How to Qualify for Medicaid in Your State

Learning how to qualify for Medicaid can transform your access to essential healthcare services, and understanding your state’s specific requirements is crucial for successful enrollment in 2025 and 2026. If you’re exploring Medicaid eligibility by state 2025 guidelines, this comprehensive guide will walk you through every step of the process. 

You’ll discover how to qualify for Medicaid based on your unique circumstances, learn about Medicaid qualifications for single adults, and understand precisely how to apply for Medicaid in your state using official government resources from Medicaid.gov and HealthCare.gov. 

By the end of this article, you’ll have all the tools needed to navigate your state’s Medicaid system confidently and secure the healthcare coverage you deserve through the official application process available at USA.gov.

Medicaid Basics: Your Foundation for 2025 and 2026 Enrollment

Medicaid serves as a joint federal-state program that provides essential healthcare coverage to millions of Americans, with each state operating its own unique system under federal guidelines. Understanding how to qualify for Medicaid begins with recognizing that your eligibility depends heavily on your state of residence, income level, and specific circumstances.

The program operates under the oversight of the Centers for Medicare & Medicaid Services (CMS), which establishes federal requirements while allowing states flexibility in implementing their programs. This structure creates significant variation in how to qualify for Medicaid across different states, making state-specific knowledge crucial for your application success.

Federal vs. State Medicaid Responsibilities

The federal government sets baseline eligibility standards and provides funding, while states determine specific income thresholds, application processes, and additional services. According to official CMS data, 78,095,734 people were enrolled in Medicaid and CHIP in the 50 states as of May 2025, underscoring the program’s extensive reach and significance.

Your state’s participation in Medicaid expansion significantly affects your eligibility options. As of 2025, 40 states and DC have accepted the Affordable Care Act (ACA)’s Medicaid expansion, which dramatically increases income limits for Medicaid qualifications for single adults and other eligible populations.

2025 and 2026 Federal Poverty Level Guidelines

The foundation for understanding income limits for Medicaid by state lies in the Federal Poverty Level (FPL) guidelines. For 2025, 100% FPL equals $15,650 for a single person, $21,150 for two people, $26,650 for three, and $32,150 for four in the 48 contiguous states and DC. 

Alaska and Hawaii maintain higher thresholds due to cost-of-living differences, as established by the U.S. Department of Health and Human Services.

2025 and 2026 Medicaid Eligibility Categories

Determining how to qualify for Medicaid requires understanding which eligibility category applies to your situation. The program divides applicants into specific groups, each with distinct requirements and income thresholds that vary by state.

Medicaid eligibility categories fall into two primary systems: Modified Adjusted Gross Income (MAGI)-based and non-MAGI categories, each serving different populations with specific qualification criteria.

Modified Adjusted Gross Income-Based Eligibility Categories

Adults Ages 19-64

In expansion states, adults qualify if their income falls at or below 138% of the Federal Poverty Level, which includes a 5% income disregard. This means your practical income limit reaches approximately $21,590 annually for a single person in 2025 and 2026. 

For detailed state-specific requirements, visit your state’s official Medicaid website through Medicaid.gov’s state directory.

Children and Adolescents

Eligibility for children extends to at least 133% of the Federal Poverty Level in every state, with most states covering children at higher income levels. Your children may qualify even if you don’t, making family applications crucial for comprehensive coverage.

Pregnant Women

Pregnant women typically qualify at higher income thresholds, often ranging from 138% to 200% of the Federal Poverty Level, depending on your state’s policies. Check your state’s specific guidelines through HealthCare.gov for current requirements.

Non-Modified Adjusted Gross Income (MAGI) Categories

Medicaid Qualifications for Single Adults (Aged, Blind, Disabled)

For most states, the income limit is $2,901 per month for single applicants seeking long-term care services, typically set at 300% of the Federal Benefit Rate. However, regular Medicaid for aged, blind, or disabled individuals often has much lower limits, approximately $967 monthly for single applicants in about half the states.

Asset Limitations

Non-Modified Adjusted Gross Income (MAGI) categories typically include asset limits of $2,000 for individuals and $3,000 for married couples. However, these limits don’t apply to Modified Adjusted Gross Income (MAGI)-based categories.

Complete State-by-State Income Limits and Expansion Status (2025-2026)

Understanding Medicaid eligibility by state 2025 requirements necessitates examining each state’s unique approach to income thresholds and expansion decisions. Your state’s expansion status directly impacts how to qualify for Medicaid in your specific location.

Medicaid Expansion States vs. Non-Expansion States

The divide between expansion and non-expansion states creates dramatically different eligibility landscapes for adults seeking coverage.

State Category	Adult Income Limit (138% FPL)	Monthly Income (Single)	Annual Income (Single)
Expansion States (40 + DC)	138% FPL + 5% disregard	~$1,800	~$21,590
Non-Expansion States (10)	Varies significantly	$100-$400	$1,200-$4,800

Expansion States (40 States + DC) – Current as of 2025

According to official KFF tracking data, these states have expanded Medicaid under the Affordable Care Act (ACA):

• Northeast: Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont
• Southeast: Kentucky, Louisiana, Virginia, West Virginia
• Midwest: Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, Wisconsin
• West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington
• Southwest: New Mexico
• DC: District of Columbia

Non-Expansion States (10 States) – Current as of 2025

These states have not expanded Medicaid, creating significant coverage gaps for adults:

Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wyoming

State-Specific Income Thresholds Table

State	Expansion Status	Adult Income Limit	Pregnant Women	Children (Ages 0-18)	Official Website
Alabama	No	18% FPL ($2,826/year)	146% FPL	146% FPL	Alabama Medicaid
Alaska	Yes	138% FPL ($21,590/year)	200% FPL	175% FPL	Alaska Medicaid
Arizona	Yes	138% FPL ($21,590/year)	156% FPL	175% FPL	Arizona AHCCCS
Arkansas	Yes	138% FPL ($21,590/year)	214% FPL	211% FPL	Arkansas DHS
California	Yes	138% FPL ($21,590/year)	213% FPL	266% FPL	California Medi-Cal
Colorado	Yes	138% FPL ($21,590/year)	195% FPL	175% FPL	Colorado HCPF
Connecticut	Yes	138% FPL ($21,590/year)	263% FPL	201% FPL	Connecticut DSS
Delaware	Yes	138% FPL ($21,590/year)	220% FPL	220% FPL	Delaware DHSS
Florida	No	32% FPL ($5,008/year)	191% FPL	210% FPL	Florida DCF
Georgia	No	35% FPL ($5,478/year)	220% FPL	247% FPL	Georgia DCH
Hawaii	Yes	138% FPL ($24,060/year)	196% FPL	175% FPL	Hawaii DHS
Idaho	Yes	138% FPL ($21,590/year)	138% FPL	175% FPL	Idaho DHW
Illinois	Yes	138% FPL ($21,590/year)	213% FPL	175% FPL	Illinois HFS
Indiana	Yes	138% FPL ($21,590/year)	213% FPL	175% FPL	Indiana FSSA
Iowa	Yes	138% FPL ($21,590/year)	380% FPL	175% FPL	Iowa DHS
Kansas	No	32% FPL ($5,008/year)	166% FPL	175% FPL	Kansas DCF
Kentucky	Yes	138% FPL ($21,590/year)	195% FPL	175% FPL	Kentucky CHFS
Louisiana	Yes	138% FPL ($21,590/year)	194% FPL	250% FPL	Louisiana DHH
Maine	Yes	138% FPL ($21,590/year)	214% FPL	175% FPL	Maine DHHS
Maryland	Yes	138% FPL ($21,590/year)	264% FPL	322% FPL	Maryland Health
Massachusetts	Yes	138% FPL ($21,590/year)	200% FPL	300% FPL	Mass Health
Michigan	Yes	138% FPL ($21,590/year)	195% FPL	212% FPL	Michigan DHHS
Minnesota	Yes	138% FPL ($21,590/year)	278% FPL	280% FPL	Minnesota DHS
Mississippi	No	24% FPL ($3,756/year)	194% FPL	211% FPL	Mississippi DOM
Missouri	Yes	138% FPL ($21,590/year)	196% FPL	305% FPL	Missouri DSS
Montana	Yes	138% FPL ($21,590/year)	158% FPL	175% FPL	Montana DPHHS
Nebraska	Yes	138% FPL ($21,590/year)	195% FPL	213% FPL	Nebraska DHHS
Nevada	Yes	138% FPL ($21,590/year)	202% FPL	175% FPL	Nevada DHHS
New Hampshire	Yes	138% FPL ($21,590/year)	196% FPL	318% FPL	New Hampshire DHHS
New Jersey	Yes	138% FPL ($21,590/year)	205% FPL	355% FPL	New Jersey DHS
New Mexico	Yes	138% FPL ($21,590/year)	250% FPL	250% FPL	New Mexico HSD
New York	Yes	138% FPL ($21,590/year)	223% FPL	223% FPL	New York DOH
North Carolina	No	43% FPL ($6,730/year)	196% FPL	211% FPL	North Carolina DHHS
North Dakota	Yes	138% FPL ($21,590/year)	138% FPL	175% FPL	North Dakota DHS
Ohio	Yes	138% FPL ($21,590/year)	200% FPL	206% FPL	Ohio Medicaid
Oklahoma	Yes	138% FPL ($21,590/year)	138% FPL	175% FPL	Oklahoma OHCA
Oregon	Yes	138% FPL ($21,590/year)	196% FPL	175% FPL	Oregon OHA
Pennsylvania	Yes	138% FPL ($21,590/year)	220% FPL	306% FPL	Pennsylvania DHS
Rhode Island	Yes	138% FPL ($21,590/year)	258% FPL	261% FPL	Rhode Island DHS
South Carolina	No	67% FPL ($10,486/year)	194% FPL	211% FPL	South Carolina DHHS
South Dakota	Yes	138% FPL ($21,590/year)	138% FPL	175% FPL	South Dakota DSS
Tennessee	No	95% FPL ($14,868/year)	195% FPL	250% FPL	Tennessee DHS
Texas	No	15% FPL ($2,348/year)	198% FPL	201% FPL	Texas HHS
Utah	Yes	138% FPL ($21,590/year)	138% FPL	175% FPL	Utah DWS
Vermont	Yes	138% FPL ($21,590/year)	213% FPL	312% FPL	Vermont DVHA
Virginia	Yes	138% FPL ($21,590/year)	143% FPL	200% FPL	Virginia DMAS
Washington	Yes	138% FPL ($21,590/year)	194% FPL	250% FPL	Washington HCA
West Virginia	Yes	138% FPL ($21,590/year)	158% FPL	175% FPL	West Virginia DHHR
Wisconsin	Yes	100% FPL ($15,650/year)	306% FPL	306% FPL	Wisconsin DHS
Wyoming	No	54% FPL ($8,451/year)	158% FPL	200% FPL	Wyoming DFS

Note: All income limits are based on 2025 Federal Poverty Level guidelines and may be subject to change in 2026. For the most current information, always consult your state’s official Medicaid website.

Documents Needed for Medicaid Application: Your Complete 2025-2026 Checklist

Completing your Medicaid application requires gathering specific documentation that proves your identity, income, residency, and eligibility status. Having the right documents ready streamlines your application process and reduces processing delays.

Understanding what documents are needed for your Medicaid application ensures you can demonstrate your qualifications efficiently and avoid standard application rejections.

Essential Identity and Citizenship Documents

Primary Identity Verification

• Birth Certificate: Original or certified copy from your state’s vital records office
• Driver’s License or State ID: Current, unexpired government-issued photo identification
• U.S. Passport: Valid passport or passport card
• Certificate of Naturalization: For naturalized U.S. citizens

Immigration Status Documentation (if applicable)

• Permanent Resident Card (Green Card): Current, unexpired card
• Employment Authorization Document (EAD): Form I-766
• Refugee/Asylum Documentation: I-94 arrival record or asylum approval letter

You can verify acceptable documents through USCIS official guidelines or your state’s Medicaid office.

Income Verification Documents

Employment Income

• Pay Stubs: Most recent 4-6 pay stubs showing year-to-date earnings
• Employment Letter: Employer verification letter stating wages and employment status
• Tax Returns: Most recent federal tax return (Form 1040) with all schedules
• W-2 Forms: Previous year’s W-2 statements from all employers

Self-Employment Income

• Schedule C: Business profit/loss statement from tax returns
• Business Records: Bank statements, invoices, and expense receipts
• 1099 Forms: All 1099-MISC, 1099-NEC, or other 1099 forms received

Other Income Sources

• Social Security Benefits: Award letter or benefit verification letter from SSA.gov
• Unemployment Benefits: Award letter and payment records
• Pension/Retirement Income: Benefit statements and award letters
• Disability Benefits: SSDI or SSI award letters
• Child Support: Court orders and payment records

Asset and Resource Documentation

Financial Assets

• Bank Statements: Most recent 3 months for all checking and savings accounts
• Investment Accounts: Statements for stocks, bonds, mutual funds, and retirement accounts
• Life Insurance: Policy information showing cash value
• Real Estate: Property deeds, mortgage statements, tax assessments

Exempt Assets (usually not counted)

• Primary Residence: Your main home where you live
• Personal Vehicle: One vehicle per household member
• Household Goods: Furniture, clothing, personal belongings
• Burial Funds: Prepaid burial plans or designated burial savings

Residency and Household Information

Proof of Residency

• Utility Bills: Recent electric, gas, water, or phone bills in your name
• Lease Agreement: Current rental agreement or mortgage statement
• Mail from Government Agencies: Official mail showing your current address
• Voter Registration: Current voter registration card

Household Composition

• Birth Certificates: For all children in your household
• Custody Documents: Court orders for child custody arrangements
• Marriage Certificate: If married and applying together
• Divorce Decree: If divorced and claiming single status

Medical and Special Circumstances Documentation

Disability-Related Documents

• Medical Records: Recent medical evaluations and treatment records
• SSDI Award Letters: Social Security Disability determination
• Doctor’s Statements: Physician assessments of functional limitations
• Hospital Records: Recent hospitalizations and discharge summaries

Pregnancy-Related Documents

• Pregnancy Verification: Doctor’s statement confirming pregnancy and due date
• Prenatal Care Records: Documentation of ongoing prenatal medical care

State-Specific Application Portals and Requirements of Medicaid

Each state maintains its own application system with specific document upload requirements:

Online Application Systems

• HealthCare.gov: Federal marketplace serving multiple states
• State-Specific Portals: Each state’s individual Medicaid website
• Mobile Applications: Many states offer smartphone apps for applications

Document Submission Methods

• Online Upload: Digital document submission through state portals
• Mail Submission: Physical documents sent to state Medicaid offices
• In-Person Delivery: Documents submitted at local offices
• Fax Submission: Documents faxed to state processing centers

For your specific state’s requirements and submission methods, visit the official Medicaid state directory.

Step-by-Step Application Process: How to Apply for Medicaid in Your State

Navigating the Medicaid application process requires understanding your state’s specific procedures, timeline expectations, and submission requirements. Each step in the application process brings you closer to securing essential healthcare coverage for 2025 and 2026.

Learning how to apply for Medicaid in your state involves choosing the right application method, completing all required sections accurately, and following up appropriately during the review process.

Pre-Application Preparation

Determine Your Eligibility Category

Before beginning your application, identify which Medicaid category applies to your situation:

• Adult Coverage (19-64): Based on income and household size
• Pregnancy-Related Coverage: For pregnant women and related services
• Child Coverage: For individuals under 19
• Aged, Blind, or Disabled: Requires additional medical documentation

Gather Required Documentation

Organize all documents needed for your Medicaid application before starting the online or paper process. Having everything ready prevents delays and reduces the likelihood of application rejection due to missing information.

Choose Your Application Method

Your state offers multiple ways to apply:

• Online Applications: Available through HealthCare.gov or your state’s Medicaid website
• Phone Applications: Call your state’s Medicaid hotline
• Paper Applications: Download and mail completed forms
• In-Person Applications: Visit local Medicaid offices or community assistance sites

Completing Your Application

Online Application Process

1. Create an Account: Register on your state’s Medicaid portal or HealthCare.gov.
2. Start Your Application: Begin the online form with personal information
3. Enter Household Details: Include all household members and their relationships
4. Report Income: Provide current income from all sources for all household members
5. Upload Documents: Submit required verification documents electronically
6. Review and Submit: Double-check all information before final submission

Common Application Sections

• Personal Information: Name, address, Social Security number, date of birth
• Household Composition: Everyone living in your household and their relationships
• Income Reporting: All income sources for all household members
• Asset Information: Bank accounts, investments, and other resources
• Health Insurance: Current coverage and previous Medicaid enrollment
• Exceptional Circumstances: Pregnancy, disability, student status

After Application Submission

Application Processing Timeline

• Initial Review: 45 days for most applications
• Disability Determinations: Up to 90 days for aged, blind, or disabled applications
• Emergency Medicaid: May be processed immediately for urgent medical needs

Interview Requirements

Some states require eligibility interviews:

• Phone Interviews: Conducted by state Medicaid staff
• In-Person Interviews: Required in certain states or circumstances
• Document Verification: Additional proof may be requested

Application Status Tracking

Monitor your application progress through:

• Online Portals: Check status updates on your state’s website
• Phone Inquiries: Call your state’s Medicaid customer service
• Written Correspondence: Expect letters regarding application status

Approval and Coverage Start

• Approval Notice: Receive written confirmation of eligibility
• Medicaid ID Card: Issued after approval for accessing services
• Coverage Effective Date: May be retroactive up to three months
• Provider Network: Access to approved doctors and hospitals in your state

For state-specific application procedures, visit your state’s official Medicaid website through the CMS state directory.

Common Medicaid Application Rejection Reasons and Solutions

Understanding why Medicaid applications get rejected helps you avoid common pitfalls and increase your approval chances. Learning from typical rejection reasons ensures your application demonstrates clear qualification for coverage.

Most Medicaid application rejections stem from incomplete documentation, income reporting errors, or failure to meet specific state requirements rather than actual ineligibility.

Income-Related Rejections

Income Exceeding Limits

Problem: Reported income appears to exceed your state’s Medicaid income limits. 

Solutions:

• Verify you’re using the correct income category for your situation
• Account for allowable deductions (work expenses, child care costs)
• Consider the 5% income disregard in Modified Adjusted Gross Income (MAGI)-based programs
• Report accurate monthly vs. annual income figures

Inconsistent Income Reporting

Problem: The income information doesn’t match the supporting documents. 

Solutions:

• Ensure pay stubs reflect the exact income amounts reported
• Include all income sources, including irregular or seasonal work
• Explain income fluctuations with additional documentation
• Update income changes promptly during the application process

Documentation Problems

Missing or Incomplete Documents

Problem: Required verification documents were not submitted or were unclear. 

Solutions:

• Submit all documents needed for the Medicaid application from the checklist.
• Ensure documents are current (typically within 60-90 days)
• Provide clear, readable copies of all documents
• Follow up with your state Medicaid office if documents aren’t received

Citizenship/Immigration Status Issues

Problem: Unable to verify citizenship or eligible immigration status. 

Solutions:

• Provide acceptable citizenship documents (birth certificate, passport)
• Submit current immigration documentation if applicable
• Contact USCIS for replacement documents if originals are lost
• Seek assistance from immigration attorneys for complex cases

Residency and Identity Verification

Residency Requirements Not Met

Problem: Cannot establish state residency for Medicaid purposes.

Solutions:

• Provide multiple forms of residency proof (utility bills, lease agreements)
• Understand that you can apply in the state where you currently live
• Temporary residence may qualify if you intend to remain permanently
• Contact your state Medicaid office for specific residency questions

Identity Verification Failures

Problem: Cannot verify identity through standard documents. 

Solutions:

• Provide alternative identity documents accepted by your state
• Contact vital records offices for certified copies of birth certificates
• Use a passport or other federal identification documents
• Seek assistance from legal aid organizations if necessary

Application Process Errors

Missed Deadlines or Interview Requirements

Problem: Failed to complete the application within the required timeframes. 

Solutions:

• Respond promptly to all state Medicaid office communications
• Schedule required interviews immediately when requested
• Provide additional information within specified deadlines
• Reapply if your application expires due to non-response

Incorrect Application Category

Problem: Applied under the wrong Medicaid eligibility category.

Solutions:

• Review all available eligibility categories for your circumstances
• Consider both Modified Adjusted Gross Income (MAGI) and non-Modified Adjusted Gross Income pathways to coverage
• Consult with Medicaid eligibility workers about category options
• Update applications when circumstances change

Appeals and Reapplication Process

Filing Appeals

If your application is denied, you have the right to appeal:

1. Request Fair Hearing: File within the specified timeframe (usually 30-90 days)
2. Gather Additional Evidence: Collect documents supporting your eligibility
3. Attend Hearing: Present your case to an administrative law judge
4. Legal Representation: Consider assistance from legal aid organizations

Reapplication Strategies

• Address Rejection Reasons: Correct specific issues mentioned in the denial letter
• Update Circumstances: Report any changes in income, household size, or other factors
• Seek Professional Help: Contact certified application assisters through HealthCare.gov.
• Document Everything: Keep records of all communications and submissions

For assistance with appeals, contact your state’s Medicaid office or find legal aid through the Legal Services Corporation’s directory.

Frequently Asked Questions

How easy is it to qualify for Medicaid?

Qualifying for Medicaid depends heavily on your state’s expansion status and your specific circumstances. In the 40 expansion states plus DC, adults earning up to approximately $21,590 annually (138% FPL) can qualify easily by meeting income requirements and providing standard documentation. However, in some states, qualifying as an adult is significantly more difficult. 

What is the maximum income to qualify for Medicaid in Maryland?

For adults aged 19-64 in Maryland, the maximum annual income to qualify for Medicaid is approximately $21,590 for a single person (138% of the Federal Poverty Level) in 2025 and 2026. For pregnant women, Maryland allows up to 264% FPL (approximately $41,354 annually), while children can qualify at up to 322% FPL. 

What are the four types of Medicaid?

The four main types of Medicaid coverage are:

• Traditional Fee-for-Service Medicaid, where the state pays providers directly for your services. 
• Medicaid Managed Care, where you receive coverage through managed care organizations that coordinate your care.
• Primary Care Case Management (PCCM), where a primary care provider coordinates your care while the state pays providers directly.
• Health Insurance Premium Programs (HIPP), where your state helps pay premiums for employer-sponsored or individual market insurance when it is cost-effective.

Does Medicaid apply in all states?

Yes, Medicaid operates in all 50 states, the District of Columbia, and U.S. territories, but coverage varies significantly between states. While federal law requires all states to participate in Medicaid, states have flexibility in setting eligibility criteria, covered services, and application processes.

What is the highest income to be eligible for Medicaid?

The highest income eligibility varies dramatically by state and category. For adults in expansion states, the limit is approximately $21,590 annually (138% FPL). For detailed income limits by state and category, refer to our comprehensive state comparison table above or visit Medicaid.gov’s eligibility information.

Conclusion

Successfully navigating how to qualify for Medicaid in your state requires understanding your specific circumstances, income limits, and application requirements for 2025 and 2026. Your next step involves visiting your state’s official Medicaid website, gathering required documentation, and beginning your application process. 

Remember that income limits for Medicaid by state vary significantly, making state-specific research crucial for your success. With proper preparation and understanding of how to apply for Medicaid in your state, you can secure essential healthcare coverage that protects your health and financial security throughout the coming years.