Am I eligible for Medicaid?
Eligibility isn't one rule — it's at least four different doorways. Find your door, then read the page for that door. I'll route you; the pathway page does the math.
Dr. Ed Weir, PhD · 20 years inside Social Security · "Former" Sergeant, USMC
Updated April 2026
Am I eligible for Medicaid?
Am I eligible for Medicaid? Probably yes if you fit one of four doorways: working-age adult under sixty-five with low income (MAGI), senior or disabled adult on a fixed income (ABD), someone needing long-term care (LTC), or a child or pregnant person (CHIP/family). Each doorway has its own rules. Find yours, then read the pathway page.
When you're not sure where to start with Medicaid
Free help finding what you may qualify for
You don't have to figure this out alone. Your state Medicaid agency runs the official screener for your state. Two-one-one (United Way) connects you to local social services and walks you through which programs you may qualify for — Medicaid, SNAP, LIHEAP, all under one phone call. If a parent or someone you're helping is sixty-five or older, your local Area Agency on Aging is the senior-focused door. All free.
Here's what to do, in 4 steps.
I built this as a four-step routing exercise. Identify which doorway, run a quick screener, apply if there's any chance you might qualify, and lean on free help when the rules confuse you. Most people who say they 'make too much' for Medicaid haven't actually checked.
1. Find your eligibility doorway
Are you working-age (under 65), 65+, disabled, pregnant, a parent, or in need of long-term care? Each of those routes you to a different Medicaid pathway. Identify the doorway first — the per-pathway page does the math.
Medicaid.gov eligibility hub ›2. Use Healthcare.gov or your state's screener
Healthcare.gov runs the basic MAGI Medicaid screener for working-age adults and routes you to your state. For ABD or long-term-care pathways, your state Medicaid agency's screener is more accurate — the federal site doesn't model state-specific asset rules.
Healthcare.gov Medicaid & CHIP ›3. Apply if there's any chance — don't pre-disqualify yourself
Most people who think they make 'too much' are wrong. State variation is huge. Working adults qualify in expansion states up to 138% of poverty. Apply if you're close — the worst that happens is denial, and a denial gives you a written reason you can appeal or use to find the right pathway.
4. Free help: 2-1-1, your state agency, or your Area Agency on Aging
If you don't know which pathway applies, 2-1-1 (United Way) connects you to your state's social services. SHIP at helps if Medicare is in the mix (dual-eligible territory). Your local Area Agency on Aging handles senior pathways. All free, all no-strings.
Find your local 2-1-1 ›The numbers behind the four doorways
Which of these sounds more like you?
Eligibility splits into doorways. Pick the situation closest to yours and the card will tell you which pathway page to read next. If none fit cleanly, the last card asks you to tell me what's specific.
I'm working but my income is lowMAGI pathway — may qualify in expansion states
If you're under 65 and working a low-wage job, MAGI Medicaid is your doorway. In expansion states, the income limit reaches 138% of poverty — around $20,800 a year for one person, around $35,600 for a household of three at the 2026 federal poverty guideline. There's no asset test on this pathway. The IRS-style MAGI calculation is what counts (your wages plus a few adjustments), not what's in your bank account.
In non-expansion states the limit drops dramatically — often parent-only with very low income thresholds. If you're in a non-expansion state and just above the cutoff, look at the Marketplace with subsidies as the bridge.
What I saw at SSA was — most people who said 'I make too much for Medicaid' had never looked at the actual limit. Expansion states reach 138% of poverty. That's higher than most people guess.
I'm 65+ and on a fixed incomeABD pathway — different rules, asset limits matter
Once you turn 65, you leave the MAGI doorway and enter Aged, Blind, and Disabled (ABD) Medicaid. Two big differences: (1) income limits are typically tied to SSI rules — lower than MAGI; (2) asset limits matter. The federal floor for SSI-linked Medicaid is $2,000 for an individual and $3,000 for a couple, though many states use higher limits.
Your state matters a lot here. In '1634 states' (about 32 states plus DC), if you qualify for SSI you automatically get Medicaid. In '209(b) states,' rules can be stricter than SSI. In 'criteria-only states,' you apply for Medicaid separately even if you have SSI. The ABD pathway also has dual-eligible coordination if you also have Medicare.
The senior pathway has asset limits that surprise people. Talk to your state Medicaid agency or your local Area Agency on Aging before assuming you don't qualify — home, one car, and household goods are usually exempt.
I'm disabled but not on SSDI or SSI yetDisability pathway — separate door from SSI/SSDI
ABD Medicaid has a disability doorway distinct from SSI or SSDI. Some states use SSI's medical disability standard for the determination, even without you actually receiving SSI cash benefits. Some states have 'medically needy' programs that let you 'spend down' medical bills to qualify even if your income is above the standard cutoff.
If you're on SSDI and your income is low enough, you may qualify for both Medicare and Medicaid (dual-eligible). Working-disabled buy-in programs exist in many states under Section 1619(b) of the Social Security Act — these let you keep Medicaid while working at higher income levels. Apply through your state Medicaid agency.
I'm pregnantPregnancy Medicaid — higher income limits
Pregnancy Medicaid is its own income window. Many states extend coverage up to 200% of poverty or higher — some go beyond 300% — because the federal government allows states to set the limit higher for pregnant individuals than for other adults. There's no asset test on this pathway.
In states that have adopted the 12-month postpartum coverage extension (most have), your Medicaid keeps running for 12 months after birth. Apply through your state Medicaid agency or Healthcare.gov. Don't wait — prenatal care matters from the first trimester.
My parent needs long-term careLTC Medicaid — its own world of rules
Long-term care Medicaid is the most complex of the four doorways. Different income rules. Different asset rules. A 5-year look-back on asset transfers. Spousal-impoverishment protections that let a 'community spouse' keep a portion of the assets. State-specific home-equity caps. And estate recovery rules that can come back at the estate after death.
This is the doorway where the rules can hurt you if you don't know them. Don't transfer assets without legal guidance — a transfer in the wrong window can disqualify your parent for years. Talk to an elder-law attorney before doing anything.
Long-term care Medicaid involves asset planning, look-back rules, spousal protections, and huge state variation. Talk to an elder-law attorney before you transfer assets. NAELA (naela.org) has a 'find an attorney' tool.
I have kids and want them coveredKids' Medicaid + CHIP — higher limits
Kids almost always have higher income limits than adults. In most states, children up to 200% of poverty qualify for Medicaid; CHIP picks up where Medicaid leaves off, typically running up to 250%, 300%, or even 400% of poverty depending on the state.
In most states, the same agency runs Medicaid and CHIP, and one application covers both. If your household income is above the adult Medicaid cutoff but below the kids' line, your kids may qualify even when you don't. Check Healthcare.gov or your state Medicaid agency — same screener, same application.
I'm helping someone figure out which pathwayBystander — start by identifying the situation
If you're helping a parent or partner figure out if they qualify, here's the route-finding sequence I use:
1. Age. Under 65 is MAGI territory. 65+ is ABD. (A disability under 65 routes to ABD too.)
2. Disability status. If they're disabled — even without SSDI or SSI — there's an ABD pathway. Some states use SSI's medical standard for the determination.
3. Long-term care need. If they need a nursing home or in-home help (HCBS waiver), LTC Medicaid is its own world — talk to an elder-law attorney before transferring assets.
4. Income and assets. Get a rough number. Don't pre-disqualify them — most people guess wrong.
5. State. Pull up your state Medicaid agency website or call 2-1-1.
If they're on Medicare and you're on the dual-eligible track, SHIP () is your free helper — trained counselors who handle Medicare-Medicaid coordination. Bring documents: ID, proof of income, list of assets, citizenship/immigration status, household composition.
My situation isn't covered aboveTell me what's specific about it
Medicaid eligibility has more sub-pathways than fit on one page — medically needy, working-disabled buy-in, breast and cervical cancer treatment program, former foster youth coverage, refugee medical assistance, Emergency Medicaid for non-qualified immigrants, and more. If your situation doesn't match the six cards above, you're not alone, and a denial isn't the end.
Start with your state Medicaid agency. Ask: 'What pathways do I qualify under in this state?' Then call 2-1-1 (United Way) for help walking through the application. Legal Aid in your state can help if you've been denied and think the denial was wrong. Email me at the bottom of this page — I'll add your situation to the next version of this guide.
If your doorway isn't here, send me what's specific. I update this page when readers tell me what's missing.
Programs Medicaid often travels with
Medicaid rarely shows up alone. People who qualify for Medicaid frequently qualify for SSI, SNAP, LIHEAP, and (for those sixty-five plus) Medicare Savings Programs. If you're applying for one, ask about the others — many states use a combined application.
SSI (Supplemental Security Income)
If you're disabled or 65+ with very low income and resources, you may qualify for SSI — and SSI gives automatic Medicaid in 32 states plus DC ('1634 states') the moment SSI is approved.
SSDI (Social Security Disability Insurance)
If you've been on SSDI for 24+ months you may qualify for Medicare. Combined with low income and assets, you may qualify for both Medicare and Medicaid (dual-eligible) and have most cost-sharing covered.
Marketplace (ACA) coverage with subsidies
If your income is just above Medicaid limits, you may qualify for Marketplace insurance with premium tax credits at Healthcare.gov — the bridge for non-expansion-state coverage gaps.
SNAP (Food Benefits)
Most Medicaid recipients also may qualify for SNAP. Many states use a combined application that screens for both at once — ask when you apply.
LIHEAP (Energy Bill Help)
Energy bill help is available for low-income households. Income limits often align with or exceed Medicaid — if you qualify for one, ask about the other.
Medicare Savings Programs (MSP)
If you're on Medicare AND your income qualifies, MSPs (QMB, SLMB, QI) pay your Part B premium and — at the QMB level — your Medicare cost-sharing too. Run by your state Medicaid agency.
Everything people ask me
How do I know if I'm eligible for Medicaid?
Eligibility isn't one rule — it's at least four different doorways. Working-age adults under 65 go through MAGI Medicaid (income-based, no asset test). Seniors 65+ and disabled adults go through ABD Medicaid (income plus assets). People who need long-term care go through LTC Medicaid (asset rules and a 5-year look-back). Kids and pregnant people have their own higher-limit pathways. Find your doorway, then read the page for that pathway.
Do I make too much for Medicaid?
Probably less than you think. MAGI Medicaid in expansion states reaches 138% of federal poverty — about $20,800 a year for one person, around $35,600 for a household of three at 2026 federal poverty guidelines. Pregnancy Medicaid and CHIP go higher (200%+ of poverty in many states). Even ABD pathways for seniors often have higher income limits than people assume. Apply if you're close — the worst that happens is denial.
Do I have too many assets for Medicaid?
Depends on the pathway. MAGI Medicaid (working-age, income-based) has NO asset test — only income matters. ABD pathways (65+ or disabled) DO have asset limits — the federal floor for SSI-linked Medicaid is $2,000 individual and $3,000 couple, but many states use higher limits. LTC Medicaid has the most complex asset rules including a 5-year look-back. Your home, one car, and household goods are usually exempt across all pathways.
Does my home count against me?
For most Medicaid pathways, your primary residence is exempt up to a state-specific home-equity limit. For LTC Medicaid, additional rules apply if you're institutionalized — your community spouse can usually keep the home, but estate recovery may apply later under federal law. Talk to your state Medicaid agency or an elder-law attorney for LTC-specific situations — the rules vary by state and the stakes are big.
What if I work? Can I still qualify?
Yes. MAGI Medicaid is specifically designed for low-wage working adults — in expansion states, the limit is 138% of poverty. Some states also have working-disabled 'buy-in' programs (under Section 1619(b) of the Social Security Act and similar state provisions) that let disabled adults work and keep Medicaid up to higher income limits. Working doesn't disqualify you — your income level does.
Do I have to be a U.S. citizen?
Not always. U.S. citizens and certain 'qualified non-citizens' (lawful permanent residents, refugees, asylees, others) can qualify, though most lawful permanent residents have a 5-year waiting period after entry before they can enroll in full Medicaid — the 'five-year bar.' States have the option to waive this for children and pregnant people in lawfully-present categories. Emergency Medicaid covers emergency medical care for non-qualified immigrants regardless of status, under federal law.
I'm 65+ — does Medicare disqualify me from Medicaid?
No. About 12 million Americans are dual-eligible — they have both Medicare and Medicaid. The Medicaid pathway changes (you go through ABD non-MAGI rather than MAGI), but Medicare doesn't disqualify you. If your income qualifies, Medicare Savings Programs may also pay your Part B premium and Medicare cost-sharing.
I was denied Medicaid — what now?
Two paths. First, appeal the denial through your state's fair hearing process — federal regulations at 42 CFR Part 431 Subpart E require states to provide one. Deadlines are short (typically 30 to 90 days), so act fast and read the denial letter carefully. Second, if your situation changes (income drops, life event), reapply — eligibility isn't permanent. Free legal help is available through Legal Aid in most states, and a denial letter spells out the reason, which often points to the right pathway you didn't apply under.
Why does my state matter so much?
Federal Medicaid law sets a floor — states can go beyond it, and many do. States choose: whether to adopt the ACA expansion (40+ have, the rest haven't), whether to offer optional pathways like medically needy or working-disabled buy-in, what asset limits to apply within federal bounds, and what services to cover beyond the federal mandatory list. Two people with identical situations can get very different answers in different states. Always check your state Medicaid agency's specific rules.
Where do I check my state's specific rules?
Three free resources, in this order. First, your state's Medicaid agency website — Medicaid.gov has a state directory linking to all 50 states plus DC. Second, Healthcare.gov runs the basic MAGI screener for working-age adults and routes to your state. Third, 2-1-1 (United Way) and your local Area Agency on Aging are person-on-the-phone help and walk you through which programs you may qualify for in your specific situation.
Sources
Every figure and rule on this page is verified against primary sources. Last verified 2026-04-28.
- ABD non-MAGI Medicaid pathways apply both income and asset limits. The federal asset floor for SSI-linked Medicaid is $2,000 for an individual and $3,000 for a couple, established under SSI rules at … —ssa.gov(verified 2026-04-28)
- SSI recipients receive Medicaid automatically in 34 states plus DC ('1634 states') when SSI is approved, under agreements between SSA and the state Medicaid agency authorized by Section 1634 of the … —secure.ssa.gov(verified 2026-04-28)
- Working-disabled adults can keep Medicaid in many states under Section 1619(b) of the Social Security Act and similar state buy-in provisions, with state-specific income thresholds typically up to … —ssa.gov(verified 2026-04-28)
- MAGI Medicaid uses the Modified Adjusted Gross Income calculation defined under federal tax law, with rules for household composition adapted from IRC § 36B and applied to Medicaid by 42 CFR § … —ecfr.gov(verified 2026-04-28)
- The ACA Medicaid expansion raised the income limit for working-age adults to 138% of the federal poverty level (effective) in expansion states. The statutory floor is 133% of FPL at 42 USC … —ecfr.gov(verified 2026-04-28)
- MAGI Medicaid has no asset test — only Modified Adjusted Gross Income matters for working-age adults under that pathway, per 42 CFR § 435.603(g). —ecfr.gov(verified 2026-04-28)
- Federal Medicaid regulations governing eligibility are codified at 42 CFR Part 435 (Eligibility in the States, District of Columbia, the Northern Mariana Islands, and American Samoa). —ecfr.gov(verified 2026-04-28)
- A primary residence is generally exempt from Medicaid asset calculations up to a state-specific home-equity limit (federal floor and ceiling set in 42 USC 1396p(f)). One vehicle and household goods … —ecfr.gov(verified 2026-04-28)
- Federal law requires every state Medicaid program to provide 'fair hearing' appeal rights for applicants and recipients, codified at 42 CFR Part 431 Subpart E. States must provide written notice of … —ecfr.gov(verified 2026-04-28)
- Medicaid has at least four major eligibility pathways: MAGI Medicaid for working-age adults, ABD (Aged, Blind, Disabled) non-MAGI Medicaid for seniors and disabled adults, long-term care Medicaid for … —medicaid.gov(verified 2026-04-28)
- As of 2026, more than 40 states plus the District of Columbia have adopted ACA Medicaid expansion. (Verify current count against Medicaid.gov state directory before publication.) —medicaid.gov(verified 2026-04-28)
- Most lawful permanent residents must wait 5 years after entry before they can enroll in full Medicaid (the 'five-year bar' under PRWORA, 8 USC 1613). States have the option under Section 214 of CHIPRA … —medicaid.gov(verified 2026-04-28)
- Emergency Medicaid covers emergency medical care for non-qualified immigrants regardless of immigration status, per 42 USC 1396b(v). —uscode.house.gov(verified 2026-04-28)
- Pregnancy Medicaid often has higher income limits than other adult Medicaid pathways — typically up to 200% of poverty or higher in most states (with some exceeding 300%). Most states have adopted the … —medicaid.gov(verified 2026-04-28)
- Children in households up to 200-400% of federal poverty (state variation) qualify for Medicaid or CHIP. CHIP is authorized at 42 USC 1397aa et seq. (Title XXI of the Social Security Act) and picks up … —law.cornell.edu(verified 2026-04-28)
Helping someone figure out which Medicaid doorway?
If you're helping a parent or partner figure out if they qualify, start with their age — under sixty-five versus sixty-five-plus is the first fork. Then disability status. Then income. The four pathways are mostly age-plus-disability-plus-income gates. Your state Medicaid agency, two-one-one, or (for seniors) the local Area Agency on Aging are your best free helpers.
→ Get help for someone elseHelp me keep it.
Eligibility rules shift — federal poverty guidelines update yearly, states change their pathway options, and pandemic-era flexibilities have been winding down. Drop your email and I'll send you the changes when they happen.
No spam. Just rule changes that affect your Medicaid eligibility.