Medicaid Eligibility Requirements
Learn who qualifies for Medicaid, how income limits work, and what citizenship, residency, and other factors affect your eligibility.
Who qualifies for Medicaid?
Medicaid eligibility is determined through a combination of federal requirements and state-specific rules. The federal government establishes mandatory eligibility groups that all states must cover and sets minimum income standards, while states have the flexibility to expand coverage beyond those federal minimums. This means that whether you qualify for Medicaid depends significantly on which state you live in.
In states that expanded Medicaid under the Affordable Care Act, most non-elderly adults with incomes up to 138% of the Federal Poverty Level (FPL) are eligible, regardless of whether they have children. In states that have not expanded, eligibility for adults without dependent children may be very limited or nonexistent under traditional Medicaid rules. Checking with your state Medicaid agency is always the most accurate way to determine your eligibility.
Groups all states must cover
Federal law requires every state Medicaid program to cover these groups:
- Low-income families with children — Parents and caretaker relatives with children who meet income and family composition requirements.
- Pregnant women — Pregnancy-related coverage is a mandatory federal category, typically available up to at least 138% of the Federal Poverty Level.
- Children under 19 in low-income households — Children in families below applicable income thresholds; higher thresholds available through CHIP in many states.
- SSI recipients — In most states, individuals receiving Supplemental Security Income automatically qualify for Medicaid.
- Certain seniors and people with disabilities — Low-income seniors (65+) and individuals with qualifying disabilities who meet income and asset tests.
- Adults up to 138% FPL (expansion states) — In the 40+ states that adopted the ACA expansion, most non-elderly adults below 138% of the FPL qualify.
How income limits work
Medicaid income limits are expressed as percentages of the Federal Poverty Level (FPL), a threshold published annually by the U.S. Department of Health and Human Services. For most eligibility groups, states use Modified Adjusted Gross Income (MAGI) methodology, which aligns with how income is calculated for federal income taxes. MAGI includes wages, salaries, self-employment income, Social Security benefits (in most cases), and other common income sources.
Income thresholds vary by household size: larger households have higher dollar-amount limits at the same FPL percentage. They also vary significantly by eligibility category — children and pregnant women typically qualify at higher income levels than adults without children. In expansion states, most non-elderly adults qualify up to 138% of the FPL. In non-expansion states, the income limit for parents can be very low, and childless adults typically do not qualify at all under standard Medicaid rules.
For detailed income limit information by state and household size, see our Medicaid income limits guide.
Citizenship and immigration requirements
To qualify for full Medicaid benefits, you generally must be a U.S. citizen, a U.S. national, or a "qualified non-citizen." Qualified non-citizens include lawful permanent residents (green card holders), refugees, asylees, people granted withholding of deportation, Cuban/Haitian entrants, certain battered non-citizens, and certain other humanitarian categories.
Most qualified non-citizens who entered after August 22, 1996, must wait five years before they can receive federally funded Medicaid. However, several groups are exempt from this waiting period, including refugees, asylees, survivors of trafficking, and military veterans and their families. Some states use their own funds to cover individuals during the waiting period.
Regardless of immigration status, all individuals who are physically present in the United States are eligible for Emergency Medicaid, which covers treatment of emergency medical conditions. Additionally, many states cover pregnant women regardless of immigration status using CHIP unborn child options or state-only funds.
State residency: no minimum waiting period
You must be a resident of the state in which you apply for Medicaid. Federal law does not require any minimum length of residency — simply living in a state with the intent to remain there is sufficient. You cannot be required to have lived in a state for any set amount of time before applying. However, states may have their own definitions of what constitutes residency, and you must typically provide documentation showing your current address in the state.
What else affects your eligibility
Beyond income, several other factors may affect your Medicaid eligibility:
- Household composition — Who counts as part of your household affects both income calculations and which eligibility category applies to you.
- Age — Some eligibility categories (such as coverage for seniors and children) have specific age requirements.
- Disability status — People with qualifying disabilities may access Medicaid through separate eligibility pathways, sometimes with different income and asset rules.
- Pregnancy — Pregnancy is its own mandatory eligibility category with typically more generous income thresholds than standard adult coverage.
- Long-term care needs — Seniors and people with disabilities seeking nursing facility or home care may face different (often more stringent) income and asset rules. See our seniors & long-term care guide.