How Do You Qualify For Medicaid?

You must have heard about Medicaid, but are you confused about whether you qualify for it or not? You have come to the right place. Continue reading to find out.

Medicaid is a joint government and state program that, along with the Children’s Health Insurance Program (CHIP), gives health coverage to over 72.5 million Americans, including children, pregnant ladies, parents, seniors, and people with disabilities. Medicaid is the single largest wellspring of health coverage in the United States.

How do you qualify for Medicaid? To take part in Medicaid, government law expects states to cover certain groups of people. Low-income families qualified pregnant ladies and youngsters, and people accepting Supplemental Security Income (SSI) fall under compulsory qualification groups. States have extra alternatives for coverage and may decide to cover different groups, for example, people getting home and community-based administrations and kids in foster care who are not in any case eligible.

The Affordable Care Act of 2010 set out the freedom for states to extend Medicaid to cover almost all low-income Americans under the age of 65. Qualification for kids was reached out to in any event 133% of the federal poverty level (FPL) in each state (most states cover youngsters to higher income levels), and states were given the alternative to stretch out eligibility to grown-ups with income at or beneath 133% of the FPL. Most states have decided to grow coverage to adults, and those that have not yet extended may decide to do as such whenever they want. Make sure to check whether your state has extended Medicaid coverage to low-income adults or not. Now let us head straight into the article.

What is Medicaid?

The term Medicaid alludes to a public health insurance program that gives health care coverage to low-income families and people in the United States. The program is subsidized by both, the federal government and individual states. However, it is operated at the state level which implies that coverage and administration can change incredibly from one state to another. It is only accessible to people and families who meet certain income-based models. Beneficiaries are U.S. citizens, permanent residents, or legal immigrants. Around 70.6 million individuals were covered by Medicaid as of September 2020.

It is a federally supported insurance program for people of all ages whose assets and income are lacking to cover health care. Medicaid does not give health care directly to people. All things being equal, it covers their PCP visits, hospital stays, long-term clinical care, custodial care, and other health-related expenses. Individual states settle on who meets all requirements for coverage, the kind of coverage, and the method of paying health care laborers and hospitals. That is on the grounds that each state is dependable to oversee and direct its own Medicaid program. The federal government matches state spending and the coordinating rate fluctuates from state to state from about a statutory minimum of 50% to a maximum of 83%. States are not needed to partake in Medicaid, however, all states still do

Is Medicaid eligibility based on income or assets?

Medicaid is a joint federal and state program that assists individuals with restricted income and few resources to cover health care costs. Remember that each state directs its own exceptional blend of Medicaid projects and sets its own monetary and clinical eligibility prerequisites (within federal boundaries) for each. States consider both income and assets in the process of financial qualification. Eligibility for Medicaid is controlled by rounding out an application through the Health Insurance Marketplace website or through your state’s Medicaid office directly.

Your eligibility is controlled by income corresponding to the FPL. The FPL is utilized to decide if a family or person’s income permits them to qualify for federal benefits. As a rule, if a person’s income is under 100% to 200% of the FPL, and they are either disabled, a child, pregnant, or old, there will be a program accessible for them. In the event that their income is under 138% of the FPL, there might be a program accessible for them. The income that is considered when deciding eligibility is a person’s modified adjusted gross income (MAGI). This is taxable income in addition to specific deductions, for example, Social Security benefits and tax-exempt interest. Keep in mind that the income and assets eligibility for each state will be different from each other.

Who qualifies for Medicaid?

The program is the biggest source of financing for health-related administrations for low-income people in the U.S. Total Medicaid spending came to $613.5 billion in 2019, representing 16% of the country’s health care bill. The federal government covered 64.5% of the bill while individual states paid 35.6%. Medicaid coverage has commonly incorporated the accompanying groups:

  • Low-income children and their parents
  • Pregnant ladies
  • Individuals with disabilities
  • Adults beyond 65 years old

Eligibility was extended to incorporate adults younger than 65, given their incomes fell under 133% of the federal poverty level (FPL), according to the Patient Protection and Affordable Care Act. Children represent 38% of enrollees with about 18% of the total cost. Comparatively, individuals with disabilities represent 14% of enrollees with about 36% of total expenses.

Pretty much every state has various Medicaid programs. However, as a decent general guideline, in the event that you make under 100% to 200% of the federal poverty level (FPL) and are pregnant, old, disabled, a parent/guardian, or a child, there is presumably a program for you. What’s more, is that in the event that you make under 133% of the FPL, there is potentially a program for you also, contingent upon whether your state extended Medicaid under Obamacare. Look below to see the eligibility requirements in your state.

Alabama Medicaid

Alabama has Medicaid programs for needy children, parents, guardians, pregnant ladies, senior citizens, and disabled residents. It did not grow Medicaid to cover low-income adults outside those boundaries.

Alaska Medicaid

Alaska extended Medicaid to cover adults from 19 to 64 years of age who are ineligible for its other projects and making under 133% of the federal poverty level (FPL). There are separate projects with fluctuating eligibility necessities for pregnant ladies, children, parents/guardians, older and disabled residents.

Arizona Medicaid

Arizona extended its Medicaid program — Arizona Health Care Cost Containment System (AHCCCS) — to cover adults who do not qualify for its other projects, yet make under 138% of FPL. A single grown-up is eligible for the expansion program in the event that you make a maximum of $1,415. Couples can make a maximum of $1,911 each month. Separate projects cover children, women, caretaker family members, the disabled, and the old.

Arkansas Medicaid

Arkansas has Medicaid programs for poor children, parents, guardians, pregnant ladies, older citizens, blind and disabled residents. It likewise has another private expansion program for adults making beneath 133% FPL. People can make a maximum of $1,414 each month and families of four can make a maximum of $2,903.83 each month. Income limits go up from that point contingent upon family size.

California Medicaid

California extended Medi-Cal to cover adults making 138% beneath the FPL. It has special projects for old, pregnant, disabled, blind, parent/caretaker, and child residents. It is one of only a handful of states that stretches out eligibility to undocumented residents. You can get Medicaid on refugee status for a restricted time frame, contingent upon how long you have been in the U.S.

Colorado Medicaid

Health First Colorado covers children, parents/caretakers, pregnant ladies, and adults without dependent children whose family income does not surpass 133% FPL. Separate projects cover old and disabled residents.

Connecticut Medicaid

Connecticut was the first state to extend Medicaid to adults making less than 138% of the FPL. It has separate projects for pregnant ladies, parents/caretakers, children, the older, and the disabled.

Delaware Medicaid

Delaware extended Medicaid to cover residents with an income of up to 133% of FPL. Parents and caretakers are eligible in the event that they make 87% FPL. Pregnant ladies are eligible for Medicaid when they make less than 212% FPL. It has special projects for pregnant, parent/caretaker, older, disabled, and child residents.

District of Columbia Medicaid

Washington, D.C., has perhaps the most liberal Medicaid programs in the U.S., covering adults with family incomes up to 210% of the FPL as a feature of its expansion program. It likewise has programs for pregnant, parent/caretaker, older, disabled, and child residents. The expansion covers adults without wards who make up to $2,082 every month while applying all alone. Old, blind, or disabled D.C. residents are eligible in the event that they make up to 100% of the FPL, or $1,063 each month for one individual, and have assets below $4,000 for one individual. D.C. likewise covers pregnant ladies with incomes up to 319% of the FPL, or $3445 month to month, and parents/caretakers with incomes up to 216% of the FPL.

Florida Medicaid

Florida has Medicaid programs for poor parents/caretakers, children, old or disabled residents, previous child care beneficiaries, and non-residents with health-related crises. It did not extend Medicaid to cover adults without children or wards.

Georgia Medicaid

Georgia has Medicaid programs for destitute children, pregnant ladies, parents/caretakers, older, disabled, and visually impaired residents and individuals needing nursing home care. It did not extend Medicaid to people outside those parameters.

Hawaii Medicaid

Hawaii carried out Medicaid expansion in 2013. Medicaid, known as Quest Integration, is accessible to children, pregnant ladies, parents, and guardians, and a few adults, including those who are 65 years old or more.

Idaho Medicaid

Medicaid is available for all residents who earn less than 138% of the poverty line. The ballot initiative provides the state with a 90-day period to submit a proposal to the federal government. Meanwhile, if you are below 19 years of age, pregnant, a parent, more than 65 years old, or disabled as per the Social Security Administration criteria, you may be eligible for Medicaid.

Illinois Medicaid

Illinois expanded its Medicaid coverage to children, pregnant women, the disabled, and low-income adults. Illinois Medicaid covers up to 147% of FPL for children, 213% for pregnant women, and 138% for adults.

Indiana Medicaid

Hoosier Healthwise gives Medicaid inclusion to children under 19 and pregnant ladies; Hoosier Care Connect for old and disabled candidates; and Healthy Indiana Plan (the development plan) for adults without children.

Iowa Medicaid

Every adult between the age of 19 and 64, earning up to 133% of the FPL, may be qualified for Medicaid. Iowa has additional programming for pregnant women, families, women with or survivors of breast cancer, individuals more than 65 years old, and disabled people.

Kansas Medicaid

Depending on the group, children, pregnant women, parents and caregivers, and seniors and the disabled may be qualified for Medicaid. Single adults who earn under 138% of the FPL are also eligible.

Kentucky Medicaid

Qualified groups include children under 19, pregnant women, parents and caretakers, and adults 19 to 65 (the expansion set).

Louisiana Medicaid

The state expanded Medicaid, so the eligibility requirement is adults with a family income of less than 133% of the FPL.

Maine Medicaid

To be qualified for Maine’s Medicaid program, known as MaineCare, applicants should be pregnant, a parent or relative caretaker, disabled or have a disabled family member in their household or be 65 years old or more. FPL limits go from 100% for people with disabling conditions and 162% for children under the age of 18. Single adults making 196% FPL are also qualified. Parents and caretakers making under 105% FPL and pregnant women making 214% FPL also qualify.

Maryland Medicaid

The minimum FPL limit for adults is 138%, because of Medicaid expansion. Children and pregnant women are qualified at higher limits.

Massachusetts Medicaid

Massachusetts combines its CHIP and Medicaid programs into one program called MassHealth. It extended Medicaid, however, coverage levels differ depending on age, regardless of whether the candidate is pregnant, disabled, HIV-positive, has breast or cervical cancer, or has children under the age of 18. A few candidates with youngsters making as much as 255% of the FPL, can find support to pay for health care from the state.

Michigan Medicaid

Michigan has Medicaid programs for low-pay children, adults under the age of 21, individuals with dependant kids, and adults who are older, visually impaired, or disabled. Families making under a specific pay level may likewise qualify. Under its expansion, adults making under 133% of the FPL can get inclusion.

Minnesota Medicaid

Minnesota’s expanded Medicaid program for individuals who make low salaries is called Medical Assistance. The state permits individuals who make more than the breaking point to utilize a “spend-down,” which allows them to deduct certain clinical costs from their pay. The program has pay limits and, for guardians who utilize a spend-down, seniors and visually impaired or disabled adults, asset limits.

Mississippi Medicaid

Mississippi did not expand Medicaid to cover everyone within a certain income limit. But children, parents, pregnant women, disabled or elderly people may qualify.

Missouri Medicaid

The Medicaid program in Missouri is known as MO HealthNet. In August 2020, the state voted to expand Medicaid to cover individuals who earn up to 133% of the FPL. People with disabilities, seniors, pregnant women, newborns, children, and women with breast or cervical cancer can get coverage if they meet income requirements.

Montana Medicaid

Montana expanded Medicaid to cover all individuals who earn up to 138% of the FPL. However, as a feature of the expansion, it requires most members to pay up to 3% of their quarterly income in copays. Every member chooses or is given a primary care provider under the Passport to Health program.

Nebraska Medicaid

Nebraska cast a ballot in November 2018 to expand Medicaid to all inhabitants making less than 133% of the FPL to give Medicaid to the old, the disabled, pregnant ladies, children, and guardians, contingent upon pay. Guardians or family members with a dependent child can qualify with family pay up to 58% of the FPL ($1,050 every month for a family of three). Pregnant ladies and babies qualify with pay up to 194% FPL and 162% FPL separately. Youngsters ages 1 through 5 can qualify with family pay up to 145% of the FPL ($2,625 for a family of three). Youngsters ages 6 through 18 qualify with pay up to 133% of the FPL ($2,408 for a family of three).

Nevada Medicaid

Nevada expanded Medicaid to households with incomes up to 138% of the FPL.

New Hampshire Medicaid

New Hampshire expanded Medicaid to cover residents making up to 133% of the FPL.

New Jersey Medicaid

New Jersey provides CHIP and Medicaid through its NJ FamilyCare project. The state expanded Medicaid to cover anyone with an income of up to 138% of the FPL.

New Mexico Medicaid

New Mexico expanded its Medicaid program to cover every poor adult. Its Centennial Care likewise offers Medicaid to infants and children up to the age of 18, along with their folks and caretakers. Pregnant ladies may likewise qualify for full advantages.

New York Medicaid

New York expanded Medicaid to cover all needy adults, along with pregnant women, infants, parents and caretaker relatives.

North Carolina Medicaid

Medicaid in North Carolina is accessible to pregnant ladies, individuals who are 65 years old or more (who can likewise apply for Medicare), individuals who are visually impaired, disabled, or need long-term care, babies, and kids under the age of 21, and guardians or overseers. The state has not extended Medicaid to cover every single penniless adult.

North Dakota Medicaid

The state extended Medicaid to cover all low-income adults. It has separate projects for Medicare recipients; laborers and youngsters with disabilities; pregnant ladies, or ladies with bosom or cervical malignant growth; kids at present in child care or financed appropriation; a few people formerly in child care, and other visually impaired and disabled individuals.

Ohio Medicaid

Ohio expanded Medicaid to cover all low-income adults, with separate projects for pregnant ladies, infants, children, senior citizens, and individuals with disabilities.

Oklahoma Medicaid

SoonerCare is essentially available to children, pregnant ladies, parents/guardians, elderly and disabled residents. The state did not expand Medicaid to cover all needy adults.

Oregon Medicaid

The state expanded the Oregon Health Plan (OHP) to cover all low-pay adults. (It considered moving back that expansion in 2017 to cover state budget gaps, however effectively financed the program through another elector-supported duty on hospitals and health insurance providers.) There are likewise programs for children, pregnant ladies, and the elderly or disabled.

Pennsylvania Medicaid

Pennsylvania expanded Medicaid so that its project Medical Assistance (MA) is offered to low-income adults between the ages of 19 and 64, adults who are 65 years old or more earning any income, blind and disabled adults, and families with children under the age of 21.

Rhode Island Medicaid

Medicaid in Rhode Island has two unique parts. Ritual Care is the state’s overseen care program, offered to guardians, children, and pregnant ladies. The subsequent part is its Medicaid expansion, which opens up medical care inclusion to any Rhode Island occupant (counting documented immigrants) between the ages of 19 and 64 who meet the state’s pay prerequisites.

South Carolina Medicaid

The state’s Medicaid program Healthy Connections is accessible to the older, blind, or disabled; individuals being treated for breast and cervical cancer; disabled children; individuals looking for services related to family planning, pregnant ladies, and Medicare beneficiaries who experience issues paying their charges. The state did not extend Medicaid to cover every single poor adult.

South Dakota Medicaid

South Dakota has Medicaid programs for low-income families, pregnant women, certain newborns, disabled residents, senior citizens, residents experiencing chronic renal failure, youths formerly in foster care, and refugees (for up to eight months from the month of entry). It did not expand Medicaid.

Tennessee Medicaid

Tennessee has Medicaid projects for pregnant women, children, parents/caretakers, and disabled, senior citizens, or uninsurable residents. It did not expand Medicaid to cover all low-income adults.

Texas Medicaid

Texas has Medicaid options for residents who are pregnant, a parent/guardian, transitioning foster care youth, blind, disabled, or older than 65. It did not expand Medicaid to cover all low-income adults.

Utah Medicaid

Projects are accessible for pregnant ladies, guardians/parents, blind, senior citizens or disabled residents, children, ladies with breast or cervical cancer, and refugees. Utah cast a ballot in December 2019 to expand Medicaid to all inhabitants earning under 138% of the federal poverty line, however, subtleties on the program’s rollout are not yet accessible. The state recently expanded Medicaid to give inclusion to single adults procuring up to 5% of the FPL in the event that they are poor, involved with the justice system (probation, parole, or court-requested treatment for substance abuse or emotional well-being issues), or need treatment for substance abuse or mental health issues.

Vermont Medicaid

Vermont expanded its Medicaid program. Residents qualify if their income is up to 138% of the FPL. There are special projects for pregnant women, parents/guardians, and the blind, disabled, and senior citizens.

Virginia Medicaid

Virginians qualified for Medicaid through the state’s expansion initiative and make 138% of the FPL could apply for inclusion.

Washington Medicaid

Washington Apple Health (Medicaid) provides coverage for adults making 138% FPL, people over 65 years old, blind and disabled individuals, pregnant women, and parents/guardians.

West Virginia Medicaid

West Virginia expanded Medicaid under Obamacare. Qualification is available for infants under the age of 1 making 163% FPL, children 1-6 years old making 146% FPL, children 6-19 making 138% FPL, pregnant women making 190% FPL, the elderly and disabled, adults with dependents, and also those without dependents. Everyone receiving benefits must meet income limitations.

Wisconsin Medicaid

While Wisconsin did not expand Medicaid under Obamacare, the state covers everyone under the federal poverty line via the state’s BadgerCare program. Tony Evers from the Democratic government has vowed to formally expand Medicaid under the ACA, however, his current plan is being blocked by the state’s Republican-led legislature.

Wyoming Medicaid

Residents are qualified for Medicaid if they are parents/caretakers, children, pregnant, senior citizens, disabled, or qualified under the Breast and Cervical Cancer Early Detection Program. The state did not expand Medicaid to all needy adults.

What to do if you don’t qualify for Medicaid?

On the off chance that you do not fit the bill for Medicaid, you can get financed medical care through the Obamacare marketplaces during a special enrollment or open enrollment period. Americans who make somewhere in the range of 100% and 400% of the FPL fit the bill for a premium tax credit that can fundamentally bring down the expense of an arrangement. Federal open enrollment for 2019 medical care plans finished on Dec. 15, 2018, however, some state exchanges are open longer and Nevada sells medical coverage lasting through the year., the federal exchange, ordinarily opens from November 1 to December 15 every year. In the event that you cannot discover reasonable medical services on your commercial center during the open enrollment, you have a couple of backup choices:

  • Short-term health insurance
  • Limited benefit plans
  • Prescription discount cards
  • Healthcare sharing ministries


Medicaid has assisted with decreasing the number of individuals without health care coverage and the ACA has leveled further. In 2013, the year before significant arrangements of the ACA came full circle, an expected 44 million individuals did not have medical coverage. By 2017, that number dropped to 27.4 million.

Numerous Americans would be without health care coverage if Medicaid did not exist. This is on the grounds that low-pay people frequently do not approach protection through their positions, and buying private health care coverage in the marketplace is not cheap. Medicaid has given admittance to medical services that have genuinely shown upgrades in the general well-being of people who otherwise would not be covered for even a simple visit to the doctor or proper medication.

Is it hard to qualify for Medicaid? Qualifying for Medicaid is certainly not a simple interaction, and with state-by-state variations, it is not getting any simpler to enroll. Get all the assistance you can from a financial advisor and a qualified senior citizen care lawyer before you start this interaction to augment your odds of acceptance. Additionally, be set up to prepare and radically decrease the size of your acceptable estate through a gifting or donation program to meet the requirements for your state.

Tony Bennett

Tony Bennett

Tony Benett makes his living in the insurance industry by teaching and consulting. He is also recognized by the legal profession as an expert on insurance coverages. His insurance experience includes having worked at the company level, owned an independent general agency and having worked for an insurance association. He has received various certificates over the past few years and helps his clients and readers by giving them a realistic outlook on what they can expect to achieve within their set targets. At Insurance Noon, he is known for his in-depth analysis and attention to details with accuracy. He has been published as one of the most referred agents by his peers in the insurance community. Tony loves the outdoors and most sport events. His passion other than providing excellent advice is playing golf.

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