Understanding Medicaid eligibility can feel complex. You may worry about healthcare costs after losing your job. You may also question if your income is too high. The truth is, Medicaid supports millions of families every year. Your children can receive doctor visits and prescription coverage. But you must know the eligibility requirements for Medicaid.
You may qualify for long-term care services as you age. You can access prenatal care during pregnancy. You can also access essential medical support for disabilities. This guide explains Medicaid eligibility in simple, clear terms. You will see how income and household size affect qualification. You will also learn how losing employer insurance impacts your coverage options.
Find out about special populations who qualify easily. Learn the step-by-step application process. Get documents ready for your interview. Understand when to renew your coverage. Start your journey to affordable healthcare today.
Table of Contents
What Is Medicaid and Who Can Get It?
Medicaid is a government program that helps cover the costs of healthcare. It covers doctor visits, hospital stays, and prescription medicines. The program serves millions of Americans every year. Each state runs its own Medicaid program with different rules.
Basic Medicaid Coverage Groups
Medicaid helps these main groups of people:
- Children and teens under 19 years old
- Pregnant women who need prenatal and delivery care
- Parents and caregivers with dependent children at home
- Adults aged 19-64 in expansion states
- Older adults over 65 who need extra help
- People with disabilities who receive government benefits
Eligibility Requirements for Medicaid for Families
The program pays for many essential health services. These include regular checkups and emergency room visits. It also covers mental health counseling and therapy sessions.
Interactive Eligibility Calculator Guide
Use this simple method to check your Medicaid eligibility. This calculator helps you understand if you qualify. Follow these easy steps to estimate your chances.
Step 1: Count Your Household Size
- Include yourself and your spouse if married
- Count children under 21 living with you
- Add any tax dependents you claim
- Pregnant women count as two people
Step 2: Calculate Your Monthly Income
- Add wages from all jobs
- Include unemployment benefits if receiving them
- Count Social Security and disability payments
- Add child support and alimony received
Step 3: Find Your State’s Income Limit
- Look up your state in the table below
- Find the limit for your household size
- Check if your state expanded Medicaid coverage
- Note different limits for different groups
Step 4: Compare Your Income
- Your monthly income should be under the limit
- Use current income, not last year’s taxes
- Include all household members’ income sources
- Consider recent changes like job loss
Step 5: Apply If You Qualify
- Submit your application within 60 days
- Gather the required documents before starting
- Be honest about all income sources
- Report any household changes quickly
Income Sources That Count
Remember to include these income types in calculations:
- Wages from employment and self-employment earnings
- Social Security benefits and veterans’ compensation
- Unemployment benefits and workers’ compensation payments
- Child support payments and spousal support
- Interest income and rental property income
Medicaid Eligibility Income Limits by State
Each state sets different income limits based on household size. Expansion states cover adults earning up to 138% of the Federal Poverty Level. This equals $21,597 for single adults in 2025 and 2026. Non-expansion states have much lower income limits.
| State | Official Resource | Income Limit (Individual / Couple, 2025 and 2026) | Asset Limit (Individual / Couple) |
| Alabama | https://medicaid.alabama.gov/ | $2,901 / $5,802 | $2,000 / $3,000 |
| Alaska | https://health.alaska.gov/en/services/division-of-public-assistance-dpa-services/apply-for-medicaid/ | $2,901 / $5,802 | $2,000 / $3,000 |
| Arizona | https://www.azahcccs.gov/ | $2,901 / $5,802 | $2,000 / $3,000 |
| Arkansas | https://portal.mmis.arkansas.gov/armedicaid/provider/Home/tabid/135/Default.aspx | $2,901 / $5,802 | $2,000 / $3,000 |
| California | https://www.dhcs.ca.gov/services/medi-cal/Pages/default.aspx | $1,801 / $2,433 | $2,000 / $3,000 |
| Colorado | https://www.healthfirstcolorado.com/ | $1,459 / $5,802 | $2,000 / $3,000 |
| Connecticut | https://portal.ct.gov/husky | $2,901 / $5,802 | $1,600 / $2,400 |
| Delaware | https://dhss.delaware.gov/dhss/dmma | $2,417 / $5,802 | $4,000 / $6,000 |
| Florida | https://ahca.myflorida.com/medicaid | $2,901 / $5,802 | $2,000 / $3,000 |
| Georgia | https://medicaid.georgia.gov | $2,901 / $5,802 | $2,000 / $3,000 |
| Hawaii | https://medquest.hawaii.gov | $1,819 / $2,452 | $2,000 / $3,000 |
| Idaho | https://www.idmedicaid.com/ | $1,470 / $2,433 | $2,000 / $3,000 |
| Illinois | https://hfs.illinois.gov/medical | $1,304 / $1,762 | $2,000 / $3,000 |
| Indiana | https://www.in.gov/medicaid/ | $1,763 / $5,802 | $1,500 / $2,250 |
| Iowa | https://hhs.iowa.gov/medicaid | $1,450 / $5,802 | $2,000 / $3,000 |
| Kansas | https://www.kancare.ks.gov/ | $2,901 / $5,802 | $2,000 / $3,000 |
| Kentucky | https://chfs.ky.gov/agencies/dms/pages/default.aspx | $1,304 / $5,802 | $2,000 / $3,000 |
| Louisiana | https://www.lamedicaid.com/provweb1/default.htm | $2,901 / $5,802 | $2,000 / $4,000 |
| Maine | https://www.maine.gov/dhhs/oms | $2,901 / $5,802 | $2,000 / $3,000 |
| Maryland | https://health.maryland.gov/mmcp/pages/home.aspx | $2,901 / $5,802 | $2,500 / $4,000 |
| Massachusetts | https://www.mass.gov/topics/masshealth | $2,901 / $5,802 | $2,000 / $3,000 |
| Michigan | https://www.michigan.gov/mdhhs/assistance-programs/medicaid | $2,901 / $5,802 | $2,000 / $3,000 |
| Minnesota | https://mn.gov/dhs/people-we-serve/adults/health-care/health-care-programs/programs-and-services/medical-assistance.jsp | $2,344 / $5,802 | $3,000 / $6,000 |
| Mississippi | https://medicaid.ms.gov/ | $2,901 / $5,802 | $4,000 / $6,000 |
| Missouri | https://mydss.mo.gov/mhd | $1,499 (both) | $1,000 / $2,000 |
| Montana | https://dphhs.mt.gov/MontanaHealthcarePrograms/MemberServices | $967 / $1,450 | $2,000 / $3,000 |
| Nebraska | https://dhhs.ne.gov/Pages/Medicaid-Eligibility.aspx | $1,305 / $1,762 | $4,000 / $6,000 |
| Nevada | https://www.medicaid.nv.gov/ | $1,304 / $2,220 | $2,000 / $3,000 |
| New Hampshire | https://www.dhhs.nh.gov/programs-services/medicaid | $1,304 / $2,220 | $2,500 / $4,000 |
| New Jersey | https://www.nj.gov/humanservices/dmahs/clients/medicaid/ | $2,901 / $5,802 | $2,000 / $4,000 |
| New Mexico | https://yes.nm.gov/nmhr/s/yesnm-health-and-benefits?language=en_US | $2,901 / $5,802 | $2,000 / $3,000 |
| New York | https://www.health.ny.gov/health_care/medicaid/ | $2,901 / $5,802 | $32,396 / $48,594 |
| North Carolina | https://medicaid.ncdhhs.gov | $1,763 / $2,752 | $2,000 / $3,000 |
| North Dakota | https://www.hhs.nd.gov/medicaid | $1,800 / $2,433 | $3,000 / $6,000 |
| Ohio | https://medicaid.ohio.gov | $2,901 / $5,802 | $1,500 / $2,250 |
| Oklahoma | https://oklahoma.gov/ohca | $1,814 / $2,451 | $2,000 / $3,000 |
| Oregon | https://www.oregon.gov/oha/HSD/OHP | $2,901 / $5,802 | $2,000 / $3,000 |
| Pennsylvania | https://www.compass.state.pa.us | $1,762 / $2,901 | $2,400 / $4,800 |
| Rhode Island | https://eohhs.ri.gov/consumer/health-care | $2,901 / $5,802 | $4,000 / $6,000 |
| South Carolina | https://www.scdhhs.gov | $2,901 / $5,802 | $2,000 / $3,000 |
| South Dakota | https://dss.sd.gov/medicaid | $2,901 / $5,802 | $2,000 / $3,000 |
| Tennessee | https://www.tn.gov/tenncare | $2,901 / $5,802 | $2,000 / $3,000 |
| Texas | https://www.yourtexasbenefits.com | $3,261 / $5,000 | $2,000 / $3,000 |
| Utah | https://medicaid.utah.gov | $1,305 / $1,763 | $2,000 / $3,000 |
| Vermont | https://dvha.vermont.gov/members | $2,901 / $5,802 | $1,000 / $2,000 |
| Virginia | https://coverva.org | $2,000 / $3,900 | $2,000 / $3,000 |
| Washington | https://www.hca.wa.gov/health-care-services-supports/apple-health-medicaid-coverage | $1,450 / $2,658 | $2,000 / $3,000 |
| West Virginia | https://dhhr.wv.gov/bms | $2,901 / $5,802 | $2,000 / $3,000 |
| Wisconsin | https://www.dhs.wisconsin.gov/badgercareplus | $2,901 / $5,802 | $2,000 / $3,000 |
| Wyoming | https://health.wyo.gov/healthcarefin/medicaid | $1,450 / $2,658 | $2,000 / $3,000 |
Understanding the Income Percentages
The percentages in the table represent Federal Poverty Level limits. For 2025 and 2026, 100% Federal Poverty Level (FPL) equals $15,650 for one person, $21,150 for two people, $26,650 for three people, and $32,150 for four people.
Special Populations Who Qualify More Easily
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Certain groups have priority access to Medicaid coverage benefits. These special populations often skip regular income requirements. They may qualify based on their circumstances alone.
Pregnant Women and Medicaid Coverage
Pregnant individuals receive priority for Medicaid enrollment nationwide. Most states cover pregnant women with higher income limits. Coverage starts immediately upon application approval.
Pregnancy Medicaid Benefits Include:
- Complete prenatal care and regular checkup visits
- Delivery services and hospital stay coverage
- Emergency services if pregnancy complications develop
- Postpartum care for 60 days after birth
- Prescription medications related to pregnancy care
Income Limits for Pregnant Women:
- Range from 138% to 375% of the Federal Poverty Level (FPL) by state
- Much higher than regular adult limits
- Covers middle-income working families, too
- No asset limits in most states
People with Disabilities Access
Individuals receiving Supplemental Security Income (SSI) automatically qualify for Medicaid coverage. Disability-based eligibility follows different rules from regular income limits. Asset limits may apply, but are often generous.
Disability Medicaid Covers:
- Medical equipment and mobility devices
- Physical therapy and rehabilitation services
- Mental health counseling and psychiatric care
- Prescription medications for chronic conditions
- Long-term care services are available when needed
Elderly Adults Over 65 Years
Seniors can combine Medicaid with their Medicare coverage. This combination pays for services Medicare doesn’t cover. Long-term care represents the most significant benefit here.
Elderly Medicaid Services:
- Nursing home care and assisted living
- Home health aide services and support
- Adult day care and respite care
- Prescription drug copayments and deductibles
- Medicare premiums and cost-sharing help
Qualifying for Medicaid After Losing Employer Insurance
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Job loss creates immediate opportunities for Medicaid enrollment. You have 60 days to apply for coverage. Medicaid can start the same day you lose insurance.
Immediate Steps After Job Loss
Take these essential actions right after losing employment:
Week 1: Apply Immediately
- Don’t wait to submit your Medicaid application
- Use current income, not previous year’s earnings
- Include severance pay as monthly income temporarily
- Report unemployment benefit applications in progress
Week 2: Gather Required Documents
- Collect termination letters from your former employer
- Get unemployment benefit award letters when available
- Update bank statements showing current account balances
- Obtain proof of any COBRA coverage options
Income Changes After Job Loss
Adults who lose employer coverage often fall into income ranges that qualify them for Medicaid. Unemployment benefits count as income for eligibility purposes. However, many people still qualify after a job loss.
Reporting Income Changes:
- Use your expected monthly income going forward
- Don’t average last year’s higher income
- Include spouse’s income if filing taxes together
- Report child support or other regular payments
Maintaining Your Medicaid Coverage Through Re-certification
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Medicaid coverage requires annual renewal to continue receiving benefits. You must report income and household changes promptly. Missing deadlines can cause coverage to end suddenly.
Annual Re-certification Requirements
Most states require yearly renewal of all Medicaid coverage. You’ll receive renewal forms by mail before your expiration date. Complete and return them on time.
Re-certification Process Steps:
- Watch for renewal notices in your mail
- Complete forms accurately and completely
- Gather updated income and household documentation
- Submit everything before the deadline date
Changes You Must Report Immediately:
- New job or significant income increases
- Moving to a different address or state
- Marriage, divorce, or separation status changes
- New babies or people joining your household
- Changes in health insurance from employers
What Happens If You Miss Renewal
Missing your renewal deadline ends Medicaid coverage immediately. You lose access to doctors and prescription medications. Emergency room visits become very expensive without coverage.
Getting Coverage Back:
- Apply as a new applicant immediately
- Explain why you missed the renewal deadline
- Provide all required documentation again
- Coverage may have a gap period.
Frequently Asked Questions
What is the highest income to be eligible for Medicaid?
The highest income varies by state and household size. Expansion states allow up to 138% of the Federal Poverty Level for adults, which equals $21,597 for single people in 2025 and 2026. Some pregnant women can earn up to 375% of the Federal Poverty Level (FPL).
What is the primary eligibility requirement for Medicaid benefits?
Income level is the primary eligibility requirement for most people. You must also be a US citizen or qualified immigrant. Additionally, you must reside in the state where you are applying.
Who gets denied for Medicaid?
People get denied when their income exceeds state limits. Non-citizens without qualified status also get rejected. Missing required documents or information can also cause denials.
How to apply for Medicaid?
Apply online through your state’s Medicaid website or HealthCare.gov. You can also apply by phone or mail. Local offices provide in-person application assistance if needed.
Conclusion
Understanding eligibility requirements for Medicaid opens doors to affordable healthcare coverage. Income limits vary significantly between expansion and non-expansion states. Medicaid household size rules directly affect your qualification chances. Special populations like pregnant women and disabled individuals have easier paths.
After losing employer insurance, act quickly to apply. Gather all required documents before starting your application process. The interview helps caseworkers understand your specific situation completely. Annual re-certification keeps your coverage active and current. Use the interactive calculator guide to estimate eligibility.
Check your state’s specific income limits in our table. Remember that Medicaid provides essential healthcare access for millions. Don’t let complex rules prevent you from applying today. Your family’s health and financial security depend on it.
