Medicaid eligibility depends on a combination of your income, household size, and what state you live in. In most states, adults with household incomes at or below 138% of the federal poverty level qualify, which works out to about $22,024 per year for a single person in 2026. But income is only part of the picture. Certain groups, including pregnant women, children, people with disabilities, and adults over 65, have their own eligibility rules that can be more generous.
Income Limits by Household Size
Medicaid uses a calculation called Modified Adjusted Gross Income (MAGI) to determine whether your earnings fall below the cutoff. The threshold is based on the federal poverty level (FPL), which changes each year and scales with household size. For 2026, the FPL for the 48 contiguous states is:
- 1 person: $15,960/year ($1,330/month)
- 2 people: $21,640/year ($1,803/month)
- 3 people: $27,320/year ($2,277/month)
- 4 people: $33,000/year ($2,750/month)
- 5 people: $38,680/year ($3,223/month)
In states that have expanded Medicaid, you qualify if your household income is at or below 138% of these figures. For a single adult, that means roughly $22,025 per year. For a family of three, it’s about $37,702. A built-in 5% income disregard is already factored into that 138% number, which is why you’ll sometimes see the official threshold listed as 133% FPL.
Parents are evaluated using the FPL for their full family size, while childless adults are measured against the individual FPL. Some states set higher income limits for specific groups like pregnant women or children, so even if you’re above the general cutoff, you may still qualify.
Expansion States vs. Non-Expansion States
Where you live matters enormously. The Affordable Care Act gave states the option to expand Medicaid to all adults under 65 earning up to 138% FPL, regardless of whether they have children, a disability, or any other qualifying category. Most states have taken this option.
In states that haven’t expanded Medicaid, the rules are far more restrictive. Childless adults generally cannot qualify no matter how low their income is, unless they meet another category like disability. Adults with children may qualify, but the income limits can be dramatically lower than in expansion states. This creates what’s known as the “coverage gap”: people whose incomes are too high for their state’s Medicaid program but too low to qualify for subsidized insurance through the Health Insurance Marketplace. If you earn below 100% FPL in a non-expansion state and don’t fit into a specific eligibility category, you may have no affordable coverage option at all.
Who Qualifies Beyond Income
Medicaid has always been tied to specific categories of people, not just low income. The major groups that qualify include:
- Children: States must cover children in families with incomes at certain levels, and many states cover children at significantly higher income thresholds than adults through Medicaid or the Children’s Health Insurance Program (CHIP).
- Pregnant women: Coverage is mandatory for pregnant women with incomes at or below 133% FPL, and many states set the limit higher.
- Adults 65 and older: Seniors with limited income and savings can qualify, often with different (non-MAGI) rules that also count assets.
- People with disabilities: Individuals receiving Supplemental Security Income (SSI) automatically qualify for Medicaid in most states.
- Children in foster care: They qualify automatically.
Forty-seven states also offer a Medicaid Buy-In program for adults with disabilities who want to work. This allows people who might earn too much for standard Medicaid to purchase coverage at a reduced cost. Nine states extend coverage to children with disabilities in families earning up to 300% FPL through the Family Opportunity Act. And 43 states use the Katie Beckett option, which covers children under 19 with significant disabilities who need an institutional level of care but live at home, without counting the parents’ income.
How Disability Is Defined
If you’re applying based on a disability, Medicaid generally uses the same definition as SSI. For adults, that means having a physical or mental condition that prevents you from doing any substantial work and that has lasted, or is expected to last, at least 12 months or result in death. For children under 18, the standard is a condition that causes “marked and severe functional limitations” on the same timeline.
Certain conditions are fast-tracked through a process called Compassionate Allowances, which quickly identifies diseases that clearly meet disability standards. These include certain cancers, brain disorders in adults, and rare conditions affecting children. If your condition falls into this category, the approval process is significantly shorter.
Asset Limits for Seniors and Long-Term Care
For most working-age adults and children, Medicaid only looks at income. But if you’re 65 or older, have a disability, or need nursing home care, the program also counts your assets. The specific dollar limits vary by state, but the rules generally exempt certain things: your primary home (up to an equity limit of $752,000 or $1,130,000, depending on your state), one vehicle, personal belongings, and small amounts of life insurance.
Bank accounts, investments, and additional property do count. States that follow SSI rules typically set the asset limit at $2,000 for an individual. If you’re married, the rules protect a portion of the couple’s combined assets for the spouse who isn’t entering a nursing home, so they aren’t left with nothing.
The Spend-Down Option for High Medical Bills
If your income is above the Medicaid limit but you have large medical expenses, 34 states offer a “medically needy” pathway that works like a deductible. You must fall into an eligible category (aged, disabled, pregnant, or a parent of dependent children) but can have income above the normal threshold.
Here’s how it works: you subtract your medical expenses from your income until the remainder falls below your state’s medically needy income level. Once you “spend down” to that point, Medicaid kicks in for the rest of the month (or for a six-month period if you’re applying for long-term care). You can count doctor visits, prescriptions, medical equipment, home care, insurance premiums, copayments, and even transportation to medical appointments. Old medical bills still owed from up to three months before your application count too. The catch is that Medicaid won’t retroactively pay for the expenses you used to meet your spend-down amount, and only the portion you’re personally responsible for counts. Bills covered by other insurance don’t apply.
Citizenship and Immigration Requirements
You must be a U.S. resident living in the state where you’re applying. U.S. citizens and nationals qualify if they meet the other criteria. For immigrants, the rules are more complex.
“Qualified non-citizens” can get Medicaid, but most must wait five years after receiving their immigration status before becoming eligible. This group includes lawful permanent residents (green card holders), those paroled into the U.S. for at least one year, battered non-citizens, and victims of trafficking. Refugees and asylees are exempt from the five-year waiting period, as are lawful permanent residents who previously held refugee or asylee status. Members of federally recognized Indian tribes and citizens of the Marshall Islands, Micronesia, and Palau living in the U.S. also qualify without a waiting period.
Many states have chosen to waive the five-year bar for pregnant women and children who are lawfully residing in the U.S., so coverage depends partly on your state’s policy. Undocumented immigrants are generally not eligible for full Medicaid, though most states cover emergency medical services regardless of immigration status.
Qualifying for Both Medicare and Medicaid
People who are 65 or older, or who have certain disabilities, may qualify for both Medicare and Medicaid at the same time. These “dual eligible” individuals get Medicare as their primary insurance for hospital stays, doctor visits, and short-term rehabilitation, while Medicaid fills in the gaps. That can mean Medicaid pays your Medicare premiums and copays, and covers services Medicare doesn’t, like long-term nursing home care, dental work, and home-based support. To qualify for both, you need to meet Medicare’s age or disability requirements and also fall within your state’s Medicaid income and asset limits for older adults or people with disabilities.