Income Limits: The Primary Factor

For most Medicaid programs, income is the primary eligibility factor. Income limits are expressed as a percentage of the Federal Poverty Level (FPL). In 2026, 100% FPL is approximately $15,060/year for an individual and $31,200/year for a family of four.

Under the ACA Medicaid expansion (adopted by most states), adults without dependent children can qualify with incomes up to 138% FPL — about $20,800/year for an individual. States that have not expanded Medicaid may have much lower income limits for adults.

• ACA expansion states: adults qualify up to ~138% FPL (~$20,800/year individual)
• Non-expansion states: income limits for adults may be much lower or nonexistent
• Children: typically qualify up to 200–300% FPL in most states
• Pregnant women: typically qualify up to 200% FPL or higher
• Seniors and people with disabilities: separate income rules, often higher limits

Expansion vs. Non-Expansion States

As of 2026, the vast majority of states have adopted the ACA Medicaid expansion, which extended coverage to low-income adults regardless of family status. A small number of states have not expanded, meaning adults without dependent children may not qualify for Medicaid regardless of income in those states.

If you live in a non-expansion state and don't qualify for Medicaid, you may be eligible for subsidized coverage through the ACA marketplace.

Asset Tests

Most standard Medicaid programs (for families and children) do not have asset tests — only income is considered. However, long-term care Medicaid programs (which cover nursing home and home-based care for seniors and people with disabilities) typically do have asset limits.

For long-term care Medicaid, most states limit countable assets to $2,000 for an individual. Certain assets are typically exempt: a primary home (with conditions), one vehicle, personal belongings, and some retirement accounts.

Categorical Eligibility Groups

Beyond income, Medicaid eligibility is also tied to categorical groups. Different rules apply to different populations:

• Children and families: income-based, generally more generous limits
• Pregnant women: higher income limits, coverage for pregnancy-related care
• Seniors (65+): separate income and asset rules for long-term care programs
• People with disabilities: may qualify through SSI or disability-based Medicaid
• Adults without dependents: covered in expansion states, limited in non-expansion states

Residency and Citizenship Requirements

To qualify for Medicaid, you must be a resident of the state where you are applying and a U.S. citizen or qualified immigrant. Undocumented immigrants generally do not qualify for full Medicaid, though emergency Medicaid is available for emergency medical conditions regardless of immigration status. Some states have extended coverage to additional immigrant populations using state funds.

How to Check Your State's Rules

The most reliable way to check current eligibility rules in your state is to contact your state's Medicaid agency directly or use the healthcare.gov eligibility screener. Rules change periodically, so it's worth checking even if you were denied in the past.