With such broad coverage, Medicaid is vital for millions of Americans who depend on the program to access necessary healthcare services. Wondering how to get Medicaid? Head to the next slide to learn about the eligibility criteria and program requirements.

Medicaid eligibility can vary depending on where you live, as the program is a partnership between the federal government and individual states. While federal guidelines set a foundation for eligibility, each state can adjust its requirements based on local needs. 

Here’s how Medicaid eligibility is generally broken down:

Federal Requirements

At the federal level, Medicaid is designed to provide healthcare for low-income individuals and families, but eligibility is based on several core factors:

1. Income Level: Medicaid is income-based, meaning your household income must be below a certain percentage of the Federal Poverty Level (FPL) to qualify. For many states, this is set at 138% of the FPL. Federal guidelines serve as a baseline for income limits, but each state can adjust the specific percentage.
2. Priority Groups: Federal guidelines require states to offer Medicaid to certain groups, including:
   • Low-income children (through Medicaid and the Children’s Health Insurance Program, or CHIP).
   • Pregnant women in low-income households.
   • Seniors and individuals with disabilities who may need long-term care or specific medical services.
3. Automatic Eligibility for SSI Recipients: Individuals receiving Supplemental Security Income (SSI) are eligible for Medicaid in 35 states.

State-Specific Requirements

While federal guidelines offer a basic structure, each state has the flexibility to expand or limit Medicaid coverage. This leads to different eligibility requirements across the country. Here’s a breakdown of how some states adjust their requirements:

1. Medicaid Expansion States: States that opted to expand Medicaid under the ACA offer coverage to more low-income adults, regardless of whether they fall into traditional Medicaid categories. Adults aged 19-64 can qualify in these states if their income is below 138% of the FPL. This opens Medicaid eligibility to individuals without dependents, helping more people access healthcare.
2. Non-Expansion States: In states that did not expand Medicaid, eligibility is often limited to traditional groups, such as:

• Seniors
• Children
• Individuals with dependents
• People with disabilities

This means low-income adults without children or disabilities might not qualify for Medicaid in these states, even if their income is below the poverty line. As of 2024, non-Medicaid expansion states include the following:

• Alabama
• Florida
• Georgia
• Kansas
• Mississippi
• South Carolina
• Tennessee
• Texas
• Wisconsin
• Wyoming

3. Other State-Specific Factors: Some states have additional criteria for Medicaid eligibility, such as:

• Asset limits: Certain states consider an individual’s assets, such as savings and property, when determining eligibility.

Special programs: States may have specific Medicaid programs for high-needs populations, such as those requiring long-term care or specialized medical services.