Do I Qualify for Medicaid? An Overview

Do I Qualify for Medicaid? An Overview

Medical expenses are some of the most debilitating bills many of us deal with. Something as common as the flu or breaking a bone could land you thousands of dollars in debt, especially if you don’t have health insurance. For many people living on low incomes, Medicaid is a great way to get the care they need without breaking the bank.

If you struggle to pay your medical bills, you may find yourself wondering, “Do I qualify for Medicaid?” Read on to learn more about this program and what goes into determining who may get this aid.

Overall Eligibility Requirements

Before we dive into specific Medicaid requirements, there are a few overall requirements you must meet. First, you must be a resident of the state in which you’re applying for the program. You also have to be either a citizen or a qualified non-citizen of the United States.

Each state has its own requirements for Medicaid eligibility which can vary from place to place. For instance, in some states, you may need to meet certain age requirements. You may also have to meet pregnancy or parenting status requirements in order to qualify.


In most cases, the biggest factor that will determine your eligibility for Medicaid is your income. When the Affordable Care Act was passed, it established a new methodology for determining if someone qualifies for aid. This method uses your Modified Adjusted Gross Income, or MAGI, to decide your eligibility.

The MAGI process takes a look, not only at your taxable income, but also at various tax relationships to determine eligibility. For example, if you’re still supporting a child, you may be able to qualify for Medicaid even with a slightly higher income. This method takes into account the fact that you’re still paying for that child and so don’t have as much income to dedicate to healthcare expenses.

Social Security Income Eligibility

If you’re ad adult over the age of 65, your eligibility for Medicaid may not be based on your MAGI. Instead, the government will take a look at information they already have – your Social Security income. This prevents you from having to input a whole new set of numbers, especially when your income may be primarily from the government anyway.

Each state’s eligibility requirements for Medicaid will be different. In fact, some states prefer to use stricter criteria than the SSI criteria in order to limit the number of eligible applicants. You’ll need to check your state requirements to determine if you qualify for this particular aid program.

Other Program Enrollment

Oftentimes, people who apply for Medicaid also qualify for other government-sponsored aid programs. This may include everything from CHIP and SSI to the breast and cervical cancer treatment and prevention program. There are also some youth-focused programs, including the foster care program, that can qualify young people for Medicaid.

Household Size

Aside from your income, the next big factor impacting your Medicaid eligibility is your household size. A household of two people making $100,000 a year may be doing just fine financially. However, a household of eight people trying to live on the same income might struggle to pay even basic bills.

As with income and Social Security eligibility, the household size qualification requirements for Medicaid vary from state to state. Certain states that are expanding Medicaid may have recently changed their requirements. Check the site for your state’s current chart regarding income and household size eligibility requirements.


Although Medicaid is primarily aimed at people who are in financial need, some people living with a disability may also qualify. Oftentimes, these requirements will overlap, since many disabilities prevent people from working good-paying, full-time jobs. In particular, your state may have a “medically needy” program for people whose medical issues cost more than they can reasonably afford.

In order to be medically needy, you must spend a certain amount of your income on medical expenses that you can’t get covered by health insurance. If you spend enough that your remaining income drops below the threshold for Medicaid eligibility, you can qualify for the program. There are also specific programs tailored towards the blind and disabled adults over the age of 65.

Family Status

There are also some family status factors that may come into play in some states when determining Medicaid eligibility. In most cases, these rules apply to children living in the household and who has custody over them. For instance, any infant born to a parent who qualifies for Medicaid will automatically qualify for Medicaid care for their first year of life in some states.

If a non-parent is caring for a child but doesn’t have legal custody of them, they may not be able to enroll that child in the Medicaid program. Their own eligibility may also not take into account the fact that they’re caring for that child. Check your state’s specific requirements to see the rules on family status qualifications in your area.

Answer “Do I Qualify For Medicaid?”

The question, “Do I qualify for Medicaid?” unfortunately doesn’t have one solid answer. Eligibility requirements vary from state to state, and there are a lot of factors that go into determining whether you qualify. You’ll need to read up on your state’s specific rules to determine if you meet all the necessary criteria to get this aid.

If you’d like to find more help getting the medical care you need, check out the rest of our site at We know finding the right plan can be difficult, but we summarize all the key info for you. Check out our Affordable Care Act plans and start getting healthcare for as little as $30 a month.