Medicaid eligibility depends on your income, household size, and which state you live in. In the 40 states (plus Washington, D.C.) that have expanded Medicaid, most adults under 65 qualify if their household income falls at or below 138% of the federal poverty level, which works out to about $20,783 per year for an individual in 2025. In the remaining states, eligibility is narrower and typically limited to specific groups like children, pregnant women, seniors, and people with disabilities.
How Income Eligibility Works
Medicaid uses a calculation called Modified Adjusted Gross Income (MAGI) to determine whether you financially qualify. This is essentially your taxable income as reported on your tax return, adjusted for household size and tax filing relationships. Unlike older methods that varied wildly from state to state, MAGI provides a standardized way to measure eligibility. It does not count assets like savings accounts, cars, or property for most applicants (seniors and people with disabilities are a major exception, covered below).
The income cutoff is tied to the federal poverty level (FPL), which updates each year. Here are the 2025 poverty guidelines for the 48 contiguous states:
- 1 person: $15,650
- 2 people: $21,150
- 3 people: $26,650
- 4 people: $32,150
- 5 people: $37,650
- 6 people: $43,150
In Medicaid expansion states, the income limit is 138% of these numbers. For a family of four, that means a household income up to roughly $44,367 per year. Alaska and Hawaii have higher poverty guidelines, so their dollar thresholds are higher too.
Expansion vs. Non-Expansion States
Whether you qualify as an adult without children depends almost entirely on where you live. Forty states and D.C. have adopted the Affordable Care Act’s Medicaid expansion, which covers nearly all low-income adults under 65 at or below 138% FPL. In these states, you don’t need to be a parent, pregnant, or disabled to qualify. Low income alone is enough.
In the remaining non-expansion states, childless adults generally cannot get Medicaid regardless of how low their income is. These states limit coverage to “categorically eligible” groups: children, pregnant women, parents with very low incomes (often well below the poverty line), seniors, and individuals with qualifying disabilities. If you live in a non-expansion state and don’t fall into one of these groups, you may fall into a “coverage gap” where your income is too high for Medicaid but too low for marketplace subsidies.
Children and Pregnant Women
Children have the broadest eligibility of any group. Every state covers children in families earning up to at least 138% FPL through Medicaid, and most states extend coverage significantly higher than that through Medicaid or the Children’s Health Insurance Program (CHIP). Many states cover children in families earning 200% to 300% of the poverty level or more.
Pregnant women qualify for Medicaid at a minimum of 138% FPL in every state, but the majority of states set the threshold higher, sometimes reaching 200% FPL or above. Some states also provide pregnancy-related coverage through CHIP, which may offer a more limited set of benefits. Coverage typically begins when pregnancy is confirmed and extends through a postpartum period.
Seniors and People With Disabilities
If you’re 65 or older, blind, or have a qualifying disability, Medicaid uses different rules. Unlike the MAGI-based system for most applicants, this pathway does count your assets and savings.
The most common route is through the Supplemental Security Income (SSI) program. If you receive SSI, you automatically qualify for Medicaid in most states. SSI’s income limit is $967 per month for an individual in 2025, and you must have less than $2,000 in countable financial resources (bank accounts, investments, and similar liquid assets).
For people on Medicare who need help with premiums and copays, Medicare Savings Programs cover beneficiaries with income up to $1,781 per month and assets below $9,660 for an individual in 2025. Working adults with disabilities can often qualify through Medicaid Buy-In programs, which have significantly higher limits. The median income threshold across states is 250% FPL ($3,261 per month), and the median asset limit is $10,000 for an individual.
The Medically Needy Pathway
Some states offer a “medically needy” or “spend-down” option for people whose income exceeds normal Medicaid limits but who face overwhelming medical bills. Under this pathway, you subtract your medical expenses from your income until it falls below the state’s threshold. The income limits are typically very low, often below 50% of FPL, and most states cap assets at $2,000. Not every state offers this option.
Long-Term Care and Nursing Home Coverage
Medicaid is the primary payer for nursing home care in the United States, but qualifying requires meeting strict financial criteria. The income limit for long-term care is typically 300% of the SSI benefit level, which is $2,901 per month per individual in 2025. Most states limit countable assets to $2,000 per person.
Your home is generally exempt from the asset count while you or a spouse lives in it, but there is a cap on home equity. Federal rules set the 2025 limit between $730,000 and $1,097,000 in home equity, with most states using the lower number.
Medicaid also enforces a five-year “look-back period” when you apply for long-term care coverage. The state reviews all financial transactions you’ve made in the 60 months before your application date. If you gave away money or property, sold assets below fair market value, or made certain financial arrangements during that window, Medicaid can impose a penalty period during which you won’t receive long-term care benefits. This applies to things like transferring a home to a family member, purchasing a life estate in someone else’s property without living there for at least a year, or buying annuities without naming the state as a beneficiary. Promissory notes and loans must have actuarially sound repayment terms with equal payments and no balloon payments, or they’ll be treated as asset transfers too.
Citizenship and Residency Requirements
You must be a resident of the state where you’re applying. Medicaid is a state-run program, so you apply in the state where you currently live.
U.S. citizens and nationals qualify if they meet all other eligibility criteria. Lawful permanent residents and other “qualified” immigrants can also qualify, but many face a five-year waiting period after obtaining their immigration status before they can receive full Medicaid benefits. During that waiting period, states are required to cover emergency medical treatment for otherwise-eligible individuals, and some states have opted to waive the five-year wait entirely for certain groups, including children and pregnant women.
How to Apply
You can apply for Medicaid through your state’s Medicaid agency, through the federal health insurance marketplace at HealthCare.gov, or in person at a local Department of Social Services office. Applications are accepted year-round with no enrollment period restrictions. Processing times vary by state but typically take 30 to 45 days. If you’re applying on the basis of a disability, the determination may take longer because it requires a medical review. Many states now offer online portals that let you check your application status and upload documents electronically.
If your income fluctuates throughout the year, Medicaid generally looks at your current monthly income rather than your annual total. This means you might qualify during months when your earnings dip even if your yearly income would otherwise be too high. Some states will request pay stubs or tax information to verify what you report.