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Understanding
medicaid and eligibility:
a state-by-state guide

Fact-checked with HomeInsurance.com

Table of contents

Finding affordable health insurance can be difficult for many people, which is why nearly 70 million uninsured individuals in America turn to Medicaid. This program allows those who can’t afford private healthcare the chance to get their medical needs met by covering their medical costs. And with the recent COVID-19 pandemic, it’s more important than ever to have health insurance you can count on.

Medicaid is a public assistance program funded by both federal and state governments that covers the medical costs for low-income children, pregnant women, people with disabilities and adults over the age of 65. In some states, low-income adults are also covered. It works just like health insurance, covering services like doctor’s visits, hospitalizations, diagnostic tests and long-term care services. 

Medicaid is different from the children’s health insurance program (CHIP). The CHIP program focuses on making sure all children have health coverage, even if they just miss the mark to qualify for Medicaid. For example, if the income limit for Medicaid was $1,000 per month, but the parent made slightly over that, the child could be disqualified from Medicaid, but could still qualify for health insurance through CHIP, as long as they don’t have any secondary insurance. While CHIP is more limited in its coverage than Medicaid, it is still a good option for low-income youth to have some form of health care coverage. 

Medicaid is also different from Medicare. Medicare is age-based and restricted to anyone over 65 or anyone under 65 with an approved disability, regardless of income. Medicaid, on the other hand, is income-based and provides coverage for anyone of any age as long as they meet the income requirements and other eligibility requirements for their respective group. Some people may qualify for both government programs; this is called dual-eligibility. For example, if you are over the age of 65 and you are also low-income, you may qualify for both Medicare and Medicaid.

How Medicaid works

Medicaid is funded through both federal and state funds. While states are required to provide health insurance coverage to specific groups, each state can determine its own income requirements and eligibility guidelines. You do not get Medicaid automatically; you must apply to know if you’re eligible. 

To qualify for Medicaid, you must have an income that is less than your state’s designated amount for your respective household size. Income requirements are often expressed as a percentage of the federal poverty level (FPL). If your income is at 100% or below (<100%) the FPL for your household size, you qualify for Medicaid. The federal poverty levels are in dollar amounts, while the income limit is represented as a percentage. 

In general, your income level is determined using your modified adjusted gross income (MAGI). Your MAGI is your adjusted gross income (AGI) with any excluded foreign income, non-taxable portions of your Social Security income and tax-exempt interest.  

Many states have chosen to expand their Medicaid coverage to certain groups who may make more than the FPL (<133% to 200%) but are still considered low-income or medically needy. Some states, for example, have chosen to expand their coverage to cover any adult making less than 133% of the FPL, or any pregnant woman making less than 147% of the FPL. Again, this differs from state to state. And some groups, including those who have a disability and those on Medicare, may also have a choice between MAGI and non-MAGI Medicaid, with non-MAGI Medicaid having slightly different income and resource guidelines for eligibility and services.

States are allowed to charge enrollment fees, premiums, deductibles, copays or coinsurance for certain recipients, but the federal government is very particular about who can be charged, for what services, and the amounts. All charges and premiums cannot exceed 5% of the family’s monthly income, and people with income less than 150% of the FPL cannot be charged premiums at all.

HHS poverty guidelines for 2020

According to the federal government, if your household income is below the federal poverty level (FPL), you qualify for Medicaid. Keep in mind that your state may offer coverage even if you make above the FPL (see state-by-state chart below).  

US CONTINGUOUS STATES + D.C.ALASKAHAWAII
Persons Per HouseholdPoverty GuidelinePersons Per Household Poverty Guideline Persons Per Household Poverty Guideline
1$12,7601 $15,950 1 $14,680
2$17,2402 $21,550 2 $19,830
3$21,7203 $27,150 3 $24,980
4$26,2004 $32,750 4 $30,130
5$30,6805 $38,350 5 $35,280
6$35,1606 $43,950 6 $40,430
7$39,6407 $49,550 7 $45,580
8$44,1208 $55,150 8 $50,730
For those with more than 8 persons, add $4,480 for each additional person.

Source: https://aspe.hhs.gov/poverty-guidelines
For those with more than
8 persons, add $5,600 for each
additional person.
For those with more than
8 persons, add $5,150 for each
additional person.

Medicaid plans

Each state has its own Medicaid website that includes coverage information like which providers are available and covered, as well as other benefits. If you have a particular doctor you would like to use, make sure to choose a plan that includes that doctor. Depending on your state and county, you will be provided a list of Medicaid-approved health plans to choose from, such as Molina, UnitedHealthcare, Fidelis and Blue Cross Blue Shield. 

Some benefits are federally mandated, including inpatient and outpatient hospital services, doctor visits, labs, tests and X-rays, autism services, preventative medicine, behavioral health services, and early and periodic screening, diagnostic and treatment services. 

Some states offer additional benefits, such as prescription drug coverage, physical therapy, respiratory care services, podiatry services, optometry, dental services, hospice and other home and community-based services.

Eligibility

Federal law requires states to provide Medicaid assistance to the following groups: 

  • Low-income families
  • Low-income pregnant women and children
  • Adults over the age of 65
  • People with disabilities

Each state then has the option to expand its Medicaid program to include other groups. For example, 35 states have elected to expand Medicaid coverage to cover low-income adults. Additionally, some states provide Medicaid coverage to people who are considered “medically needy” — that is, their income is too high to typically qualify for Medicaid, but their significant medical needs cover a large portion of their income. 

If you are in a group that is eligible for Medicaid, there are some basic eligibility guidelines:

  • You must be a U.S. citizen or legal alien in good standing with immigration
  • You must be a resident of the state to which you are applying
  • You must not currently be an inmate at an institution (although you can apply for coverage upon release)

The coverage will provide either free or low-cost health care for those who are eligible. Eligibility requirements vary from state to state and may depend on one or a combination of the following:

  • State of residence
  • Income level
  • Age
  • Disability or pregnancy status
  • Household size
  • Role within the household

How to apply for medicaid

The easiest way to see if you qualify for Medicaid/CHIP is by applying through the Health Insurance Marketplace at healthcare.gov. Most states also have a paper application or online portal you can use to apply as well. 

 To apply, you will need the following information: 

  • Proof of citizenship (birth certificate, national ID card, military service record, passport, etc.) 
  • Proof of age/identity (driver’s license, state or federal ID, military card, passport, etc.)
  • Proof of income (recent pay stubs, previous year’s tax return, earnings record, award letter, etc.)
  • Bank statements (checking and savings accounts)
  • Proof of address (rent or utility bill, property tax records, mail addressed to you within the last six months)
  • Proof of disability, if applicable (medical records) 

The results will be given to you in the form of a Letter of Eligibility, which tells you whether you qualify or not.

Medicaid state-by-state  eligibility and requirements

Income requirements in this table are based on your MAGI and household size, and they are expressed as percentages of the federal poverty level (FPL). States frequently update and revise their Medicaid coverage and policies, so for the most current and accurate information, contact your state’s Medicaid office or visit their website. You may also find the latest information about your state, plus a federal poverty level calculator, on healthinsurance.org.

STATEMEDICAID INFORMATION (as of 04/01/2020)
AlabamaEligibility: Alabama Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults. 
Income requirements: To qualify for Medicaid, your MAGI must be less than 141% of the FPL for children, 312% for uninsured children, 141% for pregnant women and 13% for parents/caretakers. (Source)
How to apply: Get specific details on the available programs as well as all application forms by visiting Alabama Medicaid. For general questions, call 1-800-362-1504. You can also apply via the Health Insurance Marketplace
AlaskaEligibility: Alaska uses alternative FPL guidelines (see chart above). Alaska elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 177% of the FPL for children, 203% for uninsured children, 200% for pregnant women and 133% for low-income adults. To see a detailed breakdown of income requirements for all eligible persons for the state of Alaska, see this document (PDF). (Source)
How to apply: The fastest way to apply is through the Health Insurance Marketplace, but you can also fill out the form Application for Services (PDF) or apply through the ARIES Self-Service Portal under Services for Individuals. 
ArizonaEligibility: Arizona elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 147% for children (depending on age), 200% for uninsured children, 156% for pregnant women, 106% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: You can apply through the Health Insurance Marketplace, through the Health-e-Arizona PLUS online application portal or by going to AHCCCS
ArkansasEligibility: Arkansas elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than142% of the FPL for children, 209% for pregnant women, 17% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: Visit ARMedicaid for more information. The best way to apply is online, but you can also apply at your county’s Department of Human Services (DHS) or print an application from the DHS website. You can also apply via the Health Insurance Marketplace
CaliforniaEligibility: California elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 261% of the FPL for children, 208% for pregnant women, 109% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To apply online, visit the Covered California online application portal, or download an application through the Apply for Medi-Cal page. Additionally, you can apply via the Health Insurance Marketplace
ColoradoEligibility: Colorado elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than142% to 260% of the FPL for children (depending on age), 195% for pregnant women, 68% for parents/caretakers and 133% for low-income adults.  (Source)
How to apply: Visit the Colorado PEAK online application portal to apply online, or visit the How to Apply page to download an application. Also, you can always apply through the Health Insurance Marketplace
ConnecticutEligibility: Connecticut elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 196% of the FPL for children, 258% for pregnant women,150% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To apply online, visit the ConneCT online application portal or the Health Insurance Marketplace. For more information, visit the How to Qualify page. 
DelawareEligibility: Delaware elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 212% of the FPL for children (depending on age), 212% for pregnant women, 87% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: You can apply online at Delaware ASSIST, apply in-person by visiting your local office for the Division of Social Services (DSS) or have an application mailed to you by calling 1-866-843-7212. You can also apply via the Health Insurance Marketplace
District of ColumbiaEligibility: Washington D.C. elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities. Washington, D.C. has one of the most generous Medicaid expansion plans in the nation.  
Income requirements: To qualify for Medicaid, your MAGI must be less than 319% FPL for children, 319% for pregnant women, 216% for parents/caretakers, 210% for low-income adults (over 21) and 216% for low-income adults ages 19 and 20. (Source)
How to apply: For application information and to download an application, visit the DC.gov Apply for Benefits page. You can also apply through the Health Insurance Marketplace
FloridaEligibility: Florida Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults, however the state does provide coverage for low-income adults ages 19 and 20. 
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 210% of the FPL for children (depending on age),191% for pregnant women, 28% for parents/caretakers and 28% for low-income adults ages 19 and 20. (Source)
How to apply: To learn more about Florida Medicaid, visit the Florida Medicaid website. To find your local Medicaid office, visit Recipient Information. And to see more information on eligibility, the information is available on the Medicaid Eligible Reports page. You can also apply via the Health Insurance Marketplace
GeorgiaEligibility: Georgia Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults, but its income limits are generous. 
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 247% of the FPL for children (depending on age), 220% for pregnant women and 32% for parents/caretakers. (Source)
How to apply: To apply online, visit the Georgia Gateway online application portal. To download an application and for more information, visit its Applying for Medicaid page. Also, you can always apply through the Health Insurance Marketplace.
HawaiiEligibility: Hawaii is one of the many states that elected to expand its Medicaid coverage to include low-income adults. It has two programs: Medicaid Fee-for-Service is for ages 65 and older, people who are certified as blind and people with disabilities, while Hawaii QUEST is for other applicants. 
Income requirements: Hawaii uses alternative FPL guidelines (see chart above). To qualify for Medicaid, your MAGI must be less than 308% of the FPL for children,191% for pregnant women, 105% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: The Med-QUEST Division has application forms at its eligibility offices. You must complete the form and return it to an office. You may then be required to have an interview. If you are receiving food stamps already, your caseworker can process the application. To find your nearest office, visit Med-QUEST Division’s Eligibility Branch. You may also visit Hawaii My Medical Benefits to access applications. You can also apply via the Health Insurance Marketplace
IdahoEligibility: Idaho Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 185% of the FPL for children (depending on age),133% for pregnant women and 23% for parents/caretakers. (Source)
How to apply: For more information, visit About Medicaid. You can download an application from the Commonly Used Forms page or pick up an application at your local Department of Health and Welfare Office by calling the Idaho CareLine at 1-800-926-2588. You can also apply via the Health Insurance Marketplace
IllinoisEligibility: Illinoise elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities. The state also covers those who were formerly in foster care. 
Income requirements: To qualify for Medicaid, your MAGI must be less than 142% to 313% of the FPL for children (depending on age), 208% for pregnant women, 133% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: For more information, contact the Health Benefits Hotline at 1-800-843-6154 or visit the Department of Healthcare and Family Services. You can also apply via the Health Insurance Marketplace
IndianaEligibility: Indiana elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 158% to 250% of the FPL for children (depending on age), 208% for pregnant women,19% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To get more information, including specific eligibility requirements, visit the Indiana Medicaid website or call 1-800-457-4584. You can also apply via the Health Insurance Marketplace
IowaEligibility: Iowa elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities. Iowa has generous eligibility guidelines for pregnant women and children ages 0 to 11. Some services covered by Medicaid may require a small co-payment. 
Income requirements: To qualify for Medicaid, your MAGI must be less than 167% to 375% of the FPL for children (depending on age), 375% for pregnant women, 51% for parents/caretakers and 133% for low-income adults.  (Source)  
How to apply: Visit Iowa.gov to apply, call 1-800-972-2017 or visit any Department of Human Services office. You can also apply via the Health Insurance Marketplace
KansasEligibility: Kansas Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. It did not vote to expand coverage to include low-income adults.  
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 230% of the FPL for children (depending on age, 166% for pregnant women and 33% for parents/caretakers. (Source)
How to apply: To learn more about KanCare, visit the Kansas Department of Health and Environment website. Or, you can speak with a customer representative about Medicaid through your local Department of Social and Rehabilitation Services Service Access Point. You can also apply through the Health Insurance Marketplace
KentuckyEligibility: Kentucky elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities. The program also covers children in foster care homes and individuals under age 21 in psychiatric hospitals. 
Income requirements: To qualify for Medicaid, your MAGI must be less than 159% to 213% of the FPL for children (depending on age), 195% for pregnant women, 24% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: Visit the Kentucky Medical Program website to apply, call 502-564-5472 or apply via the Health Insurance Marketplace.
LouisianaEligibility: Louisiana elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 212% to 250% of the FPL for children (depending on age), 133% for pregnant women, 19% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: Download an application here, call 1-888-342-6207 or visit Louisiana’s Medicaid Program website. Alternatively, you can apply via the Health Insurance Marketplace
MaineEligibility: Maine elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 157% to 191% of the FPL for children (depending on age), 208% for uninsured children, 208% for pregnant women, 100% for parents/caretakers, 133% for low-income adults (over 21) and 156% for low-income adults ages 19 and 20. (Source)
How to apply: MaineCare information and an application can be found here, or you can call 1-207-624-4168. You can also apply via the Health Insurance Marketplace.  
MarylandEligibility: Maryland elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 317% of the FPL for children, 259% for pregnant women, 123% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To apply online, visit the Maryland Health Connection online application portal or through the Health Insurance Marketplace
MassachusettsEligibility: Massachusetts elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 150% to 200% of the FPL for children (depending on age), 300% for uninsured children, 200% for pregnant women,133% for parents/caretakers, 133% for low-income adults (over 21) and 150% for low-income adults ages 19 and 20.  (Source)
How to apply: Apply online on the Massachusetts Health Connector page or you can download an Application for Health Coverage and Help Paying Costs from Mass.gov. You may also call 1-800-841-2900, or you can also apply via the Health Insurance Marketplace.  
MichiganEligibility: Michigan elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65, people with disabilities, children in foster care and those under 21 in psychiatric care.
Income requirements: To qualify for Medicaid, your MAGI must be less than 212% of the FPL for children, 195% for pregnant women, 54% for parents/caretakers and 133% for low-income adults. (Source)
How to apply:  Visit your local health department or your local DHS county office. You can also apply via the Health Insurance Marketplace.  
MinnesotaEligibility: Minnesota elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 275% to 283% of the FPL for children (depending on age), 278% for pregnant women, 133% for parents/caretakers and 200% for low-income adults. (Source)
How to apply: Learn more by visiting the Medical Assistance page. You can apply for assistance by visiting your respective page: adults, children and families, and people with disabilities.You can also apply via the Health Insurance Marketplace.  
MississippiEligibility: Mississippi Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults.  
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 194% of the FPL for children (depending on age), 209% for uninsured children, 194% for pregnant women and 23% for parents/caretakers. (Source)
How to apply: Applications for individuals over 65 and people with disabilities can be filed at your county’s Medicaid Regional Office, or you can learn more by visiting the Division of Medicaid website. You can also apply via the Health Insurance Marketplace.  
MissouriEligibility: Missouri Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include all low-income adults, although the state may offer coverage to some adults with limitations and an enrollment cap.
Income requirements: To qualify for Medicaid, your MAGI must be less than 150% to 196% of the FPL for children (depending on age), 300% for uninsured children,196% for pregnant women and 17% for parents/caretakers. (Source)
How to apply: For more information, visit the Missouri MO HealthNet website or call MO HealthNet Division at 573-751-3425. You can also apply via the Health Insurance Marketplace.  
MontanaEligibility: Montana elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 143% of the FPL for children, 261% for uninsured children, 157% for pregnant women, 24% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: For questions or application instructions, read more about Montana Medicaid or call 1-800-362-8312. You can also apply via the Health Insurance Marketplace.  
NebraskaEligibility: Nebraska Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults.  
Income requirements: To qualify for Medicaid, your MAGI must be less than 213% of the FPL for children,194% for pregnant women and 58% for parents/caretakers. (Source)
How to apply: To apply online for the Nebraska Medical Assistance Program, apply via ACCESSNebraska or download an application and return it to your local Department of Health and Human Services office. You can also apply via the Health Insurance Marketplace.  
NevadaEligibility: Nevada elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 160% of the FPL for children (depending on age), 200% for uninsured children, 160% for pregnant women, 31% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To learn more, visit the Nevada Department of Health and Human Services website. For adults over 65, you can call the Nevada Division of Aging’s Elder Care Help Line to speak to an elder rights advocate at 1-800-307-4444. You can also apply through the Health Insurance Marketplace
New HampshireEligibility: New Hampshire elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 318% of the FPL for children, 196% for pregnant women, 64% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: For more information, visit the New Hampshire Medicaid page or call 1-800-852-3345. You can also apply through the Health Insurance Marketplace
New JerseyEligibility: New Jersey elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 142% to 194% of the FPL for children (depending on age), 350% for uninsured children, 194% for pregnant women, 30% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To apply, visit the online application portal, or download an application and get more information at the Apply for NJ FamilyCare page. Also, you can visit your nearest County Welfare Agency or apply through the Health Insurance Marketplace
New MexicoEligibility: New Mexico elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 240% to 300% of the FPL for children (depending on age), 250% for pregnant women, 43% for parents/caretakers and133% for low-income adults. (Source)
How to apply: To apply online, go to the YES New Mexico online application portal or visit the Health Insurance Marketplace. For additional information visit the Medicaid page, Basic Health Program page or the Apply for Benefits page. 
New YorkEligibility: New York elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 149% to 218% of the FPL for children (depending on age), 400% for uninsured children, 218% for pregnant women, 133% for parents/caretakers and 200% for low-income adults. (Source)
How to apply: You can apply at your local department of social services, online at the New York State of Health website or online at the Health Insurance Marketplace
North CarolinaEligibility: North Carolina Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65, including long-term care residents and some Medicare recipients. The state did not vote to expand coverage to include low-income adults, although the state does cover some adults ages 19 and 20. An eligibility summary is located on this webpage
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 210% of the FPL for children (depending on age), 211% for uninsured children ages 6 to 19, 196% for pregnant women, 42% for parents/caretakers and 42% for low-income adults ages 19 and 20. (Source)
How to apply: Application directions can be found on the Medicaid Primary Care Providers page, but you can also apply at your local department of social services or call the NC CARE-LINE service at 1-800-662-7030. You can also apply through the Health Insurance Marketplace
North DakotaEligibility: North Dakota elected to expand its Medicaid program to include low-income adults, as well as children (up to age 21), pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 147% of the FPL for children (depending on age), 170% for uninsured children, 147% for pregnant women, 50% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: For information and applications, visit the North Dakota Medicaid website, or contact your local County Social Service office. You can also apply through the Health Insurance Marketplace
OhioEligibility: Ohio elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 206% of the FPL for children, 200% for pregnant women, 90% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To learn more, visit the Ohio Department of Medicaid home page, and for application information, visit the GetCoverage page. You can also apply through the Health Insurance Marketplace
OklahomaEligibility: Oklahoma Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults.  
Income requirements: To qualify for Medicaid, your MAGI must be less than 205% of the FPL for children,133% for pregnant women and 39% for parents/caretakers. (Source)
How to apply: For more information, visit Health Related and Medical Services or contact your local DHS County Office. You can download an application from the OKDHS website. You can also apply through the Health Insurance Marketplace
OregonEligibility: Oregon elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 185% of the FPL for children (depending on age), 300% for uninsured children, 185% for pregnant women, 38% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To apply for the Oregon Health Plan, you can apply online at Oregon.gov, get applications from local DHS branches, on outreach sites and at the OHP Application Center at 1-800-359-9517. For adults over 65 and people with disabilities, applications are available from DHS offices for Adults and People with Disabilities or the local Area Agency on Aging. You can also apply through the Health Insurance Marketplace
PennsylvaniaEligibility: Pennsylvania elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 215% of the FPL for children (depending on age), 314% for uninsured children; 215% for pregnant women, 33% for parents/caretakers, 33% and 133% for low-income adults. (Source)
How to apply: To apply online, visit the COMPASS online application portal. To download an application and learn more about how to apply, visit the Health Care/Medical Assistance site. You can also apply through the Health Insurance Marketplace
Rhode IslandEligibility: Rhode Island elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 261% of the FPL for children,190% for pregnant women,116% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To apply, visit the Forms & Applications page on the Executive Office of Health & Human Services of the State of Rhode Island website, or call at 401-462-5300. You can also apply through the Health Insurance Marketplace
South CarolinaEligibility: South Carolina Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults.  
Income requirements: To qualify for Medicaid, your MAGI must be less than 208% of the FPL for children, 194% for pregnant women and 62% for parents/caretakers. (Source)
How to apply: To apply online, visit the South Carolina Healthy Connections online application portal or get more information from the Getting Started page. You can also apply through the Health Insurance Marketplace
South DakotaEligibility: South Dakota Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults.
Income requirements: To qualify for Medicaid, your MAGI must be less than 182% for children, 204% for uninsured children, 133% for pregnant women and 54% for parents/caretakers. (Source)
How to apply: For more information on South Dakota’s Medical Assistance for Low-Income Families (LIF) program, call 1-800-305-3064, visit your local Department of Social Services Office or visit the South Dakota Department of Social Services website. You can also apply via the Health Insurance Marketplace.
TennesseeEligibility: Tennessee Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 195% of the FPL for children (depending on age), 250% for uninsured children, 195% for pregnant women and 98% for parents/caretakers. (Source)
How to apply: For more information, visit the TennCare website. You can also apply through the Health Insurance Marketplace.
TexasEligibility: Texas Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 198% of the FPL for children (depending on age), 201% for uninsured children,198% for pregnant women and 15% for parents/caretakers. (Source)
How to apply: To learn more, visit the Texas Medicaid website or call the Texas Medicaid hotline at 1-900-252-8263. You can also apply through the Health Insurance Marketplace
UtahEligibility: Utah elected to expand its Medicaid program to include some low-income adults (with limitations on eligibility and an enrollment cap), as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 139% of the FPL for children (depending on age), 200% for uninsured children, 139% for pregnant women, 42% for parents/caretakers and 95% for the low-income adults who qualify. (Source)
How to apply: Visit Utah Medicaid to learn more or call Utah Medicaid at 1-800-662-9651. You can also apply through the Health Insurance Marketplace
VermontEligibility: Vermont elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 312% of the FPL for children, 208% for pregnant women, 52% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: To learn more, please visit the Vermont Medicaid page or contact your local office on the Economic Service Division (ESD) page. You can also apply through the Health Insurance Marketplace
VirginiaEligibility: Virginia elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 143% of the FPL for children, 200% for uninsured children, 143% for pregnant women, 47% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: Individuals or families may apply for Medicaid online or through its local Department of Social Services. Those who are adults over 65, blind or people with disabilities may apply online by using CommonHelp. Download a paper application to be mailed or delivered in person to the local Social Services office. You can also apply through the Health Insurance Marketplace
WashingtonEligibility: Washington elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 210% of the FPL for children, 312% for uninsured children,193% for pregnant women, 40% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: For more information, visit the Washington Medicaid website or call customer service at 1-800-562-3022. You can also apply via the Health Insurance Marketplace
West VirginiaEligibility: West Virginia elected to expand its Medicaid program to include low-income adults, as well as children, pregnant women, parents/caretakers, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 158% of the FPL for children (depending on age), 300% for uninsured children, 158% for pregnant women, 18% for parents/caretakers and 133% for low-income adults. (Source)
How to apply: Visit the West Virginia Medicaid website for more information. You can apply online or find out if you’re eligible by visiting the inROADS website, or by contacting your local Bureau for Children and Families county office. You can also apply via the Health Insurance Marketplace
WisconsinEligibility: Wisconsin elected to expand its Medicaid program to include some low-income adults and some parents/caretakers (with limitations on eligibility and an enrollment cap), as well as children, pregnant women, adults over 65 and people with disabilities.
Income requirements: To qualify for Medicaid, your MAGI must be less than 151% to 301% of the FPL for children (depending on age), 301% for uninsured children, 301% for pregnant women, 95% for eligible parents/caretakers and 95% for eligible low-income adults. (Source)
How to apply: Apply online via the Wisconsin.gov Access application portal, download an application on the ForwardHealth Program Resources page or call 1-800-362-3002. You can also apply via the Health Insurance Marketplace
Wyoming Eligibility: Wyoming Medicaid covers children, pregnant women, parents/caretakers, people with disabilities and adults over 65. The state did not vote to expand coverage to include low-income adults.  
Income requirements: To qualify for Medicaid, your MAGI must be less than 133% to 154% of the FPL for children (depending on age), 200% for uninsured children, 154% for pregnant women and 52% for parents/caretakers. (Source)
How to apply: To apply online, visit the Wyoming Eligibility System, request an application over the phone by calling 1-855-294-2127 or apply through the Health Insurance Marketplace. For more information, visit the Wyoming Medicaid website. 

What if you don’t qualify?

If you apply and discover you do not qualify for Medicaid, you do have the right to appeal within your state. You may appeal if you believe there were erroneous actions taken by the state agency or if the state did not act with reasonable promptness. More information on how to appeal in your state should be provided in the Letter of Eligibility notice you receive. 

You also have other health insurance options. Depending on your income level, you may qualify for substantial government subsidies towards health insurance premiums via the Health Insurance Marketplace. These subsidies could result in your premium being more affordable or even free. 

The Affordable Care Act (ACA) of 2010 expanded Medicaid to include individuals ages 19 through 64 at or below 133% FPL. However, you may find yourself to be one of the two million low-income adults who are not able to get healthcare coverage because your state did not choose to expand their Medicaid coverage. In these cases, you fall into what’s called the “coverage gap.” This means your income is too high to qualify for Medicaid, but it is also too low to be eligible for the premium tax credits through the Marketplace. 

Unfortunately, those in the Medicaid coverage gap are limited in their options for affordable health care, and most will go uninsured. If you fall in this coverage gap, here are some alternate ways you can receive discounted medical care:

  • Most states and communities have income-based clinics that charge on a sliding scale, which can make doctor visits affordable. Your local health department may offer such services. 
  • There are many prescription savings programs and cards, such as GoodRx, SingleCare, and Pharmacy Checker, which can help offset the cost of prescription medicines. (Always try to get the generic brand, if possible, to help save.)
  • In the case of hospitalization or surgery, most hospitals have a charitable financial assistance program that can cover half or even all of your outstanding medical bills. 
  • If you have the chance to open a Flexible Spending Account (FSA) through your employer, it is well worth it to set aside even $100 per pay period to go towards this account for your future medical needs. 
  • It may be more affordable (albeit temporary) to purchase a short-term catastrophic plan through private insurance companies like Aflac, Progressive or USAA. 

Bottom line

Medicaid is a vital service for millions of Americans who cannot afford health insurance on their own. If you are low-income, expecting a child, have a child, have a disability or are over the age of 65, it is worth applying to see if you qualify for coverage. There is no penalty for applying — it’s as easy as checking a box on the Health Insurance Marketplace application. In this current health crisis with COVID-19, it’s especially important for everyone to seek assistance and get health care coverage if eligible.