What is Medicaid and how do you qualify?

Medicaid is a joint federal-state program that provides free or low-cost health coverage to low-income individuals and families, people with disabilities, and certain other groups. Eligibility rules vary by state, but 41 states + DC have expanded Medicaid under the ACA to cover adults up to 138% of the federal poverty level.

Medicaid is a means-tested government health insurance program administered by states with federal funding. It covers medical care at little to no cost for qualifying individuals. The Medicaid.gov eligibility overview explains who qualifies and how coverage works.

Who qualifies for Medicaid

• Low-income adults and children (income thresholds vary by state).
• In states that expanded Medicaid under the ACA: adults up to 138% of the federal poverty level (~$20,783/year for a single person in 2024).
• Pregnant women (higher income thresholds in many states).
• People age 65+ with low incomes (may also qualify for Medicare — called 'dual eligibility').
• People with disabilities who receive SSI or meet similar criteria.
• Children through CHIP at higher income thresholds in all states.

Medicaid expansion states

As of 2024, 41 states and DC have adopted ACA Medicaid expansion, covering adults earning up to 138% FPL. Ten states have not expanded; in non-expansion states, low-income adults without children may not qualify unless they meet other criteria. KFF's Medicaid expansion tracker shows current status by state.

How to apply

Apply for Medicaid year-round through your state's Medicaid agency, through HealthCare.gov (for most states), or by calling 1-800-318-2596. If you apply during Open Enrollment and appear to qualify for Medicaid, HealthCare.gov automatically routes your application to your state's program. Medicaid can often be backdated to cover services received up to 3 months before your application date in some states.

Federal sources

• Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. States administer Medicaid programs within federal guidelines. — Medicaid.gov
• Under the ACA's Medicaid expansion, states can extend Medicaid coverage to all adults under age 65 with incomes up to 138% of the federal poverty level. — Medicaid.gov

Key takeaways

• Medicaid is free or very low-cost — no monthly premiums in most states for qualifying low-income adults.
• In expansion states, adults up to 138% FPL (~$20,783 for single in 2024) qualify.
• You can apply year-round — no Open Enrollment window required.
• Non-expansion states have stricter eligibility rules — check your state's rules at Medicaid.gov.
• Use HealthCare.gov to apply; it routes you to Medicaid automatically if you appear to qualify.

Related

• What is the Affordable Care Act (ACA) and how does it work?
• What is open enrollment for health insurance?
• What is a qualifying life event and how does it affect health insurance enrollment?
• What are the health insurance options for self-employed people?

Browse all answers
More answers to common questions about financing, banking, and credit.