Medicaid eligibility depends on your income, household size, and which state you live in. In the 40 states (plus D.C.) 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 $21,597 a year for a single person in 2025. Beyond income, you’ll need to meet requirements for residency, citizenship or immigration status, and in some cases, asset limits.
Income Limits by Household Size
Medicaid uses a formula called Modified Adjusted Gross Income (MAGI) to determine whether you qualify. This is essentially your tax return income, and it applies to most applicants: children, pregnant women, parents, and other adults. The key threshold in expansion states is 138% of the federal poverty level. Here’s what that looks like in 2025 for the 48 contiguous states and D.C.:
- 1 person: $21,597 per year ($1,800 per month)
- 2 people: $29,187 per year ($2,432 per month)
- 3 people: $36,777 per year ($3,065 per month)
- 4 people: $44,367 per year ($3,697 per month)
Children and pregnant women often qualify at higher income levels than other adults, with thresholds varying by state. Parents in some states also have slightly different limits than adults without children. The income calculation includes a built-in 5 percentage point disregard, which is why you’ll sometimes see the cutoff described as 133% FPL even though the effective limit is 138%.
How Non-Expansion States Differ
Ten states have not adopted the ACA’s Medicaid expansion, and their rules are significantly more restrictive. In these states, being a low-income adult without children is usually not enough to qualify. You typically need to fall into a specific category: being pregnant, having a disability, being 65 or older, or being a parent with very low income. Even then, the income limits for parents can be far below the poverty level.
This creates what’s known as a coverage gap. Adults in non-expansion states whose income falls below 100% of the federal poverty level ($15,650 for a single person) but who don’t meet a categorical requirement are too poor to get subsidized Marketplace insurance, yet don’t qualify for Medicaid either. If you’re in this situation, your state may still have targeted programs for specific groups like pregnant women or people with disabilities.
Who Qualifies Beyond Income
Medicaid isn’t purely about how much you earn. Certain groups have their own eligibility pathways with different rules. People who are 65 or older, blind, or have a disability are evaluated using the income rules from the Supplemental Security Income (SSI) program rather than the standard MAGI formula. These non-MAGI pathways may include asset and resource tests, meaning the state looks at what you own (bank accounts, property, vehicles) in addition to what you earn. The standard MAGI pathway does not include any asset test.
Children generally qualify at higher income thresholds than adults, and the Children’s Health Insurance Program (CHIP) extends coverage even further up the income scale. Pregnant women also have expanded eligibility in most states, covering prenatal care, delivery, and a postpartum period.
Citizenship and Residency Rules
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 in the state and intend to stay.
U.S. citizens and nationals who meet income requirements are eligible. For immigrants, the rules are more complex. Lawful permanent residents (green card holders) face a five-year waiting period before they can enroll in Medicaid. However, several groups are exempt from this waiting period: refugees, asylees, Cuban and Haitian entrants, trafficking victims, and families of veterans. Some states have also opted to cover lawfully present children and pregnant women without a waiting period, regardless of when they entered the country.
Documents You’ll Need to Apply
When you apply, you’ll need to verify your identity, income, and residency. Requirements can vary somewhat by state, but here’s what to have ready:
- Identity: A state driver’s license or ID card with a photo, a government-issued ID, U.S. military card, or school ID with a photo. For children under 16, clinic or hospital records can work.
- Income: Proof of gross income for the past four weeks. Paycheck stubs are the most common option, but a signed letter from your employer, recent tax returns, or award letters for Social Security, unemployment, or veterans’ benefits all count.
- Residency: A document dated within six months showing your address. This can be a lease, rent receipt, utility bill, property tax record, mortgage statement, or even a postmarked envelope (P.O. boxes are not accepted).
Many states allow you to apply online, by phone, by mail, or in person at a local office. The application process also determines whether you qualify for other programs like CHIP or Marketplace subsidies, so you won’t need to apply separately.
Retroactive Coverage for Past Medical Bills
One feature of Medicaid that many people don’t know about: federal rules require states to provide up to three months of retroactive coverage. If you received medical services before you applied and would have been eligible at the time, Medicaid can cover those bills going back three months from your application date.
That said, many states have shortened or eliminated this retroactive period through federal waivers. Florida and Iowa, for example, only cover back to the first day of the month you applied, giving you between 1 and 30 days of retroactive coverage. Arkansas limits it to 30 days before the application date. Massachusetts and Hawaii restrict it to just ten days. A few states, including Indiana and Kentucky, don’t begin coverage until you’ve paid your first premium. States that limit retroactive eligibility generally still provide the full three months for certain groups, including pregnant women, infants, people with disabilities, and former foster youth.
If you think you might qualify, applying as soon as possible protects your ability to get retroactive coverage for any recent medical expenses.