Medicaid eligibility requirements

Last verified: June 2026

Informational purposes only

This page provides general information about Medicaid. It is not legal or medical advice. Contact your state Medicaid agency or a qualified professional for guidance specific to your situation.

Medicaid eligibility depends on your income, household size, age, and family status — and the specific rules differ by state. The program covers over 77.9 million Americans, per CMS, making it the single largest source of health coverage in the country. But meeting the general criteria is only the starting point. Which income methodology applies to you, whether your state has expanded Medicaid under the ACA, and whether you fall into a federally required eligibility group all factor into whether you qualify.

This page walks through the main eligibility categories, the income rules, how expansion states differ from non-expansion states, and some situations where the rules work differently than people expect.

Who Medicaid is required to cover

Federal law requires every state to cover certain groups, regardless of whether the state has expanded Medicaid. States also must cover qualified Medicare beneficiaries (QMBs) who need help with Medicare cost-sharing.

Low-income families with children
Qualified pregnant women
Children — required up to at least 133% FPL (effectively 138% with the 5% MAGI disregard)
Individuals receiving Supplemental Security Income (SSI)
Qualified Medicare Beneficiaries (QMBs) who need help with Medicare cost-sharing
Former foster care youth who aged out with Medicaid — eligible at any income up to age 26
Children with Title IV-E adoption assistance agreements

Foster care: cross-state portability since 2023

As of January 1, 2023, former foster care youth who aged out in any state retain Medicaid eligibility at any income level up to age 26 — even if they move to a different state. Someone who aged out in Louisiana can now use Medicaid in Florida without re-qualifying under Florida's standard rules.

Medicaid expansion and ACA: what 138% FPL means

The Affordable Care Act gave states the option to extend Medicaid to most adults with incomes at or below 138% of the federal poverty level. As of 2025, 41 states and DC have adopted expansion, per KFF. The 138% figure comes from the statutory 133% FPL ceiling plus a mandatory 5% income disregard — the disregard is automatic and does not need to be requested.

Expansion state (e.g. Arizona)

Non-elderly adults with incomes up to 138% FPL qualify for Medicaid regardless of family status or disability. A single adult earning $20,000/year would likely qualify.

Non-expansion state (e.g. Texas)

Childless adults without a disability generally do not qualify — even at very low incomes. The same $20,000/year single adult would not qualify under Texas Medicaid.

Coverage gap in non-expansion states

If your state has not expanded Medicaid and your income is below 100% FPL, you may not qualify for either Medicaid (if you don't fit a mandatory category) or marketplace subsidies — which start at 100% FPL. Check your state's Medicaid agency directly to confirm what options exist.

MAGI vs non-MAGI: two separate income rules

Medicaid uses two distinct methodologies for measuring income. Which one applies depends on which eligibility group you fall into.

MAGI rules

✓ Applies to children, pregnant women, parents, and ACA expansion adults
✓ No asset test — only income counted by tax rules
✓ Required for most groups since 2014 under the ACA
✓ 5% income disregard applied automatically

Non-MAGI rules

✓ Applies to seniors (65+), people with disabilities, blind individuals
✓ Uses SSI income and asset methodologies — includes an asset test
✓ 209(b) states may apply criteria more restrictive than SSI
✓ Spenddown allowed when income exceeds the applicable limit

Common misconception: Medicaid doesn't always check assets

Many people assume Medicaid reviews bank balances and property for everyone. For most under-65 applicants, it does not. Asset tests were removed for MAGI-covered groups as part of the ACA's eligibility reforms. The asset test only applies to non-MAGI groups — primarily long-term care applicants and SSI-linked cases.

Categorical eligibility groups

Income alone does not determine eligibility. You must also fit into one of Medicaid's recognized eligibility categories — defined by federal statute and implemented by each state.

Children and pregnant women

Children qualify at the highest income thresholds — most states cover children up to at least 200% FPL through Medicaid or CHIP. Pregnant women are covered through 60 days postpartum; many states have extended that window to 12 months via an option made permanent under the American Rescue Plan Act in 2021.

Low-income families and parents

Parents and caretaker relatives can qualify in every state, but income limits vary dramatically. In non-expansion states the parent limit is often well below 100% FPL — sometimes as low as 17% in certain states, per KFF. Childless adults without a disability rarely qualify in non-expansion states.

Seniors and people with disabilities

Individuals who receive SSI are automatically eligible in most states. People 65+ with limited income may qualify for both Medicare and Medicaid (dual eligibility). Long-term care applicants go through separate non-MAGI financial assessments, including asset reviews.

ACA expansion adults

In the 41 expansion states plus DC, non-elderly adults without dependent children can qualify at up to 138% FPL. This group did not exist as a Medicaid category before 2014 — it was created entirely by the Affordable Care Act.

The medically needy pathway and spenddown

Some people earn slightly too much to qualify for standard Medicaid but have significant medical costs. For them, 36 states and DC operate spenddown programs, per CMS. These allow an applicant to subtract documented medical expenses from their countable income until it falls below the state's medically needy income standard.

How spenddown works — a simple example

$600/mo

state income limit

$900/mo

your income

$300

unreimbursed medical bills

$600 countable

meets the limit — you qualify

Once the spenddown obligation is met for a coverage period, Medicaid covers further costs for that period.

Not all states offer a spenddown program

States without a medically needy program have a hard income cutoff — if your income exceeds the limit, you do not qualify regardless of medical costs. Florida, for example, does not operate a medically needy program for most adults. Check your state's Medicaid agency to confirm whether spenddown is available.

Retroactive coverage and the three-month lookback

Medicaid can cover medical expenses incurred before you applied — in some cases going back three months prior to the application month. This retroactive coverage applies if you would have been eligible during that period. It can significantly reduce out-of-pocket costs for people who sought care before realizing they might qualify.

Retroactive coverage is not automatic in every state — some states have limited or eliminated it under federal waivers. Whether it applies depends on your income at the time of service, not just at the time of application.

Tip: claim retroactive coverage after emergency care

If you had emergency medical care in the past three months and are now applying for Medicaid, tell your caseworker at the time of application. Provide bills or explanation of benefits from that period — the agency will assess whether you were eligible at the time of service and can apply coverage retroactively.

How to apply and what happens next

You can apply for Medicaid year-round — there is no open enrollment window. Applications go through your state Medicaid agency directly or through the federal Health Insurance Marketplace at healthcare.gov. Both routes work; the Marketplace will automatically screen for Medicaid eligibility and transfer your application to the state if you appear to qualify.

days to process
most applications
(42 CFR 435.912)

days for
disability-based
applications

Apply year-round — no enrollment period for Medicaid
Apply through your state agency or at healthcare.gov
Fast-track approvals possible in days for ACA expansion adults via data matches
Ask about retroactive coverage if you had recent medical expenses
Request a fair hearing if you are denied — denial notices must explain the reason

State-by-state variation

States design their own Medicaid programs within federal minimums. A person who qualifies in one state may not qualify in another — not just because of expansion status, but because of different income limits for specific groups, optional categories each state covers, and different managed care arrangements.

NC Medicaid completed its expansion in December 2023. Louisiana expanded in 2016. Florida remains a non-expansion state as of mid-2026. These differences are not administrative quirks — they translate directly to whether millions of people have coverage at all. Some states use Medicaid managed care through private insurance companies; others use traditional fee-for-service. Federal minimum benefits apply in both cases.

Find your state's eligibility rules

Income limits, optional categories, and program details vary by state. Every state has a dedicated page with specific rules, income tables, and a link to the official state Medicaid agency.

Browse all 50 states →

Not sure if you qualify?

Medicaid eligibility depends on your income, household size, state, and category. Use our free screener to get a quick sense of whether you may qualify — no personal information required.

Check your eligibility →