Medicaid eligibility: who can get Medicaid and the income limits by family size

Who can get Medicaid

Medicaid is run by each state within federal rules. Federal law makes every state cover certain groups, such as low-income families, qualified pregnant women and children, and people who get SSI. States may cover more groups. Every state covers children up to at least 133 percent of the poverty level, and most go higher.

You must also live in the state and be a U.S. citizen or a qualified noncitizen. Since Oct. 1, 2026, section 71109 of Public Law 119-21 limits federal funding for noncitizens to green card holders, Cuban and Haitian entrants and COFA migrants. HealthCare.gov now says only these noncitizens can get full Medicaid or CHIP. Some states also cover lawfully residing children and pregnant women. The limits do not apply to emergency Medicaid.

For people 65 and older, blind or with a disability, states mostly use SSI income rules. In 36 states and D.C., people with high medical bills can spend down to the income limit.

Adults on income alone: the expansion group

In expansion states, adults qualify if they are 19 to 64, not pregnant and not on Medicare, with income at or below 133 percent of the poverty level. The rules subtract 5 points of the poverty level, so the real limit is 138 percent. The CMS rule published June 3, 2026, counts 40 states and D.C. that have expanded.

The Medicaid.gov state table, with data as of Dec. 1, 2023, shows 10 states without expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. Wisconsin covers some adults up to 95 percent of the poverty level through a waiver. Georgia covers some adults through a waiver with a work rule. In these states, adults may still qualify as parents, as pregnant women or through a disability.

Income limits by family size

The poverty guidelines are higher in Alaska and Hawaii. For one person, 138 percent is about $27,531 in Alaska and $25,337 in Hawaii. For four people, it is $56,925 and $52,371. States can start using new guidelines on their own date, so treat this table as a guide.

CHIP for children

CHIP covers children in families that earn too much for Medicaid. In some states it also covers pregnant women. One application checks for both, any time of year. CHIP covers check-ups, shots, doctor visits, prescriptions, dental and vision care, and hospital care.

When coverage starts

Coverage starts on the date you apply or the first day of that month. It can also reach back up to 3 months before the month you apply. Under section 71112 of Public Law 119-21, for applications made on or after Jan. 1, 2027, that window is 1 month for the expansion group and 2 months for everyone else.

Frequently asked questions

What does 138 percent of the poverty level mean?

The law sets 133 percent for the expansion group. The rules then subtract 5 points of the poverty level from income, so the limit works out to 138 percent.

Does Medicaid count my savings or my car?

Not for most children, pregnant women, parents and expansion adults. Their income is judged by modified adjusted gross income, which has no asset test. Rules for people 65 and older or with a disability are different.

My state did not expand. Should I still apply?

Yes. You may still qualify through children, pregnancy or a disability. Apply to your state agency or through the Marketplace.

Can my child get coverage if I cannot?

Often, yes. Every state covers children up to at least 133 percent of the poverty level, and CHIP covers children in families that earn too much for Medicaid.