Who Qualifies For Medicaid? Check Our Eligibility Guide

Medicaid is the national healthcare program that provides medical assistance to low-income individuals and families across the U.S. Eligibility rules vary by state, and factors such as income, household size, disability status, and age can all determine whether someone qualifies.  

In this guide, let’s see who qualifies for Medicaid, what the income limits are, and how different states set their own requirements. If you’re wondering whether you or a loved one qualifies, read on to learn more.

1. Who Qualifies for Medicaid?

Medicaid is a healthcare program that offers medical assistance to low-income individuals across the U.S. The program covers essential services like doctor visits, hospital stays, prescriptions, mental health care, and dental treatments. It also supports vulnerable groups, including pregnant women, seniors, and people with disabilities. 

Medicaid eligibility depends on income, household size, disability, family status, and other factors.

1.1. Key factors that determine Medicaid eligibility  

Medicaid offers free or low-cost healthcare benefits to eligible customers, including: 

• Low-income adults 
• Children 
• Pregnant women 
• People age 65 or over 
• People with disabilities 

Generally, Medicaid eligibility is based on one or a combination of the following factors: 

• Income level 
• Age 
• Household size 
• Pregnancy status or disability 

Income Level 

Medicaid is developed for low-income people. Your eligibility is based on the Federal Poverty Level (FPL), but each state sets its own income limits. 

Some states follow the basic federal guidelines, while others have expanded coverage under the Affordable Care Act (ACA). As of February 2025, Medicaid expansion has been adopted by 41 states, including the District of Columbia. 

In states that have expanded Medicaid, eligibility is based solely on income: if your household income is below 138% of the FPL, you qualify.

However, a few states set slightly different income thresholds. 

But what if your state hasn’t expanded Medicaid? If your income falls below the FPL, and you don’t meet other qualifying factors (such as pregnancy, disability, or having dependent children), you might not qualify for Medicaid or financial help through a Marketplace health plan. This gap, often called the coverage gap, leaves some individuals without affordable insurance options.  

Household Size

Your household size impacts eligibility. 

Disability & Health Conditions 

Medicaid also helps people with disabilities or serious medical conditions. Medicaid provides care for 5 out of 8 nursing home residents in 2022. Additionally, KFF reported that 23% of non-elderly adults with mental illness and 40% of non-elderly adults with HIV rely on Medicaid for essential medical services. 

If you are blind, disabled, or require long-term care in a nursing home, Medicaid could help cover the costs. 

Age & Family Status 

If you fall into one of these categories, you might qualify even if your income is slightly above the standard limit: 

• Children 
• Pregnant Women 
• Seniors (65 and older) 

Medicaid provided coverage for 4 in 10 children nationwide and supported 8 in 10 children living in poverty, according to a 2022 report.  

State-Specific Rules

Each state has unique Medicaid rules. Some states expanded coverage to include more low-income adults under the ACA, while others kept stricter requirements.

1.2. Who qualifies for Medicaid? (Specific groups)

Below, we’ll go over the different groups that qualify for Medicaid, but keep in mind that each state has its own specific guidelines.

If you want to know exactly who qualifies for Medicaid in Texas, Florida, or anywhere else, it’s best to check directly with your state’s Medicaid office. 

Table: Medicaid Income Eligibility Limits for Children (May 2024) (Source)

Table: Medicaid Income Eligibility Limits for Pregnant Women (May 2024) (Source)

Table: Medicaid Income Eligibility Limits for Adults (May 2024) (Source)

Texas, Florida, and Georgia have not expanded Medicaid. As a result, non-disabled adults without dependent children generally do not qualify for Medicaid, regardless of income. Parents in these states must have very low incomes to be eligible.  

In 2023, about 1.4 million people fell into the coverage gap. Texas accounted for the largest share at approximately 42%, followed by Florida at 19% and Georgia at 14%. 

2. How to Apply for Medicaid 

You can apply for Medicaid at any time. There are two main ways to start your application: 

Through your state’s Medicaid agency

Every state runs its own Medicaid program, so check with your state’s Medicaid office. You must apply in the state where you live, and they’ll walk you through the specific requirements. 

Through the Health Insurance Marketplace

Another option is to apply through the Health Insurance Marketplace. When you fill out an application, the system automatically checks if you or anyone in your household qualifies for Medicaid.  

If you do, your information will be sent to your state’s Medicaid agency, and they’ll follow up with you about the next steps. 

What You Need for Your Medicaid Application

Each state has different requirements, but most applications will ask for some basic information and documents. Here’s what you may need: 

• Your full name and date of birth 
• Social Security number 
• Proof of Income: Recent pay stubs, tax returns (W-2s), or documentation of other income sources 
• Housing Expenses: Information about your rent, mortgage, or utility bills 
• Citizenship or Immigration Status 
• Current Health Insurance Information 
• Other Government Benefits: If you receive assistance from other programs like SNAP, you may need to verify those as well 

You also need to renew your coverage periodically. States review your eligibility each year, and if they need more information from you, they’ll send a renewal notice. It’s important to respond quickly to avoid any gaps in your healthcare coverage. 

>>> Check more How To Get Free Cell Phones For Seniors 

Conclusion  

Now, you know who qualifies for Medicaid. Gather your documents and get the healthcare coverage you need. If you ever feel stuck, your state’s Medicaid office is just a call or a click away.