You can find out if you’re eligible for Medicaid by checking your income, household size, age, disability status, and state of residence. The fastest way is to visit your state’s Medicaid website or the federal marketplace (HealthCare.gov), where you can fill out a short eligibility form. Generally, adults earning up to 138% of the federal poverty level (FPL) may qualify in expansion states. Eligibility also depends on non-financial factors, such as citizenship, residency, and medical need.
Quick Summary
Medicaid is a joint federal–state program providing health coverage for low-income individuals and families. Each state manages its own eligibility rules within federal guidelines. This guide breaks down how to determine eligibility, how income and household factors are evaluated, and what to do if your application is denied so you can confidently find out whether you qualify.
Also Read: Medicaid Long Term Care Eligibility Criteria
Introduction: Why Medicaid Eligibility Matters
Medicaid serves as the foundation of America’s safety net, providing healthcare to more than 77 million people from children and pregnant women to seniors and individuals with disabilities. But because Medicaid isn’t a one-size-fits-all program, figuring out whether you qualify can feel complicated.
The good news? Modern eligibility systems, driven by the Affordable Care Act (ACA), make it much easier to find out if you qualify in your state. Whether you apply online, by phone, or in person, this guide will show you exactly what to check and what happens next.
Understanding Medicaid Eligibility Basics
Financial vs. Non-Financial Criteria
Medicaid eligibility is determined by two major factors: financial (income and assets) and non-financial (residency, citizenship, and medical need).
- Financial Criteria: Most applicants qualify based on income limits tied to the Federal Poverty Level (FPL). These limits vary by state and family size.
- Non-Financial Criteria: Applicants must live in the state where they’re applying, have U.S. citizenship or qualified non-citizen status, and meet any group-specific requirements (such as pregnancy, disability, or age).
MAGI: The Standardized Income Rule
The Affordable Care Act introduced Modified Adjusted Gross Income (MAGI), simplifying Medicaid and CHIP eligibility. MAGI uses the same income definitions as federal tax returns, ensuring consistent standards across Medicaid, CHIP, and Marketplace coverage.
Some groups — including seniors, people with disabilities, and those needing long-term care — are exempt from MAGI and follow SSI-based income rules instead.
Step-by-Step Guide to Find Out if You’re Eligible
Step 1: Determine Your Household Income
Check your gross monthly income against your state’s Medicaid income limits. These limits are based on your household size and the Federal Poverty Level (FPL).
- In Medicaid expansion states, most adults under 65 qualify if their income is 138% of the FPL or lower.
- Children and pregnant women often qualify at higher thresholds — sometimes up to 200–300% of the FPL.
Use your state’s Medicaid income chart or the HealthCare.gov calculator to estimate your eligibility.
Step 2: Identify Which Eligibility Category You Fall Into
Medicaid covers several groups:
- Low-income adults (in expansion states)
- Children (through Medicaid or CHIP)
- Pregnant women
- Seniors aged 65 and older
- Individuals with disabilities or long-term care needs
Each category may have slightly different income and non-financial requirements.
Step 3: Check Non-Financial Requirements
Even if you meet income limits, you must also satisfy:
- Residency: You must apply in your current state of residence.
- Citizenship: You must be a U.S. citizen or qualified non-citizen.
- Social Security Number (SSN): Most states require this for verification.
Step 4: Use Official Tools to Check Eligibility
You have multiple ways to find out if you qualify:
- Online: Visit your state’s Medicaid website or HealthCare.gov.
- By Phone: Call your state Medicaid office or HealthCare.gov (1-800-318-2596).
- In Person: Visit a local Medicaid office or an Assistance Center.
After entering your income, household size, and other details, you’ll get an immediate eligibility estimate or referral to your state agency.
Step 5: Apply for Medicaid
Even if you’re unsure, apply anyway. Many applicants underestimate their eligibility. When you apply:
- Provide proof of income (pay stubs, tax returns)
- Verify your residency and citizenship
- Submit your Social Security Number (if applicable)
If your application is denied, you have the right to appeal. Each state has a formal appeal process to review eligibility decisions.
What If You Don’t Qualify for Medicaid?
If you’re not eligible for Medicaid, you may still qualify for:
- CHIP (Children’s Health Insurance Program) for children and teens
- Marketplace coverage with premium tax credits if your income is above Medicaid limits
- Medically Needy Programs, which allow you to “spend down” excess income through medical expenses to qualify for partial Medicaid coverage
Common Mistakes Applicants Make
- Not applying because they assume they’re ineligible. Income limits are higher than many expect.
- Failing to update information. Your eligibility can change if your income or household size changes.
- Overlooking state differences. Each state sets its own eligibility limits within federal rules.
State-by-State Flexibility in Medicaid
Medicaid gives states flexibility to expand or adjust eligibility through waivers and demonstrations. Examples include:
- Home and Community-Based Services (HCBS) for individuals with disabilities
- Spousal impoverishment protections for long-term care couples
- Estate recovery programs after a beneficiary’s death
Because of this flexibility, eligibility rules vary widely, making it essential to check your own state’s requirements.
Retroactive and Emergency Coverage
Many states provide retroactive Medicaid coverage for up to three months before your application, covering medical bills incurred while you were eligible but not yet enrolled.
Emergency Medicaid also exists for non-citizens who meet financial but not immigration requirements and need urgent care.
What Happens After You Apply
Once you apply, your state’s Medicaid agency or the federal exchange will:
- Review your information and verify it against income databases.
- Notify you by mail, email, or online portal whether you’re eligible.
- If eligible, you’ll receive details about your Medicaid ID, plan options, and coverage start date.
If denied, you’ll receive instructions for appealing the decision.
People Also Ask
Income limits vary by state and household size. For adults in Medicaid expansion states, eligibility typically applies up to 138% of the FPL.
Yes. Medicaid acts as the payer of last resort, covering what private insurance doesn’t.
Yes. Medicaid eligibility is based on your current monthly income, not your employment status.
Most states require annual renewal, though some conduct continuous eligibility reviews.
Conclusion: Take the Next Step Toward Coverage
Determining Medicaid eligibility doesn’t have to be confusing. By checking your income, household size, and state-specific criteria, you can quickly learn whether you qualify for free or low-cost healthcare coverage. Even if you’re uncertain, it’s always worth applying — millions of people discover they’re eligible each year.
Medicaid remains one of the most powerful tools for healthcare access in America, ensuring that financial hardship doesn’t stand in the way of essential medical care.
Author Bio
Written by: Health Policy Editorial Team
Our writers specialize in healthcare coverage, Medicare, and Medicaid education, with a focus on breaking down complex policy details into actionable, trustworthy insights for American families.