Who qualifies for Medicaid and what the income limits are

How Medicaid decides who qualifies

Medicaid is a health program that the federal government and each state run together. HealthCare.gov, the federal site where people sign up for coverage, says all Medicaid programs follow federal guidelines. Each state still sets its own income levels and its own costs and benefits. That is why a neighbor in the next state may qualify when you do not.

Your state looks at two main things when it decides. The first is your group, which means the kind of person the program is built to help. The second is your household income compared with your state's limit. You also have to live in the state where you apply and meet the citizenship or immigration rules.

HealthCare.gov says Medicaid and CHIP cover the kinds of people listed below. CHIP is the Children's Health Insurance Program, a sister program that helps children whose families earn a bit too much for Medicaid.

• Children qualify, and in many states so do their parents or other adults who care for them.
• Pregnant people can qualify at higher incomes, and the Medicaid for pregnancy guide explains how.
• Adults who are 65 and older can qualify.
• People who have a disability can also qualify for coverage.
• Adults 19 to 64 with low incomes can qualify in states that expanded Medicaid.
• Young people who aged out of the state child welfare system must be covered until they turn 26, if they had Medicaid at the time.

Because that list is so long, it is worth applying even when you think your income is too high. HealthCare.gov says your state also weighs your household size, pregnancy, disability and age along with income.

What 138 percent of the poverty level means

The federal poverty level is a yearly income line that the government sets for each household size. The U.S. Department of Health and Human Services, through its research office called ASPE, publishes the numbers every January. Programs then use a percentage of that line to decide who gets help.

The Affordable Care Act, the 2010 federal health law, let states cover every adult under a set income. HealthCare.gov explains that the law names 133 percent of the poverty level. A 5 point income allowance is built into the rules, so the real line works out to 138 percent. A few states use a different limit than that.

For the 48 contiguous states and Washington, DC, ASPE's 2026 poverty guidelines are $15,960 a year for one person. For two people the number is $21,640. The number is $27,320 for three people and $33,000 for four people. Alaska and Hawaii have their own, higher tables.

The list below is our own math from those numbers. Please treat it as an estimate and not as an official limit.

• For one person, 138 percent of $15,960 is about $22,025 a year.
• For two people, 138 percent of $21,640 is about $29,863 a year.
• For three people, 138 percent of $27,320 is about $37,702 a year.
• For four people, 138 percent of $33,000 is $45,540 a year.

Your state may start using a new year's table a few weeks or months after it is published. The number from your state agency is the one that counts.

How your income is counted

Most people in the groups above are checked with a method called MAGI, short for modified adjusted gross income. It is a tax-style way of adding up the income of the people in your household. Federal rules say states must not apply an asset test to these groups. An asset test is a limit on what you own, such as savings or a car.

The same rules say a state looks at your current monthly household income and your family size. A recent job loss or a drop in hours can therefore change the answer. Adults who qualify because of age or disability are checked in a different way, and some states do look at their savings.

Where your state stands on expansion

Expansion means a state chose to cover all low-income adults and not just certain groups. KFF, a health policy research group, said on October 1, 2026, that 41 states, including Washington, DC, have adopted the expansion and 10 have not.

In the 10 states that have not expanded, the rules can be very strict. KFF's January 2026 table shows that parents in Texas qualify only if they earn less than about 15 percent of the poverty level. Adults without children get 0 percent there, which means they do not qualify on income alone. Parents in Tennessee qualify with income up to about 105 percent. Wisconsin covers adults up to 100 percent. Georgia also reaches 100 percent through its Pathways program, but only for adults who show 80 hours a month of work or similar activity.

If you live in one of those states and earn too little for a Marketplace plan, you may fall into a hole in coverage. Our guide to the Medicaid coverage gap explains what to do.

Does your immigration status matter?

HealthCare.gov says that, because of a law change, only people with certain immigration statuses can now get full Medicaid or CHIP. These are lawful permanent residents (green card holders), Cuban or Haitian entrants and people from the Compact of Free Association countries. Many green card holders must wait 5 years after getting their status before they can get full Medicaid. Depending on the state, pregnant people and children who are lawfully residing may also qualify. The rules are complicated, so ask a legal aid office or a trained application helper if you are unsure.

Emergency care follows a separate rule from the others. Federal law requires an emergency room to treat anyone who comes in, with or without Medicaid. Emergency Medicaid can also help pay for emergency care for people who meet the income rules and the state's other rules, whatever their immigration status.

How to check your own state's limit

1. Go to HealthCare.gov and use the tool that asks for your state and household size. It tells you if you might qualify for Medicaid, CHIP or savings on a Marketplace plan.
2. Find your state's Medicaid agency online, because its website lists the income limit for each group.
3. Apply anyway if you are close to the line, and use the how to apply for Medicaid guide to walk through it.
4. Keep the written answer, even if it is a denial, because many clinics and hospital aid programs ask to see it.

A new federal work rule will soon apply to many adults in the expansion group. You can read about it in our Medicaid work requirements guide.

If your income is too high for Medicaid, a Marketplace plan or a community health center may fit. You can also search for a cash-pay doctor in the meantime. This page is general information and not medical advice. In an emergency, call 911 or go to the nearest emergency room.