How Medicaid Eligibility Works
Medicaid is a joint federal-state program, which means each state sets its own eligibility rules within broad federal guidelines. This creates significant variation: a family qualifying in one state might be ineligible just across the border. The two biggest factors determining eligibility are income and whether your state expanded Medicaid under the Affordable Care Act (ACA).
ACA Medicaid Expansion Status
Under the ACA, states can expand Medicaid to cover all adults with incomes up to 138% of the Federal Poverty Level (FPL). As of 2026, 40 states plus DC have adopted expansion. The 10 non-expansion states leave a significant coverage gap — adults without children earning below 100% FPL may qualify for neither Medicaid nor ACA marketplace subsidies.
| Status | States |
|---|---|
| Expanded (40 + DC) | Including CA, NY, TX (partial), FL (pending), OH, PA, IL, and most others |
| Not expanded (10) | AL, FL, GA, KS, MS, SC, TN, TX, WI*, WY |
*Wisconsin covers adults up to 100% FPL through a waiver but has not formally adopted expansion.
2026 Federal Poverty Level Guidelines
| Household Size | 100% FPL | 138% FPL (Expansion Threshold) |
|---|---|---|
| 1 | $15,650 | $21,597 |
| 2 | $21,150 | $29,187 |
| 3 | $26,650 | $36,777 |
| 4 | $32,150 | $44,367 |
In expansion states, a single adult earning under approximately $21,597 per year qualifies for Medicaid. In non-expansion states, adults without dependent children often face much lower thresholds — sometimes as low as 17-26% FPL.
Eligibility Categories
Adults in expansion states
Income at or below 138% FPL. No asset test in most states. This is the broadest category and covers the most enrollees.
Children (CHIP)
Children are covered at higher income levels — typically 200-300% FPL depending on the state. Some states cover children up to 400% FPL through the Children's Health Insurance Program (CHIP).
Pregnant women
Covered at 138-200%+ FPL in most states, with some states extending eligibility to 300% FPL. Coverage typically begins immediately and extends through 12 months postpartum under new federal rules.
Seniors and people with disabilities
Supplemental Security Income (SSI) recipients automatically qualify in most states. Others must meet income and asset tests. Many seniors who qualify for both Medicare and Medicaid become dual eligibles with enhanced benefits.
Asset Tests
For most working-age adults in expansion states, there is no asset test — only income matters. However, seniors and people with disabilities applying for long-term care Medicaid typically face strict asset limits:
- Individual: $2,000 in countable assets (some states higher)
- Married couple: Community Spouse Resource Allowance up to $154,140 in 2026
- Exempt assets: Primary home (up to $713,000 equity in most states), one vehicle, personal belongings, burial funds
Medicaid look-back rules examine asset transfers made within 60 months before application. Gifts or transfers during this period can trigger a penalty period of ineligibility for nursing home coverage.
State-by-State Highlights
California (Medi-Cal)
Expanded Medicaid, eliminated the asset test entirely for all categories including seniors. Among the most generous programs in the country, covering dental, vision, and comprehensive mental health services.
Texas
Has not expanded Medicaid. Non-disabled adults without children do not qualify regardless of how low their income is. Parents qualify only at approximately 17% FPL (~$3,700/year for a family of 3).
New York
Expanded Medicaid with relatively generous income thresholds. Strong provider networks and comprehensive benefits including extensive home and community-based services.
How to Apply
Apply through your state's Medicaid agency website, HealthCare.gov, by phone, or in person. You will need proof of income (pay stubs, tax returns), identification, residency documentation, and Social Security number. Most states process applications within 45 days (90 days for disability-based applications). If denied, you have the right to appeal.