Understanding Medicaid eligibility requirements can feel overwhelming when you need healthcare coverage. You deserve clear answers about qualifying for this vital program. Medicaid eligibility requirements vary by state, but income limits remain key factors in 2025-2026.
If your household income falls below 138% of the federal poverty level, you may qualify in expansion states. You’ll discover precisely what Medicaid eligibility requirements your family must meet in this comprehensive guide. This resource covers income limits for all 50 states with current data.
You’ll learn about the documents needed for your application process. We’ll explain how families of four can qualify for benefits. You’ll understand Medicaid eligibility requirements whether you work or not. Let’s explore your pathway to affordable healthcare coverage through official resources at Medicaid.gov and HealthCare.gov.
Table of Contents
Basic Medicaid Eligibility Requirements
Medicaid serves as a crucial safety net for low-income families across America. Your eligibility depends on several factors that determine your qualification status. Medicaid eligibility requirements are based on both federal guidelines and state-specific rules in 2025-2026.
Federal vs. State-Level Requirements
The federal government sets minimum Medicaid eligibility requirements for all states. However, your state can expand these requirements to cover more people.
States were given the option to extend eligibility to adults with income at or below 133% of the Federal Poverty Level (FPL) according to Medicaid.gov. Your state’s decision regarding expansion significantly affects your coverage options.
Primary Eligibility Categories
You may qualify for Medicaid if you fall into these categories:
- Low-income families with dependent children under 19 years old
- Pregnant women during pregnancy and the 60-day postpartum period
- Individuals with disabilities receiving Supplemental Security Income (SSI)
- Seniors aged 65 and older requiring long-term care services
- Adults without dependent children in expansion states only.
Financial Eligibility Criteria of Medicaid
Your income determines your Medicaid qualification more than any other factor. Understanding these financial thresholds helps you determine your eligibility status accurately.
Income Limits and Federal Poverty Level Guidelines
The 2025 Federal Poverty Level for the 48 contiguous states and DC is $15,650 for one person, $21,150 for two, $26,650 for three, and $32,150 for four, according to GovFacts. Alaska and Hawaii have higher poverty levels due to cost differences.
Your monthly income limits vary based on your state’s expansion status:
- Expansion states: Up to 138% of FPL (approximately $21,597 annually)
- Non-expansion states: Varies by category, typically much lower limits
- Special populations: Different limits apply for seniors and disabled individuals
State-Specific Income Limits for Low-Income Families
Based on the 2025-2026 Federal Poverty Level Guidelines:
- Individual (138% FPL): $21,597 annually / $1,800 monthly
- Family of 4 (138% FPL): $44,670 annually / $3,723 monthly
Expansion States
Income limits based on 138% of the Federal Poverty Level
| State | Expansion Status | Adult Income Limit (Monthly) | Family of 4 Limit (Monthly) |
| Alaska | Expansion | $1,800 | $3,723 |
| Arizona | Expansion | $1,800 | $3,723 |
| Arkansas | Expansion | $1,800 | $3,723 |
| California | Expansion | $1,800 | $3,723 |
| Colorado | Expansion | $1,800 | $3,723 |
| Connecticut | Expansion | $1,800 | $3,723 |
| Delaware | Expansion | $1,800 | $3,723 |
| District of Columbia | Expansion | $1,800 | $3,723 |
| Hawaii | Expansion | $1,800 | $3,723 |
| Idaho | Expansion | $1,800 | $3,723 |
| Illinois | Expansion | $1,800 | $3,723 |
| Indiana | Expansion | $1,800 | $3,723 |
| Iowa | Expansion | $1,800 | $3,723 |
| Kentucky | Expansion | $1,800 | $3,723 |
| Louisiana | Expansion | $1,800 | $3,723 |
| Maine | Expansion | $1,800 | $3,723 |
| Maryland | Expansion | $1,800 | $3,723 |
| Massachusetts | Expansion | $1,800 | $3,723 |
| Michigan | Expansion | $1,800 | $3,723 |
| Minnesota | Expansion | $1,800 | $3,723 |
| Missouri | Expansion | $1,800 | $3,723 |
| Montana | Expansion | $1,800 | $3,723 |
| Nebraska | Expansion | $1,800 | $3,723 |
| Nevada | Expansion | $1,800 | $3,723 |
| New Hampshire | Expansion | $1,800 | $3,723 |
| New Jersey | Expansion | $1,800 | $3,723 |
| New Mexico | Expansion | $1,800 | $3,723 |
| New York | Expansion | $1,800 | $3,723 |
| North Carolina | Expansion | $1,800 | $3,723 |
| North Dakota | Expansion | $1,800 | $3,723 |
| Ohio | Expansion | $1,800 | $3,723 |
| Oklahoma | Expansion | $1,800 | $3,723 |
| Oregon | Expansion | $1,800 | $3,723 |
| Pennsylvania | Expansion | $1,800 | $3,723 |
| Rhode Island | Expansion | $1,800 | $3,723 |
| South Dakota | Expansion | $1,800 | $3,723 |
| Utah | Expansion | $1,800 | $3,723 |
| Vermont | Expansion | $1,800 | $3,723 |
| Virginia | Expansion | $1,800 | $3,723 |
| Washington | Expansion | $1,800 | $3,723 |
| West Virginia | Expansion | $1,800 | $3,723 |
Non-Expansion States
Traditional Medicaid eligibility varies significantly by state
| State | Expansion Status | Adult Income Limit (Monthly)* | Family of 4 Limit (Monthly)** |
| Alabama | Non-expansion | Varies by category*** | $649 (parents only) |
| Florida | Non-expansion | Varies by category*** | $649 (parents only) |
| Georgia | Non-expansion | Varies by category*** | $649 (parents only) |
| Kansas | Non-expansion | Varies by category*** | $649 (parents only) |
| Mississippi | Non-expansion | Varies by category*** | $649 (parents only) |
| South Carolina | Non-expansion | Varies by category*** | $649 (parents only) |
| Tennessee | Non-expansion | Varies by category*** | $649 (parents only) |
| Texas | Non-expansion | Varies by category*** | $649 (parents only) |
| Wisconsin | Non-expansion | Varies by category*** | $649 (parents only) |
| Wyoming | Non-expansion | Varies by category*** | $649 (parents only) |
Important Notes:
*Adult Coverage in Non-Expansion States:
- Most non-expansion states do NOT provide Medicaid coverage for childless adults, regardless of income
- Adults may qualify if they are pregnant, disabled, elderly, or parents/caretakers of dependent children
- Income limits for eligible adults vary significantly by state and category
**Family Coverage:
- Family limits shown are for parents/caretakers with dependent children
- Children typically qualify for CHIP at higher income levels (up to 200-300% FPL)
***Category-Specific Eligibility: Non-expansion states have complex eligibility rules that vary by:
- Pregnancy status
- Disability status
- Age (elderly)
- Parental/caretaker status
- Assets and other factors
Asset and Resource Limits
Your assets matter less for most Medicaid programs than your income. However, certain limits still apply for specific populations in 2025-2026.
Standard Asset Limits:
- Most families: No asset limit under Modified Adjusted Gross Income (MAGI) rules
- Seniors and disabled: $4,000 for a single person according to DC Medicaid
- Married couples (both applying): $6,000 combined
Excluded Assets:
- Your primary residence and surrounding property
- One vehicle used for transportation
- Personal belongings and household items
- Life insurance policies under $1,500 face value
- Burial plots and prepaid funeral arrangements
Non-Financial Eligibility Requirements
Your citizenship status and residency determine your Medicaid qualification beyond income. These requirements protect program integrity while ensuring coverage for eligible individuals.
Citizenship and Immigration Status
You must be a United States citizen or qualified immigrant. Acceptable documentation includes your birth certificate, passport, or naturalization certificate. Qualified immigrants include lawful permanent residents, refugees, and asylum seekers. Emergency Medicaid covers undocumented immigrants only for emergency medical conditions.
Residency Requirements
You must live in the state where you apply for coverage. Your state considers you a resident if you intend to remain. Temporary absences for medical care, education, or work don’t affect residency. You can change states and transfer your application if needed.
Age and Family Composition Factors
Your family size affects your income limits and eligibility category. Dependent children include those under 19 years old living with you. Pregnancy counts as an additional family member for income calculations. Caregiver relatives can qualify if they care for dependent children.
Application Process of Medicaid: Step-by-Step Guide
Applying for Medicaid doesn’t need to be complicated when you know the process. Your application can be completed online, by phone, or in person.
Where and How to Apply
You can apply through multiple channels for your convenience:
- Online: Visit HealthCare.gov or your state’s marketplace
- Phone: Call 1-800-318-2596 for application assistance
- In-person: Visit your local Medicaid office or community health center
- Mail: Send completed paper applications to your state agency
Documents Needed to Apply for Medicaid
Gather these essential documents before starting your application:
Income Verification:
- Pay stubs from the last 30 days
- Tax returns from the previous year
- Bank statements showing deposits
- Social Security benefit letters
- Unemployment compensation statements
Identity and Citizenship:
- Birth certificate or passport
- Driver’s license or state identification
- Social Security cards for all applicants
- Immigration documents, if applicable
Household Information:
- Proof of address (utility bills, lease agreements)
- Marriage certificates or divorce decrees
- Court orders for child support or custody
Application Timeline and Processing
Your application processing time varies by state and the complexity of your case. Most states process applications within 45 days for standard cases. Disability determinations may take up to 90 days for completion. Emergencies receive expedited processing within days when needed.
Special Circumstances and Programs
Certain situations require different Medicaid eligibility requirements and coverage options. Understanding these programs helps you access appropriate healthcare benefits.
Medically Needy Programs
You may qualify for Medically Needy Medicaid if your income exceeds standard limits. This program allows you to “spend down” excess income on medical expenses.
For most states, the Medicaid income limit is $2,901 per month for single applicants and $5,802 for married applicants. Your state calculates your share of the cost based on income differences.
Emergency Medicaid Coverage
Emergency Medicaid covers life-threatening conditions regardless of income in some cases. You must meet all other eligibility requirements except income limits. Coverage includes emergency room visits, emergency surgery, and labor and delivery. This coverage doesn’t include follow-up care or routine medical services.
Transitional Coverage Programs
You may keep Medicaid temporarily when your income increases slightly. Continuous eligibility protects children from coverage gaps during income fluctuations. Adult coverage may continue for up to 12 months. Report income changes promptly to avoid coverage problems later.
Recent Medicaid Expansion Updates (2025-2026)
Medicaid expansion continues evolving as more states consider program changes. Your coverage options depend on your state’s current status regarding Medicaid expansion.
Current Expansion Status
Most states plus D.C. have expanded Medicaid to 138% FPL for adults. Forty-one states and Washington, D.C., currently participate in expansion programs. Ten states have not expanded Medicaid as of 2025-2026.
Non-expansion states include Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.
Impact on Eligibility
Expansion significantly affects your coverage options and income thresholds. Adults qualify if their income is 138% of the FPL or lower, which includes a 5% income disregard. Enhanced federal matching rates help states fund expanded coverage. Previously ineligible adults without dependent children now qualify in expansion states.
Future Expansion Prospects
Several non-expansion states continue evaluating program expansion for 2025-2026. Political and financial considerations influence state decision-making processes. Federal incentives encourage remaining states to adopt expansion programs. Budget concerns and political opposition remain primary barriers to expansion.
Appeals and Your Rights
You have the necessary rights when applying for or maintaining Medicaid coverage. Understanding these rights protects your access to healthcare benefits.
Appeal Process Overview
You can appeal any Medicaid decision with which you disagree entirely. Every day, appealable decisions include eligibility denials, coverage terminations, and benefit reductions. Your state must provide written notice explaining appeal rights. Submit appeals within specified timeframes to protect your rights adequately.
Maintaining Coverage During Appeals
Your benefits may continue during appeal processes under certain circumstances. Continued coverage applies if you appeal before your termination date. Request continued benefits specifically on your appeal form or letter. You may need to repay benefits if your appeal fails.
Frequently Asked Questions
What is the maximum amount of income to qualify for Medicaid?
Your maximum income depends on your household size and state expansion status. For a family of four in 2025, the limit is $32,150 annually (100% FPL) in non-expansion states, according to GovFacts. Expansion states allow up to 138% FPL, approximately $44,367 for four people.
How much do you have to make to qualify for Medicaid in DC?
In Washington, DC, you must have a household income that does not exceed 210% of the Federal Poverty Level for childless adults per DC Health and Human Services. Families qualify at higher percentages based on their specific circumstances.
Why would a person not be eligible for Medicaid?
Common reasons for ineligibility include income above state thresholds, non-citizen status, failure to provide required documentation, or living in non-expansion states. Asset limits may disqualify seniors and disabled individuals with excessive resources.
Which one is for low income, Medicare or Medicaid?
Medicaid is specifically designed for low-income individuals and families. Medicare serves people 65 and older or those with disabilities, regardless of income. You may qualify for both programs simultaneously in certain situations.
Conclusion
Medicaid eligibility requirements provide essential healthcare coverage for millions of low-income families. Your qualification depends on income, household size, and state expansion status. Understanding these Medicaid eligibility requirements helps you access needed medical care effectively.
Income limits vary significantly between expansion and non-expansion states in 2025-2026. Gather required documents and apply through HealthCare.gov or your state’s marketplace today. Don’t let complex Medicaid eligibility requirements prevent you from seeking coverage.
Professional assistance is available through community health centers and state agencies. Your family deserves quality healthcare regardless of income level.
