To qualify for Medicaid, you generally must meet both financial and non- financial eligibility criteria, which can vary somewhat by state but follow federal guidelines:
Financial Eligibility
- Most adults, children, pregnant women, and parents are evaluated based on Modified Adjusted Gross Income (MAGI), which considers taxable income and tax filing relationships without asset tests for these groups
- Individuals who are 65 or older, blind, or disabled are usually assessed using Supplemental Security Income (SSI) income methodologies, which may include asset limits (e.g., typically a $2,000 asset limit for a single person)
- Some states offer "medically needy" programs allowing individuals with higher incomes but significant medical expenses to qualify by "spending down" income on medical costs
- Income limits depend on family size and state-specific thresholds; many states have expanded Medicaid to cover more adults below certain income levels
Non-Financial Eligibility
- Must be a resident of the state where applying for Medicaid
- Must be a U.S. citizen or a qualified non-citizen (e.g., lawful permanent residents); some non-citizens may qualify for limited emergency Medicaid
- Certain eligibility groups are defined by age, pregnancy status, disability, or parenting status
Additional Notes
- Some individuals qualify automatically by participation in other programs like SSI or foster care
- Coverage can start retroactively up to three months before application if eligible during that time
- Application can be made directly through the state Medicaid agency or via the Health Insurance Marketplace
In summary, to qualify for Medicaid you must be a state resident, a U.S. citizen or qualified non-citizen, meet income criteria based on MAGI or SSI methodologies depending on your group, and fit into an eligible category such as low-income adult, child, pregnant woman, elderly, or disabled person
