 21.
Estate Recovery After Your Death
One aspect of Medicaid that catches people off guard is estate recovery. Federal law requires states to seek repayment from the estates of deceased Medicaid recipients for certain costs, particularly nursing home care and other long-term services. This means that after you pass away, the state may file a claim against your estate to recoup what Medicaid spent on your care.
There are important protections. States cannot pursue estate recovery if you’re survived by a spouse, a child under 21, or a child of any age who is blind or disabled. States must also have hardship waiver procedures in place for situations where recovery would cause undue financial harm to surviving family members. If remaining funds sit in a trust after a Medicaid enrollee’s death, those may also be subject to recovery. This is worth understanding before applying, especially if preserving assets for heirs is a priority.