Medicaid Eligibility: Common Questions Answered
Medicaid Eligibility: straight answers to the questions people actually ask, with the figures behind them.
The rules that decide who can get Medicaid, the joint federal and state program that covers people with limited income.
Key takeaways
- Run by: each state, within federal rules
- Expansion states: cover adults with income up to 138 percent of the federal poverty level
- Most useful single change: Apply through your state Medicaid agency or HealthCare.gov.
- Commonest mistake: Assuming you earn too much without checking your state's limits.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
What is Medicaid Eligibility?
The rules that decide who can get Medicaid, the joint federal and state program that covers people with limited income.
Why does it matter?
Eligibility differs by state and changes with income and life events, so many people who qualify do not realize it.
Run by for Medicaid Eligibility?
Each state, within federal rules.
Expansion states for Medicaid Eligibility?
Cover adults with income up to 138 percent of the federal poverty level.
Other groups for Medicaid Eligibility?
Children, pregnant people, older adults and people with disabilities may qualify under different rules.
When to apply for Medicaid Eligibility?
Any time of year.
What is the single most useful thing to do?
Apply through your state Medicaid agency or HealthCare.gov.
What is the most common mistake?
Assuming you earn too much without checking your state's limits.
When should I see a doctor?
If you lose Medicaid, you usually have a special enrollment period to get Marketplace coverage, so act quickly. Call 911 in an emergency; emergency rooms must screen and stabilize patients regardless of insurance.
More questions, answered
Can I have Medicaid and a job at the same time?
Yes. Many people with Medicaid work, especially in jobs that do not offer affordable health insurance. Eligibility depends on household income rather than whether you work. If your income rises, report it, since you may move to Marketplace coverage, and some states offer buy-in programs for working people with disabilities.
Does owning a home stop me from getting Medicaid?
For most children, pregnant people and adults under 65, Medicaid does not count assets at all. For long-term care and some programs for older adults or people with disabilities, your home is often excluded while you or a spouse live there, within limits. States may seek repayment from some estates after death, so get advice.
Can Medicaid pay bills from before I applied?
Many states can cover medical bills from a short period before the month you applied if you would have been eligible then. The length of this retroactive coverage varies by state and group and is changing under recent federal law. Ask about it when you apply, and keep any unpaid bills from recent months.
What is the difference between Medicaid and Medicare?
Medicare is federal health insurance mainly for people 65 and older and some people with disabilities, regardless of income. Medicaid is a joint federal and state program for people with limited income and resources. Some people qualify for both, and Medicaid can then help pay costs Medicare does not cover.
Will my Medicaid card work in another state?
Medicaid generally covers care only in the state that issued it, apart from emergencies and some other care when you are traveling. If you move, you need to apply in your new state and close your case in the old one. Coverage does not transfer automatically, so apply quickly.
Is there a cost to apply for Medicaid?
No. Applying is free, and state agencies, community health centers, hospitals and trained navigators can help you at no cost. Be cautious of anyone who charges a fee to submit an application for you, and never pay to be told whether you qualify.
Related topics
- Hospital Financial Assistance: Sorting the Evidence From the Noise (Health Insurance and Costs)
- What the Guidance Really Says About Benefits and Financial Support (Long-Term Conditions)
- What the Guidance Really Says About Practical Support for Caregivers (Carers)
- The Evidence on Diabetes and Driving, Without the Hype (Diabetes)
Where to go next
- Medicaid Eligibility, Explained Without the Jargon
- Medicaid Eligibility: The Practical To-Do List
- Medicaid Eligibility — the reference entry
- Medicare and Medicaid: The Complete Guide
- CHIP Coverage for Children: What the Evidence Actually Says
- Medicare Wellness Visits: What the Evidence Actually Says
When to speak to a doctor
If you lose Medicaid, you usually have a special enrollment period to get Marketplace coverage, so act quickly. Call 911 in an emergency; emergency rooms must screen and stabilize patients regardless of insurance.
Where this comes from
- Medicaid.gov — Eligibility
- HealthCare.gov — Medicaid & CHIP coverage
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.
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