Medicaid covers low-income children, pregnant women, seniors, people with disabilities, and, in most states, adults earning below 138% of the federal poverty level. That translates to roughly $20,783 a year for a single person or $43,056 for a family of four (based on 2024 guidelines). Beyond income, eligibility depends on your state, your age, and whether you’re a U.S. citizen or qualified non-citizen.
Adults in Expansion States
The Affordable Care Act gave states the option to extend Medicaid to all adults ages 18 to 65 with household income at or below 138% of the federal poverty level, regardless of whether they have children, a disability, or any particular health condition. As of late 2023, 40 states plus Washington, D.C. have implemented this expansion. In these states, income is the only financial test. You do not need to meet an asset or resource limit.
If you live in one of the roughly 10 states that have not expanded Medicaid, eligibility for adults without children is extremely limited. In many of those states, a healthy adult without dependents cannot qualify at any income level. Parents may still qualify, but the income cutoff is often well below the poverty line.
Children and Pregnant Women
Children have the broadest eligibility of any group. Federal law requires states to cover children up to at least 133% of the federal poverty level, and most states set the bar higher through their Children’s Health Insurance Program (CHIP), often reaching 200% or more. Coverage typically extends from birth through age 18.
Pregnant women must be covered at a minimum of 133% of the poverty level in every state, and many states set higher thresholds. Coverage includes prenatal care, labor and delivery, and postpartum care. Some states have extended the postpartum coverage period to 12 months after delivery.
Seniors and People With Disabilities
If you receive Supplemental Security Income (SSI), you are likely eligible for Medicaid automatically. In most states, an SSI application doubles as a Medicaid application, and approval for one means approval for both. A smaller number of states require a separate Medicaid application, but the criteria remain closely tied to SSI rules.
For seniors and people with disabilities, Medicaid uses a different financial test than it does for most other groups. Instead of looking only at income, the program also counts assets and resources like savings accounts, investments, and property beyond your primary home. The specific dollar limits vary by state, but they follow the framework used by the SSI program or a state-chosen standard that cannot be stricter than SSI’s rules (with a few exceptions for states that had tighter rules in place before SSI existed).
People who qualify for both Medicare and Medicaid, sometimes called “dual eligibles,” get an additional benefit: Medicaid pays their Medicare premiums and may also cover services Medicare does not, such as long-term nursing home care. If you receive SSI and have Medicare, you also automatically qualify for Extra Help with Medicare prescription drug costs without filing a separate application.
Former Foster Youth
If you were in foster care on your 18th birthday, you can qualify for Medicaid up to age 26 in every state, similar to how private insurance lets young adults stay on a parent’s plan. Some states set the age cutoff at 19 or 20 for an optional coverage group, but federal law requires coverage of former foster youth who aged out of the system in that state. Income limits, when applied, must be at least as generous as the state’s standard for other adults.
People Diagnosed Through Cancer Screening Programs
Women under 65 who are screened through the CDC’s Breast and Cervical Cancer Early Detection Program and found to need treatment can qualify for Medicaid even if their income would otherwise be too high. The key requirements: you must need active treatment (not just routine monitoring), you must not already have insurance that covers cancer treatment, and you must not be eligible for mandatory Medicaid coverage through another pathway. This is a state option, but every state has adopted it.
The Spend-Down Option for High Medical Bills
Some states offer a “medically needy” pathway for people whose income is above the Medicaid limit but who face large medical bills. The concept works like a deductible: you accumulate qualifying medical expenses until the total brings your effective income down to the state’s threshold, and Medicaid then covers the rest of your care for that eligibility period.
Only bills you are personally responsible for count toward your spend-down amount. Expenses covered by other insurance, Medicare, or that a provider has written off cannot be used. You can include unpaid bills from up to three months before your application date, as well as current expenses. For community Medicaid, the eligibility period is typically one month at a time. For long-term care, the period stretches to six months, and coverage begins the first day of the month you meet your spend-down amount.
Not every state offers medically needy programs, and the rules vary considerably. This pathway is most relevant for older adults or people with disabilities whose income slightly exceeds regular Medicaid limits but who have ongoing, expensive care needs.
Citizenship and Residency Requirements
You must be a resident of the state where you’re applying, and you generally must be a U.S. citizen, U.S. national, or qualified non-citizen. Qualified non-citizens include lawful permanent residents (green card holders), refugees, and people granted asylum, among other categories defined by federal immigration law.
Most qualified non-citizens face a five-year waiting period before they can receive full Medicaid benefits. During that waiting period, states are still required to cover emergency medical treatment. Some states have chosen to waive the five-year bar for certain groups, particularly pregnant women and children who are lawfully present.
Undocumented immigrants are not eligible for full Medicaid coverage. They can receive Medicaid-funded care only for emergency medical conditions, which includes emergency labor and delivery.
How Income Is Calculated
For most applicants, including children, pregnant women, parents, and expansion adults, Medicaid uses Modified Adjusted Gross Income (MAGI). This is based on the income figure from your tax return, with a few adjustments. Under MAGI rules, states cannot apply an asset or resource test or use income disregards that existed under older Medicaid rules. The calculation is straightforward: if your household income falls below the percentage of the federal poverty level your state uses for your eligibility group, you qualify.
For groups not subject to MAGI, primarily seniors and people with disabilities, the financial rules are more complex. These individuals may face both an income test and an asset test, and states have more flexibility in how they count things like spousal income, retirement accounts, and property. If you fall into one of these groups and are close to the limits, your state Medicaid office can walk you through which assets are countable and which are exempt.
What the Income Limits Look Like in Dollars
For 2024 in the 48 contiguous states, 138% of the federal poverty level (the expansion adult threshold) works out to:
- Single person: $20,783 per year, or about $1,732 per month
- Family of four: $43,056 per year, or about $3,588 per month
Alaska and Hawaii have higher poverty level figures. Children and pregnant women often qualify at higher income percentages, so the dollar amounts for those groups are more generous. Your state’s Medicaid website or the federal marketplace at HealthCare.gov can show you the exact thresholds that apply to your household size and situation.