Medicaid eligibility requirements

Updated August 2026

Medicaid eligibility depends on your income, household size, age, and family status — and the specific rules differ by state. The program and CHIP together cover about 73.9 million Americans, per CMS, making Medicaid the single largest source of health coverage in the country. 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.

73.9M

Americans covered by Medicaid/CHIP (CMS, Apr 2026)

138%

of FPL — ACA expansion income threshold

41 + DC

states with ACA Medicaid expansion (KFF)

45 days

to process most applications

Who Medicaid is required to cover

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

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.

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

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.

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.

State type	What it means
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.

Expansion state (e.g. Arizona)

What it means: 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)

What it means: 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.

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.

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.

MAGI rules	Non-MAGI rules
Applies to children, pregnant women, parents, and ACA expansion adults	Applies to seniors (65+), people with disabilities, and blind individuals
No asset test — only income counted under tax rules	Uses SSI income and asset methodologies, including an asset test
Required for most groups since 2014 under the ACA	209(b) states may apply criteria more restrictive than SSI
5% income disregard applied automatically	Spend-down allowed when income exceeds the applicable limit

Applies to children, pregnant women, parents, and ACA expansion adults

Non-MAGI rules: Applies to seniors (65+), people with disabilities, and blind individuals

No asset test — only income counted under tax rules

Non-MAGI rules: Uses SSI income and asset methodologies, including an asset test

Required for most groups since 2014 under the ACA

Non-MAGI rules: 209(b) states may apply criteria more restrictive than SSI

5% income disregard applied automatically

Non-MAGI rules: Spend-down allowed when income exceeds the applicable limit

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.

Group	What applies
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 — Texas's limit, the nation's lowest, sits around 15% FPL, 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.

Children and pregnant women

What applies: 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

What applies: 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 — Texas's limit, the nation's lowest, sits around 15% FPL, per KFF. Childless adults without a disability rarely qualify in non-expansion states.

Seniors and people with disabilities

What applies: 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

What applies: 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 spend-down

Some people earn slightly too much to qualify for standard Medicaid but have significant medical costs. For them, roughly 34 states operate spend-down (medically needy) programs, per KFF — confirm your state's current status, as it can change. These allow an applicant to subtract documented medical expenses from their countable income until it falls below the state's medically needy income standard.

Not all states offer a spend-down 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. Several states, including Alabama and Arizona, do not operate a medically needy program for most adults. Check your state's Medicaid agency to confirm whether spend-down is available.

1

State income limit

In this example, the state income limit is $600 per month.
2

Your income

Your actual income is $900 per month — above the state limit.
3

Unreimbursed medical bills

$300 in documented medical expenses can be subtracted from your countable income.
4

Countable income after spend-down

$600 — meets the limit, so you qualify. Once the spend-down obligation is met for a coverage period, Medicaid covers further costs for that period.

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.

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.

45 days

to process most applications (42 CFR 435.912)

90 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.

North Carolina completed its Medicaid 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.

Income limits, optional categories, and program details vary by state — check your state's Medicaid agency for state-specific rules and income tables.

A new work requirement for expansion adults

The 2025 federal budget reconciliation law created a federal Medicaid work requirement, taking effect no later than January 1, 2027 in the 43 expansion states plus DC. Most ACA expansion adults ages 19–64 must document at least 80 hours per month of work, school, job training, or qualifying community engagement, with exemptions for parents of young children, people with disabilities, pregnant women, and other groups. This is now enacted federal law — not a discretionary state waiver — and states must verify compliance at application and at renewal.

Medicaid rules vary by state

Find your state's specific income limits, application steps, and covered benefits.

Find your state