More than 90 million Americans are enrolled in Medicaid, making it the largest health insurance program in the country. Yet millions of eligible people never apply — often because they assume they won’t qualify or don’t know where to start. In expansion states, a single adult earning under $21,597 per year qualifies, and the application takes as little as 15 minutes online.
1. Who qualifies for Medicaid
Medicaid eligibility depends on three factors: income, household size, and what state you live in. After the Affordable Care Act, 40 states plus Washington, D.C. expanded Medicaid to cover all adults with income up to 138% of the Federal Poverty Level (FPL). The remaining 10 states have more restrictive eligibility rules.
In general, these groups may qualify for Medicaid regardless of state:
- Low-income adults (in expansion states): income at or below 138% FPL
- Children: most states cover children up to 200–300% FPL through Medicaid or CHIP
- Pregnant women: typically eligible up to 200% FPL (higher in some states)
- Elderly adults (65+): may qualify based on income and asset limits
- People with disabilities: eligible through SSI or state disability criteria
- Parents and caretaker relatives: income limits vary by state
2. Income limits by family size (2026)
The table below shows the Federal Poverty Level and the Medicaid income limit (138% FPL) for expansion states. These numbers are updated annually.
| Household size | 100% FPL (annual) | 138% FPL — Medicaid limit | Monthly income limit |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $1,800 |
| 2 | $21,150 | $29,187 | $2,432 |
| 3 | $26,650 | $36,777 | $3,065 |
| 4 | $32,150 | $44,367 | $3,697 |
| 5 | $37,650 | $51,957 | $4,330 |
| 6 | $43,150 | $59,547 | $4,962 |
| 7 | $48,650 | $67,137 | $5,595 |
| 8 | $54,150 | $74,727 | $6,227 |
For each additional person beyond 8, add $5,500 to the 100% FPL figure. Note: Medicaid uses Modified Adjusted Gross Income (MAGI), which includes wages, self-employment income, Social Security benefits, and tax-exempt interest — but does not count asset values like your home or car.
3. Expansion vs. non-expansion states
Whether you qualify as a non-disabled, non-pregnant adult depends heavily on your state. As of 2026, 40 states and D.C. have expanded Medicaid.
| Status | States | Adult income limit |
|---|---|---|
| Expansion states (40 + D.C.) | AK, AZ, AR, CA, CO, CT, DE, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SD, UT, VA, VT, WA, WV, D.C. | 138% FPL ($21,597 for individual) |
| Non-expansion states (10) | AL, FL, GA, MS, SC, TN, TX, WI, WY | Varies; many cover parents only below 50% FPL and do not cover childless adults |
In non-expansion states, childless adults without a disability often fall into a “coverage gap” — they earn too much for traditional Medicaid but too little for Marketplace subsidies. If you are in this situation, check whether your state offers any limited benefit programs or see our guide on managing hospital bills without insurance.
Case study: Maria in Texas vs. Maria in California
Maria is a 34-year-old single adult earning $18,000 per year as a part-time retail worker. In California (expansion state), she qualifies for Medi-Cal with zero premiums and zero copays. In Texas (non-expansion state), she does not qualify for Medicaid because Texas does not cover childless adults regardless of income. Her only option is a Marketplace plan — but at her income, she would qualify for substantial subsidies through the ACA. The difference in coverage access is entirely determined by which state she lives in.
4. Step-by-step application process
There are four ways to apply for Medicaid. The online method is fastest, but all paths lead to the same result.
Option A: Apply online (fastest — 15 to 30 minutes)
- Go to HealthCare.gov or your state’s Medicaid website. HealthCare.gov will route you to Medicaid if your income qualifies.
- Create an account with your name, email, and a password.
- Fill out the application. You’ll answer questions about household size, income, citizenship, and current coverage.
- Submit supporting documents (see checklist below). Many states verify income electronically, so you may not need to upload anything.
- Submit and wait. You’ll receive a confirmation number. Most states process applications within 45 days.
Option B: Apply by phone
Call the Health Insurance Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325). Agents can complete the application over the phone. You can also call your state’s Medicaid agency directly — search “[your state] Medicaid application phone number.”
Option C: Apply in person
Visit your local Department of Social Services, community health center, or a certified application counselor. Bring all documents listed below. In-person help is especially useful if you have a complicated situation (disability, mixed-immigration household, etc.).
Option D: Apply by mail
Download the paper application from your state Medicaid website or request one by phone. Fill it out, attach copies (not originals) of required documents, and mail to your state agency. This is the slowest method — allow extra time for postal delivery.
5. Documents you need
Gather these before you start the application to avoid delays:
| Category | Accepted documents |
|---|---|
| Identity | Driver’s license, state ID, passport, or birth certificate |
| Citizenship/immigration status | U.S. birth certificate, passport, naturalization certificate, or immigration documents (green card, work permit) |
| Social Security number | Social Security card or a document showing your SSN |
| Income proof | Recent pay stubs (last 30 days), tax return, W-2, self-employment records, Social Security award letter, unemployment benefits letter |
| Household information | Names, dates of birth, and SSNs for everyone in your household |
| Current insurance | Insurance card or policy number (if you have any current coverage) |
| Pregnancy verification | Doctor’s note or medical record confirming pregnancy and due date (if applicable) |
| Disability documentation | SSI award letter, doctor’s statements, or disability determination (if applying based on disability) |
What if you don’t have all documents? Submit the application anyway. Most states will give you 30 to 90 days to provide missing documents after submission. Do not delay applying because you’re missing one item.
6. What Medicaid covers
Medicaid is one of the most comprehensive health insurance programs available. Federal law requires every state to cover these mandatory benefits:
- Inpatient and outpatient hospital services
- Doctor and physician visits
- Laboratory and X-ray services
- Nursing facility services (for adults 21+)
- Home health services
- Prescription drugs
- Family planning services and supplies
- Federally qualified health center and rural health clinic services
- Pediatric and family nurse practitioner services
- Emergency services, including emergency room visits
- Transportation to medical appointments (non-emergency medical transportation)
Many states also cover these optional benefits:
- Dental care (comprehensive adult dental in ~35 states)
- Vision and eyeglasses
- Hearing aids
- Physical, occupational, and speech therapy
- Mental health and substance use disorder treatment
- Chiropractic services
- Durable medical equipment (wheelchairs, oxygen, etc.)
- Hospice care
7. Special situations
Pregnant women
Every state covers pregnant women with income up to at least 138% FPL, and many states set the limit higher — up to 200% or even 300% FPL. Medicaid for pregnant women covers all prenatal care, labor and delivery, postpartum care (typically 12 months after delivery), and care for the newborn. You can apply at any time during pregnancy; there is no enrollment period.
Children and CHIP
Children qualify for Medicaid at higher income levels than adults. If your child’s income exceeds the Medicaid limit, they may qualify for the Children’s Health Insurance Program (CHIP), which covers children in families earning up to 200–300% FPL depending on the state. CHIP applications are processed alongside Medicaid — apply once and your child will be enrolled in whichever program they qualify for.
Elderly adults (65+)
Seniors with low income may qualify for Medicaid in addition to Medicare. “Dual eligibility” means Medicaid can pay your Medicare premiums, deductibles, and copays, and cover services Medicare doesn’t (like long-term nursing home care and dental). Programs like the Medicare Savings Program (MSP) and Qualified Medicare Beneficiary (QMB) program help seniors with income up to 135% FPL.
People with disabilities
If you receive Supplemental Security Income (SSI), you automatically qualify for Medicaid in most states. If you have a disability but don’t receive SSI, you may still qualify through your state’s Medicaid program — the application process takes up to 90 days instead of the standard 45 because disability determinations require medical review.
Retroactive coverage
Medicaid can cover medical expenses from up to 3 months before your application date, provided you would have been eligible during that time. This is critical if you have outstanding hospital bills. When you apply, tell your caseworker about any unpaid medical expenses from the prior 3 months so they can apply retroactive coverage.
Case study: Retroactive coverage saves $14,200
James, a 28-year-old in Ohio, was hospitalized after a car accident in January. He had no insurance and received a $14,200 bill. In March, a hospital financial counselor helped him apply for Medicaid. Because Ohio is an expansion state and James earned $19,000 per year, he qualified. Medicaid applied retroactive coverage to the January hospitalization, and the entire bill was covered. James paid $0 out of pocket.
8. What to do if you’re denied
If your Medicaid application is denied, you have the right to appeal. Here is the process:
- Read the denial letter carefully. It will state the specific reason for denial (income too high, missing documentation, citizenship issue, etc.) and the deadline to appeal (typically 30 to 90 days).
- File an appeal immediately. Do not wait. Send a written appeal to the address listed in the denial letter. Most states also allow you to appeal online or by phone.
- Gather supporting evidence. If denied for income, provide updated pay stubs or a letter from your employer showing reduced hours. If denied for missing documents, submit them with your appeal.
- Request a fair hearing. You are entitled to a hearing before an impartial officer. At the hearing, you can present evidence and explain your situation.
- Get help. Contact your state’s Legal Aid office, a certified application counselor, or a community health center navigator. These services are free and can dramatically improve your chances of winning an appeal.
Common reasons for denial and how to respond:
| Denial reason | What to do |
|---|---|
| Income too high | Verify the income figure used. If incorrect, provide updated documentation. If correct, check if you qualify for a Marketplace plan with subsidies. |
| Missing documents | Submit the missing documents with your appeal. Call to confirm receipt. |
| Citizenship/immigration issue | Provide additional documentation. Lawful permanent residents who have been in the U.S. for 5+ years qualify. Undocumented immigrants may qualify for emergency Medicaid only. |
| Already covered by other insurance | Clarify that having other coverage does not always disqualify you. Medicaid can serve as secondary insurance. |
| Did not respond to request for information | Explain that you did not receive the request (if true) and provide the information now. |
If you are dealing with medical bills while waiting for Medicaid approval, ask your hospital about financial assistance programs and request that they pause collections until your Medicaid determination is complete. Most hospitals will honor this request.
Frequently asked questions
How long does it take to get approved for Medicaid?
Most Medicaid applications are processed within 45 days. If you are applying based on a disability, states have up to 90 days to make a determination. In many expansion states, online applications with electronic income verification can be approved in as little as 24 to 72 hours. You can check your application status through your state’s Medicaid portal or by calling the state agency directly.
What income is too high for Medicaid?
In the 40 Medicaid expansion states (plus D.C.), adults can qualify with household income up to 138% of the Federal Poverty Level — $21,597 per year for a single person or $44,367 for a family of four in 2026. Children qualify at higher levels (typically 200–300% FPL), and pregnant women often qualify up to 200% FPL. In the 10 non-expansion states, income limits for non-disabled adults are much lower and vary by state.
Can I get Medicaid if I have a job?
Yes. Medicaid eligibility is based on income, not employment status. Many Medicaid enrollees work part-time or full-time in low-wage jobs that either do not offer health insurance or offer plans they cannot afford. If your household income falls below your state’s Medicaid threshold, you can qualify regardless of whether you are employed.
Does Medicaid cover dental, vision, and prescriptions?
Medicaid covers prescriptions in every state. Dental and vision coverage varies: most states provide at least emergency dental for adults, and about 35 states offer comprehensive adult dental benefits. All states must cover dental, vision, and hearing for children under the EPSDT benefit. Check your state’s plan for specifics.
Can Medicaid cover bills I already received?
Yes. Medicaid offers retroactive coverage for up to 3 months before your application date, as long as you would have been eligible during that period and had medical expenses. This means if you received a hospital bill two months ago and then enrolled in Medicaid, the program can pay for those services retroactively. Ask your caseworker about retroactive eligibility when you apply.