One in five people in the U.S. receives free or low-cost health coverage through Medicaid, a joint federal and state program administered by individual states under federal guidelines. Each state has different rules about who qualifies for Medicaid and how to apply.

You can apply for Medicaid anytime and must have documented proof of eligibility, including citizenship, residence, age, income and resources, and medical expenses or disability. Eligibility redeterminations are conducted regularly. If you qualify, you can have both Medicare and Medicaid.

What You Should Know About How to Qualify and Apply for Medicaid

  • Free or low-cost health coverage: Medicaid provides free or low-cost health coverage to U.S. residents with low-income, people with disabilities, some Medicare beneficiaries, and others who do not have access to affordable health insurance.
  • State rules vary: Medicaid is a joint federal and state health program, but each state has full responsibility for administering the program and has different rules about eligibility and applying for Medicaid. Find out if you qualify and learn how to apply by contacting your state Medicaid program.
  • No specific enrollment dates: You can apply for Medicaid at any time. You will be required to show proof of your eligibility when you apply, and ongoing through a renewal/redetermination process, typically once per year, or if your financial situation changes or you move to another state.

What Is Medicaid?

Medicaid is a joint federal and state health program that provides health coverage to families with low income, qualified pregnant women and children, and persons who are receiving Supplemental Security Income (SSI).

States, following federal guidelines, administer Medicaid programs and are given the option to expand Medicaid coverage. For example, states may provide Medicaid coverage to individuals who are receiving home and community-based services, children in foster care, and adults with income at or below 133% of the federal poverty level (FPL). The 2021 FPL is $12,880 for individuals and $17,420 for a family of two.

How Do You Qualify For Medicaid?

To qualify for Medicaid, you must meet financial eligibility requirements and be:

  • A resident of the state in which you receive Medicaid
  • Either a U.S. citizen or a lawful permanent resident, in addition to meeting financial eligibility requirements

Financial eligibility for Medicaid is generally based on the Modified Adjusted Gross Income (MAGI), which considers taxable income and tax filing relationships. Some individuals who are blind, disabled, or age 65 or older may financially qualify for Medicaid by using the income methodologies of the SSI program, which the Social Security Administration (SSA) administers.

Persons in certain groups do not require a determination of income by Medicaid. Instead, eligibility is based on enrollment in another program. For example:

  • The breast and cervical cancer treatment and prevention program
  • Adopted children are generally automatically eligible for Medicaid when an adoption assistance agreement is in effect under the SSA Act
  • Young adults who are former foster care recipients, regardless of income level

States can also establish a medically needy program for persons with significant health needs whose income is too high to qualify for Medicaid otherwise. These states let you subtract your medical expenses from your income to become eligible for Medicaid.

Some states’ Medicaid eligibility requirements are more restrictive than the SSI program. These are known as 209(b) states, and they must allow a spend down to the same income eligibility levels for groups based on disability, blindness, or age (65 or older).

Because each state has different rules about eligibility and how to apply, you must contact your state Medicaid program to find out if you qualify. A good place to start is to see what your state’s income and resource maximum limits are.

Who Doesn’t Qualify for Medicaid?

One in five Americans has Medicaid coverage. Those who do not qualify are:

  • People with incomes that are higher than the limit set by the state in which they live. These limits vary among the states but are more stringent in those states that did not choose to expand Medicaid coverage under the Affordable Care Act (ACA).
  • People who are not U.S. citizens or do not meet the requirements for a lawful, permanent resident.
  • People who previously qualified but have a status change; for instance, they are no longer pregnant, their income has increased through employment or gift/inheritance, or they have moved to a state with different eligibility requirements.
  • People who do not report status changes in a timely manner (typically within 30 days) or who fail to renew during the redetermination period may lose their benefits. Under federal law, you have 90 days to provide your state Medicaid agency with all required information after you lose coverage.

Can You Have Medicaid and Medicare?

Yes. This is known as dual eligibility, and most of your health care costs are likely covered. Medicare is typically considered to be the primary insurance (unless you also have employer group health plan coverage), and Medicaid is the payer of last resort.

Medicaid pays only after Medicare, employer group health plans, and a Medicare Supplement (Medigap) insurance have paid. Note: If you qualify for Medicaid and your income/circumstances are unlikely to change, you should not need supplemental insurance.

Medicaid helps Medicare beneficiaries with Medicare premiums and cost-sharing. Also, it provides many of them with benefits not covered by Medicare, such as help with long-term care needs, some medications, or eyeglasses.

If you, as a Medicare beneficiary, qualify for Medicaid, you are automatically eligible for Extra Help, a Medicare program to assist with paying for drug costs like premiums, copays, and deductibles.

Some states and health plans offer Medicare-Medicaid plans for certain people who have both programs  to make it easier to get the services they need.

As with anything that is Medicaid related, contact your state agency for assistance.

What Should You Know About Applying for Medicaid?

If you are unsure whether or not you might qualify for Medicaid, but you likely meet the financial requirements in your state, you should apply.  You might be eligible depending on your household income, family size, age, or disability.

Apply for Medicaid through the Health Insurance Marketplace or directly with your state Medicaid agency. Many Medicaid enrollees get their Medicaid benefits through private managed care plans that contract with the state. You will be advised on how to apply once you access your state’s website, or contact your state’s agency.

Be ready to provide information on your Medicaid application as proof of your eligibility. You should expect to hear back within 45 days or longer if you are disabled. If your application is denied, you will receive a denial notice and instructions on how to appeal the decision.

Keep good records of the documents (copies) you use to complete your application. You may need to supply them again or show updated versions when you are up for renewal/redetermination, depending on your state’s Medicaid program. Be prepared to provide these documents:

  • Birth certificate or driver’s license
  • Proof of citizenship
  • Proof of your residence
  • Documentation of all sources of income and assets or other resources
  • Documentation of medical expenses
  • Proof of your disability, if applicable
  • Insurance ID card, if applicable

Don’t wait to apply. Unlike Medicare, there are no restrictions or open enrollment periods, so you can apply at any time. It is better to apply and be turned down than to not try at all. Renewals and redeterminations to ensure continued eligibility will occur at least every 12 months. Some states may require more frequent redeterminations, but in any case, you need to report any change in your status as soon as possible, and within 30 days.

Once your Medicaid eligibility has been determined, your coverage is effective on either the date of the application or the first day of the month of the application. Benefits may be covered retroactively for up to three months prior to when you apply if you would have been eligible during that time frame.

Coverage will stop at the end of the month that you no longer meet the eligibility requirements.

If you have questions or want to check on the status of your application, contact your state Medicaid program directly. Set up an account with the agency/organization that manages your state program.

Even though you may access your application through a state website, local county offices and agents can help you in person or on the phone.

Get Help With Medicaid
State Medicare Agency Medicaid Income Limit Medicaid Premium
Alabama Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Alaska Single: $22,597
Married: $30,444
Married, 1 child: $38,291
Married, 2 children: $46,138
Married, 3 children: $53,985
Married, 4 children: $61,832
$0
Arizona Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Arkansas Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
Up to 5% of household income
California Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Colorado Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Connecticut Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Delaware Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Florida Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Georgia Single: $33,568
Married:$45,226
Married, 1 child: $56,885
Married, 2 children: $68,543
Married, 3 children: $80,201
Married, 4 children: $91860
$0
Hawaii Single: $20,787
Married: $28,010
Married, 1 child: $35,232
Married, 2 children: $42,454
Married, 3 children: $49,676
Married, 4 children:$56,898
$0
Idaho Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Illinois Single: $18,755
Married: $25,268
Married, 1 child: $31,782
Married, 2 children: $38,295
Married, 3 children: $44,809
Married, 4 children: $51,323
$0
Indiana Single: $16,971
Married: $22,930
Married, 1 child: $28,888
Married, 2 children:$34,846
Married, 3 children: $40,805
Married, 4 children: $46,763
Up to 5% of household income
Iowa Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
Up to 5% of household income
Kansas Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Kentucky Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Louisiana Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Maine Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Maryland Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Massachusetts Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Michigan Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
Up to 5% of household income
Minnesota Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Mississippi Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Missouri Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Montana Single: $13,590
Married: $18,310
Married, 1 child: $23,030
Married, 2 children: $27,750
Married, 3 children: $32,470
Married, 4 children: $37,190
Up to 5% of household income
Nebraska Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Nevada Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
New Hampshire Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
New Jersey Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
New Mexico Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
New York Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
North Carolina Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
North Dakota Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Ohio Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Oklahoma Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Oregon Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Pennsylvania Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Rhode Island Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
South Carolina Single: $13,590
Married: $18,310
Married, 1 child: $23,030
Married, 2 children: $27,750
Married, 3 children: $32,470
Married, 4 children: $37,190
$0
South Dakota Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Tennessee Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Texas Single: $26,909
Married: $36,254
Married, 1 child: $45,600
Married, 2 children: $54,945
Married, 3 children: $64,291
Married, 4 children: $73,637
$0
Utah Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Vermont Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Virginia Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Washington Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
West Virginia Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Wisconsin Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Wyoming Single: $18,075
Married: $24,353
Married, 1 child: $30,630
Married, 2 children: $36,908
Married, 3 children: $43,186
Married, 4 children: $49,463
$0
Medicaid Resources
Resource with link How you can get help
Healthcare.gov Plan Finder This is a government website designed to help you find private health plans outside of the health insurance marketplace. These plans may often be available in the marketplace, but this offers additional options.
Local Help for Healthcare.Gov Find local help navigating marketplace plans.
Centers for Medicare and Medicaid Services Learn more about Medicaid coverage and qualifying for a low-income health insurance plan.
Medicare Medicaid Assistance Program The Medicare Medicaid Assistance Program provides unbiased help with the two programs at no charge. Certified volunteers answer questions, troubleshoot problems, and help people understand their plan choices.
The Center for Medicaid and CHIP Services The Center for Medicaid and CHIP Services (CMCS) works in close partnership with states, as well as providers, families, and other stakeholders to support effective, innovative, and high-quality health coverage programs.

Medicaid Frequently Asked Questions

What is the difference between Medicare and Medicaid?

Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income, and younger disabled people and dialysis patients.

Medicaid is an assistance program. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses.

Who is eligible for U.S. Medicaid?

In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program covers all low-income adults below a certain income level.

What is the lowest income to qualify for Medicaid?

In most states you can qualify for Medicaid if your household income is below 133% of the federal poverty level. Some states use a different income limit, however.

What is covered by Medicaid?

States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines.  However, the federal government mandates that some benefits must be covered in every state, including inpatient and outpatient hospital services, physician services, laboratory and X-ray services, and home health services, among others. Optional benefits include services including prescription drugs, case management, physical therapy, and occupational therapy.

What is not covered by Medicaid?

Most services that are not covered by Medicaid can typically be described as one of the following:

  • The medical service is deemed unreasonable or medically unnecessary
  • Charges were improperly billed
  • Providers were reimbursed through another program
  • The service or test isn’t covered (this can vary by state)
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Insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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