Can my family qualify for Medicaid?
If you're caring for kids — your own, a grandchild, a niece, a sibling — there's a Medicaid pathway built specifically for parents and caretaker relatives. It's called Section 1931, and it's been quietly carrying low-income families since 1996. In some states it's the main door. In others it sits behind MAGI Medicaid expansion.
Dr. Ed Weir, PhD · 20 years inside Social Security · "Former" Sergeant, USMC
Updated April 2026
Can my family qualify for Medicaid?
Yes, your family may qualify for Medicaid through the parents-and-caretaker-relatives pathway under Section 1931 of the Social Security Act. In expansion states, parents and caretaker relatives qualify up to one hundred thirty-eight percent of poverty under MAGI rules. In non-expansion states, the limits are usually much lower — sometimes near zero to fifty percent of poverty — but children almost always qualify even when parents do not.
When the eligibility rules feel confusing
Free help finding what you may qualify for
Family Medicaid rules vary state-to-state more than almost any other benefit. Your state Medicaid agency, the United Way's 2-1-1 line, and hospital social workers can walk a family through the right door without charging a dime. They will tell you whether the kids fit children's Medicaid, whether the adults fit Section 1931 or MAGI, and whether CHIP picks up where Medicaid leaves off.
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.
1. 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.
MAGI worksheet on Healthcare.gov ›2. 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.
Healthcare.gov application ›3. 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.
CHIP eligibility info ›4. 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.
Find local help via 2-1-1 ›What I tell families about the family-Medicaid pathway
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.
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've seen grandparents skip applying because they think they make too much, when the rule actually looks at THEIR income, not what the missing parent makes. Apply. Don't assume you're over.
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.
Don't get caught by this — in non-expansion states, parent Medicaid limits can be under 20% of poverty. If you're between the state limit and 100% FPL, you're in the coverage gap and Marketplace subsidies don't start until 100% FPL.
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.
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 a flashlight, not a courtroom. If you fall in the gap and your kids qualify but you don't, work the Marketplace subsidies and the children's coverage in parallel. Talk to a navigator or a community-health-center social worker.
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.
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.
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.
Sources
Every figure and rule on this page is verified against primary sources. Last verified 2026-04-28.
- Federal regulations governing parent and caretaker-relative Medicaid eligibility are at 42 CFR § 435.110 ("Parents and other caretaker relatives"). The regulation implements sections 1931(b) and (d) … —ecfr.gov(verified 2026-04-28)
- The minimum income standard for Section 1931 eligibility is the State's AFDC income standard in effect as of May 1, 1988 for the applicable family size, converted to a MAGI-equivalent standard. —ecfr.gov(verified 2026-04-28)
- The maximum Section 1931 income standard is the higher of (i) the state's effective income level for Section 1931 low-income families as of March 23, 2010 or December 31, 2013, MAGI-converted, or (ii) … —ecfr.gov(verified 2026-04-28)
- Caretaker relatives include parents, grandparents, aunts, uncles, siblings, and other specified relatives who serve as the primary caregiver of a child under 18 (or under 19 if still in high school) … —ecfr.gov(verified 2026-04-28)
- Pregnant women have a separate Medicaid income standard from parents and caretaker relatives. The federal statutory floor is 133% FPL under 42 USC § 1396a(l)(2)(A)(i), implemented at 42 CFR § … —ecfr.gov(verified 2026-04-28)
- Two-parent households can both qualify for parent and caretaker-relative Medicaid if combined family income is below the state's eligibility limit, since both adults living with the child and … —ecfr.gov(verified 2026-04-28)
- Family Medicaid renewals must be processed annually using ex parte (administrative) renewal first, where states attempt to renew eligibility based on existing data sources before requiring the family … —ecfr.gov(verified 2026-04-28)
- Section 1931 of the Social Security Act (added by Public Law 104-193, August 22, 1996) preserved Medicaid eligibility for low-income families with children at AFDC-era standards when AFDC was replaced … —uscode.house.gov(verified 2026-04-28)
- In Medicaid expansion states, parents and caretaker relatives may qualify under MAGI Medicaid expansion at incomes up to 138% of the federal poverty level. —medicaid.gov(verified 2026-04-28)
- In non-expansion states, parent and caretaker-relative Medicaid limits are often very low — typically between 0% and 50% of the federal poverty level for adults, depending on the state's pre-2014 … —medicaid.gov(verified 2026-04-28)
- Children's Medicaid eligibility is determined separately from parents' eligibility, and children typically qualify at much higher income limits (200%-300% of poverty depending on the state) than … —medicaid.gov(verified 2026-04-28)
- CHIP (the Children's Health Insurance Program) covers children whose family income is above Medicaid's children's limit but below the state's CHIP ceiling — typically 200% to 400% of poverty across … —medicaid.gov(verified 2026-04-28)
- Section 1931 eligibility uses the MAGI tax-household construct: the filer, the filer's spouse, and tax-claimed dependents. Stepchildren and adopted children are treated as dependent children for … —medicaid.gov(verified 2026-04-28)
- Combined Medicaid + SNAP applications are common in most states; many state agencies operate a unified application that screens both programs simultaneously, reducing duplicate paperwork for families. —medicaid.gov(verified 2026-04-28)
- CHIP is administered by the same state agency as Medicaid in most states, and the Healthcare.gov / state-exchange application screens for Medicaid, CHIP, and Marketplace subsidies in a single … —medicaid.gov(verified 2026-04-28)
Helping a relative apply for family Medicaid?
Helping a parent or relative apply for family Medicaid? You'll want their household income, who lives in the home, ages of all the kids, and any other coverage they have right now. The application asks for everyone in the tax household, not just the people on the application.
Get help for someone elseHelp 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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