To qualify for Medicaid, you generally must meet both financial and non- financial eligibility criteria, which vary by state but follow federal guidelines:
Financial Eligibility
- Most people qualify based on their income using the Modified Adjusted Gross Income (MAGI) method, which considers taxable income and tax filing relationships. This applies to most children, pregnant women, parents, and adults
- For individuals who are 65 or older, blind, or disabled, Medicaid eligibility is usually determined by income and asset tests similar to those used by the Supplemental Security Income (SSI) program
- Some states have "medically needy" programs allowing individuals with high medical expenses to "spend down" income to qualify
- Income limits depend on family size and vary by state; for example, adults 19-64 may qualify if their income is at or below 133% of the Federal Poverty Level
Non-Financial Eligibility
- You must be a resident of the state where you apply for Medicaid
- You must be a U.S. citizen or meet certain qualified non-citizen criteria, such as lawful permanent resident status
- Some eligibility groups are limited by age, pregnancy status, disability, or parenting status
- Certain groups, like children in foster care or those with adoption assistance, may be automatically eligible regardless of income
How to Apply
- You can apply directly through your state's Medicaid agency or through the Health Insurance Marketplace online
- When applying, you may need to provide documentation such as proof of income, citizenship or immigration status, Social Security number, and residency
In summary, to qualify for Medicaid, you must be a state resident, meet citizenship or immigration requirements, and have income below your state's threshold based on your family size and category (child, adult, pregnant, elderly, or disabled). Applying through your state agency or the Health Insurance Marketplace is the usual process to determine your eligibility and enroll
