Medicaid may be able to access depends on your income, household size, age, and whether you are pregnant, disabled, or caring for children

Medicaid is run by each state, so the rules that matter for you depend on where you live. Your state decides who can join based on income limits, family size, and life circumstances. Some states cover more people than others — a single adult with the same income might may have access to in one state and not in another.

The main categories are: children, pregnant people, parents or caretakers of children, people over 65, and people who are blind or disabled. Your state may also have expanded Medicaid to cover more working-age adults, or it may not. Income thresholds vary by state and change yearly.

To know whether you meet your state's rules, you need three pieces of information: your household income for the past month or year (depending on what your state checks), the number of people in your household, and which category you fall into. This article walks through how each of these works.

Key Takeaways

  • Medicaid income limits are set by your state and change every year, so a limit that applied last year may not explore this year.
  • Your household size includes you, your spouse if you are married, and your children under 19 (or 21 in some states), even if they do not live with you.
  • Some states have expanded Medicaid to cover adults earning up to 138 percent of the federal poverty level, while others have not.
  • Pregnancy, disability, blindness, age 65 or older, and caring for children are separate pathways that may have different income limits than general adult coverage.
  • Your state's Medicaid office or a local health department can tell you the exact income limit that applies to your situation right now.

How your state sets income limits

Each state Medicaid program publishes its own income limits. These are usually expressed as a percentage of the federal poverty level — for example, 138 percent or 200 percent. The federal poverty level itself changes every year, so state limits shift upward each January.

Some states use a simpler method: they set a flat dollar amount for each household size. Either way, your state publishes these numbers on its Medicaid website, usually in a table organized by household size and category (children, pregnant people, disabled adults, and so on).

The income limit for a single adult is different from the limit for a parent with two children. A parent with two children has a higher limit because the household is larger. Your state's table shows the limit for each combination.

What counts as your household income

Medicaid counts income differently than the IRS does. Your household income for Medicaid purposes usually means the gross income of everyone in your household before taxes or deductions. This includes wages, self-employment income, Social Security, unemployment benefits, and child support you receive.

Some income does not count. Supplemental Security Income (SSI) is usually not counted. Food stamps and housing information do not count. Child support you pay out is not subtracted. Your state may have other rules about what to include or exclude, so check your state's Medicaid website or call your state Medicaid office to be sure.

If you are self-employed, Medicaid counts your net income — what you earn after business expenses. If you are unemployed, Medicaid counts unemployment benefits as income. If you receive a pension or retirement income, that counts too.

Who is in your household for Medicaid purposes

Your household for Medicaid includes you, your spouse if you are married, and your children under age 19 (or under 21 in some states). It does not matter whether your children live with you — Medicaid counts them as part of your household if they are your biological or legally adopted children.

If you are a parent living with your own parent, your parent is not part of your household for Medicaid purposes. If you are an adult living with a roommate, the roommate is not part of your household. Medicaid only counts people related to you by blood, marriage, or legal adoption.

If you are pregnant, Medicaid counts only you and your spouse (if married) in your household size, not the pregnancy itself. Once the baby is born, the baby becomes part of your household.

Income limits for different categories

Medicaid has separate income limits for different groups. A child may have a higher income limit than a working-age adult in the same state. A pregnant person may have a different limit than a parent. A person over 65 may have a different limit than a younger disabled person.

Most states have expanded Medicaid to cover working-age adults with income up to 138 percent of the federal poverty level. As of 2024, that is roughly $1,810 per month for a single adult, though this amount changes yearly. Some states have not expanded Medicaid, so working-age adults without children, disability, or pregnancy may not be covered at any income level.

Children often have higher income limits than adults. A state might cover children up to 200 percent of poverty but adults only up to 138 percent. Pregnant people usually have the same limit as parents or sometimes higher. Your state's website lists the specific limit for each group.

Special rules for disabled and blind individuals

If you are blind or disabled, you may be covered under Medicaid even if your income is above the limit for working-age adults. Many states use the SSI income limit for blind and disabled people, which is higher than the general adult limit. You do not have to receive SSI to use this limit — you just have to meet the definition of blind or disabled that your state uses.

Disability for Medicaid purposes is defined by the Social Security Administration. You do not have to have a Social Security Disability Insurance (SSDI) award to count as disabled for Medicaid. Your state Medicaid office can tell you whether your condition meets the definition.

If you are over 65, you may be covered under a different set of rules. Many states cover people 65 and older with higher income limits than working-age adults. Some states cover all people 65 and older regardless of income.

How to find your state's specific rules

Your state Medicaid program publishes its income limits and rules on its official website. The website is usually called "[Your State] Medicaid" or "[Your State] Department of Health and Human Services." You can also call your state Medicaid office directly — the phone number is on the website.

If you do not know your state's website, you can search "Medicaid" plus your state name, or you can visit the federal Centers for Medicare and Medicaid Services (CMS) website, which has links to every state program. CMS also publishes a national summary of income limits by state, updated yearly.

Your local health department or a community health center can also tell you the income limit for your situation. Many of these offices help people understand whether they may be covered and how to move forward.

Frequently Asked Questions

Does my income have to be below the poverty line to get Medicaid?

No. Most states cover people with income well above the poverty line. Many states cover people up to 138 percent of poverty, and some cover higher. The exact limit depends on your state and your category — whether you are a child, pregnant, a parent, disabled, or over 65.

If I work part-time, does Medicaid count my gross pay or what I take home?

Medicaid counts your gross income — what you earn before taxes and deductions. If you earn $2,000 gross per month but take home $1,600 after taxes, Medicaid counts $2,000. Self-employment income is counted as net income after business expenses.

Does my spouse's income count if we are married but file taxes separately?

Yes. For Medicaid, your spouse's income counts as part of your household income whether you file taxes together or separately. Medicaid does not follow tax filing rules — it counts all income of everyone in your household.

What if my income changes every month because I work irregular hours?

Your state Medicaid program will ask for income from a recent period — usually the past month or the past three months, depending on the state. If your income varies, bring recent pay stubs or tax documents showing what you typically earn. Some states average your income over several months.

Can I be covered if I am unemployed and have no income?

Yes, if you fall into a covered category. Children, pregnant people, parents of young children, people over 65, and people who are blind or disabled may be covered with zero income. Working-age adults without children or disability may not be covered in states that have not expanded Medicaid, even with no income.