What I tell families about the family-Medicaid pathway
Here's what to do, in 4 steps.
Here is how I would walk a family through this. Pull together your household, your income, and a clear-eyed sense of who in your house is a child versus an adult under the rules. Then pick the right door — Healthcare.gov for MAGI screening, or your state Medicaid agency for the Section 1931 pathway.
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Add up your family's monthly MAGI
Pull together everyone in your tax household: you, your spouse, and any tax dependents. Add up their gross monthly income before deductions. That total is your MAGI for Medicaid screening. If you have not filed taxes recently, your state can still take an application — bring whatever pay stubs or benefit statements you have.
Time: 20 minutes Cost: Free MAGI worksheet on Healthcare.gov
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Apply through Healthcare.gov or your state Medicaid agency
Healthcare.gov screens your whole family for Medicaid, CHIP, and Marketplace subsidies in one application — they hand off to your state if you qualify. If your state runs its own exchange, apply there instead. Either way, you can also walk into your state Medicaid office or call them directly under the parents-and-caretaker-relatives pathway.
Time: 30-45 minutes Cost: Free Healthcare.gov application
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If income is just above the limit, screen for CHIP
Children's income limits run higher than adults' — usually two hundred to four hundred percent of poverty depending on the state. If your family income is too high for parent Medicaid but not by much, the kids almost certainly qualify for CHIP. The Healthcare.gov application screens for both at once; you do not have to apply twice.
Time: Same application Cost: Free CHIP eligibility info
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Get free help — 2-1-1, state agency, hospital social worker
The United Way's 2-1-1 line connects you to local enrollment help in every state. Hospital social workers know the rules cold, especially for pregnant women and kids. Your state Medicaid agency has navigators on staff. None of them charge — and a navigator who knows your state will catch eligibility doors I can't see from here.
Time: Same day Cost: Free Find local help via 2-1-1
Dr. Ed explains family Medicaid
Video coming soon
I'm filming this one. Family Medicaid rules carry more state variation than almost anything else I cover, so I want to walk through it carefully and show you what to look for in your state.
Which of these sounds more like you?
Family Medicaid covers a lot of ground. The pathway looks different depending on whether you are a single parent, a grandparent raising grandkids, a two-parent household, or a relative caregiver. Here are the most common situations.
I have kids and we're below the poverty lineSingle, married, working, not working — doesn't matter if income is low enough
If your household income is below the federal poverty level and you have kids in the home, you almost certainly qualify for family Medicaid — in any state. The kids qualify through children's Medicaid (which goes much higher than the adult limits anyway). The adults qualify through Section 1931 in non-expansion states or MAGI expansion in expansion states.
Apply through Healthcare.gov — it screens everyone in your tax household at once and routes the application to your state for finalization.
If you're above poverty but below 138% FPL, see the next card.
I'm a single parentOne adult plus kids — most common family Medicaid case
Single-parent households are the most common Section 1931 case. The pathway was built for you. Your tax household for Medicaid includes you and your tax-dependent children. Income is your gross monthly earnings plus any other taxable income.
In expansion states, you may qualify up to 138% of poverty. In non-expansion states the limit is much lower for adults, but the kids almost always qualify regardless. Apply once through Healthcare.gov and let it screen everyone.
I'm raising my grandkidsCaretaker-relative pathway uses YOUR income, not the parents'
Grandparents, aunts, uncles, siblings, and other specified relatives raising children count as caretaker relatives under 42 CFR 435.110. The Medicaid eligibility test uses your household income, not the absent parents' income. That's the door a lot of families don't realize is open.
If you claim the grandkids as tax dependents, they're in your tax household for MAGI Medicaid. If you don't, the kids may have their own eligibility determined separately on a child-only basis. Either way — apply.
I'm in a non-expansion state — am I covered?Section 1931 limits in non-expansion states can be brutally low for adults
If you're in a non-expansion state, your Section 1931 limit may sit between zero and fifty percent of poverty for adults — depending on the state. Some states cap it under twenty percent. That's the famous "coverage gap."
The kids are almost always still covered through children's Medicaid or CHIP, which goes much higher. But adults in the gap often have to fall back on Marketplace coverage with subsidies (which start at 100% FPL) or no coverage at all. Call your state Medicaid agency and ask for the parent/caretaker income limit — the answer is wildly state-specific.
I'm pregnant — does that change things?Yes. Pregnancy Medicaid runs at much higher income limits.
Pregnancy Medicaid uses a different (and much higher) income standard than parent Medicaid. Federal floor is 138% of poverty; many states go to 200% or higher. The unborn child also typically counts as a household member, which raises your effective limit further.
Apply specifically as pregnant. The application asks. Coverage usually starts immediately and runs through pregnancy plus 12 months postpartum in states that adopted the postpartum extension.
Pregnancy Medicaid has its own page — see pregnancy-medicaid. See pregnancy Medicaid
My kids qualify but I don'tChildren's Medicaid limits run much higher than adults' — this is normal
This split is more common than people realize. Children's Medicaid eligibility runs higher — typically 200%-300% of poverty by state — plus CHIP picks up between Medicaid and roughly 200%-400% FPL. Adult MAGI Medicaid runs at 138% in expansion states and much lower in non-expansion states.
You apply once for the family; the state determines each member separately under the right pathway. Your kids' coverage is not contingent on your eligibility.
I'm helping a relative figure out family MedicaidWhat you'll need to help them apply
Helping a sibling, parent, or in-law apply for family Medicaid? You'll need their household income (gross monthly), who lives in the home, ages of all kids, current insurance for everyone, and their tax-filing status. Healthcare.gov asks for everyone in the tax household, not just the people who need coverage.
You can be on the call or in the room with them — most state Medicaid agencies allow authorized representatives to help with the application. The 2-1-1 line and hospital social workers do this for free.
My situation is more complicated than thisMixed-status, foster, kinship care, divorce, deportation — talk to a navigator
Family Medicaid has more rule branches than I can fit on one page. Mixed-immigration-status households, foster children, kinship care arrangements, divorced parents splitting custody, deportation cases, household members with disabilities — each has its own quirks under the rules.
The move here is: don't guess. Call your state Medicaid agency, the 2-1-1 line, or a hospital social worker. A free navigator who works your state every day will see doors I can't see from here.
Everything families ask me
Can my family qualify for Medicaid?
Yes — if your household income is below your state's limit and you have a child living with you, your family may qualify under the parents-and-caretaker-relatives pathway (Section 1931 of the Social Security Act). In expansion states the limit is 138% of the federal poverty level. In non-expansion states the limit for adults is much lower, often between 0 and 50% of poverty, but children almost always qualify even when adults don't.
What's a "caretaker relative"?
Under 42 CFR 435.4 and 435.110, a caretaker relative is the parent, grandparent, aunt, uncle, sibling, or other specified relative who is the primary caregiver for a child under 18 (or under 19 if still in high school) living in the home. The pathway uses the caretaker's income, not the absent parents' income.
What's Section 1931?
Section 1931 of the Social Security Act (added by Public Law 104-193, signed August 22, 1996) preserved Medicaid eligibility for low-income families with children at the AFDC standards in place when welfare reform replaced AFDC with TANF. Without Section 1931, the elimination of AFDC would have stripped these families of Medicaid. The Affordable Care Act preserved Section 1931, and 42 CFR 435.110 implements it today.
Are stepchildren and adopted kids covered?
Yes. Under MAGI Medicaid rules, stepchildren and adopted children are treated as dependent children if they live in your household and you provide care. They count in your household for both income limit calculation and eligibility determination. Foster children have their own Medicaid pathway (see Title IV-E foster care Medicaid) and do not need to be on the family application.
What if I'm a grandparent raising my grandkids?
You qualify under the caretaker-relative pathway. Your income — not the absent parents' income — is what counts for eligibility. If you claim the grandkids as tax dependents, they're in your tax household for MAGI Medicaid; if you don't claim them, the kids may have their own eligibility determined separately on a child-only basis. Either way, apply.
What if my kids qualify but I don't?
This is normal and common. Children's Medicaid limits run much higher than adult limits — typically 200%-300% of poverty by state, plus CHIP picks up between Medicaid and roughly 200%-400% FPL. Adult MAGI Medicaid is 138% in expansion states, lower in non-expansion. You apply once for the whole family; the state determines each member separately. Your kids' coverage is not contingent on your eligibility.
What's the income limit for family Medicaid?
It depends on your state and your household size. In expansion states, parents and caretaker relatives qualify up to 138% of the federal poverty level under MAGI. In non-expansion states, the Section 1931 limit for adults can range from under 20% to about 50% of FPL. Children's limits run higher — 200% to 300%+ across states — and CHIP picks up above that. Use Healthcare.gov to screen, or call your state Medicaid agency for the exact figure.
Can two parents both qualify?
Yes. If your combined family income is below the state limit, both parents in a two-parent household may qualify under the parents-and-caretaker-relatives pathway. The income test uses the full tax household, and both adults are considered caretaker relatives if they live with the child and provide care.
What if we're in a non-expansion state?
Non-expansion states use the older Section 1931 income limits for adults, which can sit between 0% and 50% of poverty. Some states cap parent eligibility under 20% FPL. Children's Medicaid and CHIP still cover kids at much higher limits. Adults whose income lands above the state limit but below 100% FPL are in the "coverage gap" — too rich for Medicaid, too poor for Marketplace subsidies (which start at 100% FPL).
Where do we apply?
Three doors: (1) Healthcare.gov (or your state's exchange) screens your whole family at once for Medicaid, CHIP, and Marketplace subsidies; (2) your state Medicaid agency directly — most have online applications; (3) the United Way's 2-1-1 line connects you to local enrollment help. Hospital social workers, federally qualified health centers, and community navigators can all help you apply for free.
What else your family may qualify for
Most families that qualify for Medicaid also qualify for at least one of the other programs below. I have watched families miss out on hundreds of dollars a month in food and energy help because nobody told them they could apply at the same time.
CHIP (Children's Health Insurance Program)
If your family income is too high for children's Medicaid, your kids may qualify for CHIP — typically 200% to 400% of poverty, depending on the state. Same application as Medicaid.
Pregnancy Medicaid
If you or someone in your household is pregnant, you may qualify under pregnancy Medicaid — which runs at much higher income limits than parent Medicaid. Coverage typically extends 12 months postpartum.
SNAP (food assistance)
Most families that qualify for Medicaid also qualify for SNAP. Many states accept a single combined application for both. Worth screening at the same time — SNAP averages a few hundred dollars a month per household.
WIC (Women, Infants, and Children)
If you have kids under 5 or you're pregnant, you may qualify for WIC — nutrition vouchers, infant formula, and breastfeeding support. WIC income limits typically align with Medicaid, so if you qualify for one you usually qualify for the other.
LIHEAP (energy bill help)
Most Medicaid-eligible families also qualify for LIHEAP, the federal program that helps with heating, cooling, and emergency utility bills. Apply through your state agency or 2-1-1.
Marketplace coverage with subsidies (ACA)
If your family income is above the Medicaid limit but below 400% of poverty, you may qualify for Marketplace plans with premium tax credits. In non-expansion states this is often the fallback for adults whose kids are on Medicaid.
Help me keep your family covered.
Family Medicaid rules shift state-to-state and year-to-year. Drop me your email and I'll let you know when income limits change in your state, when the renewal window opens, or when CHIP eligibility shifts.
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