Medicaid is funded by the federal and state government. Federal law establishes minimum standards for eligibility, but states set their own criteria within those federal guidelines.
General Criteria
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You might be eligible for Medicaid if your income is low and you qualify as any of the following:
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- Pregnant
- Under 19
- 65 or older
- Disabled for at least one year, or with a current disability expected to last for at least one year
- An adult without dependents
Tip
In most states, if you qualify for Social Supplement Income, you automatically are eligible for Medicaid. Depending on your state, you may be able to use the same application form for both.
Income Guidelines
The United States Department of Health and Human Services issues federal poverty guidelines annually. Under federal law, states can expand their Medicaid programs to include childless or non-disabled adults who are under 65 and earn up 138 percent of the federal poverty level. Many states have implemented this expansion, but it is not mandatory. If your state expanded its program, eligibility depends only on your income and household size.
If your state did not expand its program, you may qualify for Medicaid if you earn up to 100 percent of the FPL. In that case, eligibility is based on your state's present guidelines, including age, disability, pregnancy, dependent children, income and family size.
Federal Poverty Level Percentage
To figure your FPL percentage, divide your income by the poverty guideline for your family size. For example, say there are two people in your household and your total annual household income is $18,000. Divide $18,000 by $15,930, which is the poverty guideline for a family of two as of 2015. The result is 1.13, or 113 percent of the federal poverty level.
States go by the applicant's Modified Adjusted Gross Income when determining income eligibility. Your MAGI is your adjusted gross income for federal tax purposes, plus nontaxable interest, Social Security benefits and foreign income.
Tip
If you earn more than the FLP for your household size, you can buy private insurance through the Health Insurance Marketplace. You might also qualify for premium tax credits and other savings.
Citizenship or Immigration Status
Applicants must satisfy federal and state citizenship, residency or immigration status requirements. You might be eligible for Medicaid if you are any of these:
- U.S. citizen
- Qualified alien
- Non-qualified alien
- Non-immigrant
Citizens may apply for the full scope of benefits provided under Medicaid. Qualified aliens, such as permanent residents, usually must have been a living in the country for at least five years in order to qualify for all benefits. Non-qualified aliens -- which include illegal aliens -- might only qualify for emergency coverage, as defined by state law. Non-immigrants, meaning individuals who were legally admitted into the country on a temporary basis, might qualify for emergency treatment as well.