Medicaid is the federal and state health insurance program for people with limited income and resources. It covers a wide range of medical services at little or no cost, including doctor visits, hospital care, prescriptions, mental health services, and preventive care. More than 80 million Americans are enrolled, but estimates consistently find that several million more people are eligible and not enrolled, often because they do not realize they qualify or do not know how to apply.
How income eligibility works
Medicaid eligibility is based primarily on household income relative to the federal poverty level (FPL). Under the Affordable Care Act, states that adopted the Medicaid expansion cover adults with incomes up to 138 percent of the FPL — which in 2024 was about $20,120 for a single individual or $34,300 for a family of three. States that did not expand Medicaid have narrower eligibility criteria, often with much lower income thresholds, and some do not cover adults without children at all. The rules vary meaningfully by state.
Check your state expansion status first
As of 2024, the majority of states have adopted the Medicaid expansion, but not all. If you live in a state that has not expanded, and you are an adult without children, you may fall into a coverage gap where your income is too high for traditional Medicaid but too low to qualify for Marketplace subsidies. Healthcare.gov lists which states have expanded and what the income limits are for your state.
Other factors beyond income
Income is the primary factor, but Medicaid also considers household size, citizenship or immigration status, and in some states, assets. Pregnant women, children, people with disabilities, and people over 65 often have different and sometimes more generous eligibility rules than the general adult population. CHIP, the Children's Health Insurance Program, covers children in families whose income is too high for Medicaid but who cannot afford private insurance, with income limits that reach higher than Medicaid in most states.
How to apply
You can apply for Medicaid through healthcare.gov, which will route your application to your state Medicaid agency if you qualify, or directly through your state Medicaid website. You can also apply in person at your local Department of Social Services, or call 211 for help connecting with your local enrollment office. Coverage can be retroactive in many states, meaning that if you have medical bills from the past 90 days and then enroll, those may be covered.
If you are denied, you can appeal
If your application is denied, you have the right to appeal. The denial notice must explain the reason and provide instructions for how to appeal. Common denial reasons include income calculation errors, missing documentation, or category eligibility questions that can be resolved with additional information. A legal aid organization in your area may be able to help with an appeal at no cost.