Health · guide
Medicaid eligibility: the conditions besides income
Income gets the attention, but residency, immigration status, age and the makeup of the household decide just as often.
Checked by Radif Partners · Editorial policy · How we calculate
To get Medicaid you need four things at once: to live in the state where you apply, to have a qualifying citizenship or immigration status, to belong to a coverage group (child, pregnant woman, parent, adult in an expansion state, older or disabled person), and to have income under that group's line, $1,835 a month for a single adult in the 41 expansion jurisdictions in 2026. MAGI groups have no asset test. The 2025 budget law, Public Law 119-21, changes several of these conditions on fixed dates. From October 1, 2026, federal Medicaid money pays only for citizens and nationals, green card holders, Cuban and Haitian entrants and citizens of the Compact of Free Association countries, apart from emergency care. From January 1, 2027, adults in the expansion group renew every 6 months instead of once a year, must meet a 80-hour community engagement rule, and new applicants get coverage back only 1 month before the application. Copays for expansion adults above poverty follow on October 1, 2028.
Which federal Medicaid line applies to you?
Adult expansion line
Under it
| Your income | 120% of the 2026 guideline |
| 138% line, per month | $1,835 |
| 2026 guideline for 1 | $15,960 |
Where you live and what your papers say
Medicaid is run by each state, so you apply where you live, not where you work. Residency is also written into the 2025 law: from October 1, 2026, section 71109 of Public Law 119-21 lets the federal government pay a state only for people who reside in one of the 50 states, DC or a territory and who are in one of four categories. Those categories are citizens and nationals of the United States, aliens lawfully admitted for permanent residence (green card holders), Cuban and Haitian entrants, and people lawfully residing under a Compact of Free Association with Micronesia, the Marshall Islands or Palau. The same rule applies to CHIP.
Two exceptions survive. Treatment of an emergency medical condition stays covered for people who meet every other condition but not the status test, as HealthCare.gov describes for lawfully present immigrants; from the same date the federal share for that care is held to the state's regular matching rate (section 71110). And a state option for lawfully residing children and pregnant women remains, with HealthCare.gov noting that states may waive the 5-year wait for them. Refugees, asylees and other lawfully present people who have not become permanent residents fall outside federal Medicaid funding from October 2026. Each status is compared across SNAP, Medicaid and Marketplace help in benefits for immigrants.
Your group decides the income line
Medicaid tests income group by group. The MAGI groups, the ones in the CMS table of state levels, are infants, children 1 to 5, children 6 to 18, pregnant women, parents and caretaker relatives, and in the expansion states, adults 19 to 64. Federal law requires every state to cover children and pregnant women up to at least 133% of poverty, 138% once the disregard is counted, which is $4,803 a month for a child in a family of three in 2026. Most states go well beyond it. Parents in states without expansion are covered only up to a state standard, sometimes a small fraction of the poverty line. The mini-calculator above shows where your household stands against these federal lines; the Medicaid income limits page applies the exact level of your state.
Anyone entitled to Medicare Part A or enrolled in Part B is outside the expansion group, which is defined for adults under 65 who are not pregnant and not otherwise eligible under the state plan. Age 65 and over, blindness, disability and the need for nursing-home or home-based long-term care open other pathways that do not use MAGI at all, as 42 CFR 435.603(j) sets out. Those pathways have their own income rules and, usually, a limit on savings and property, and the 2025 law revises the home equity limit used for long-term care starting January 1, 2028 (section 71108). This site does not model those tests; the state agency applies them.
Who is in your Medicaid household
MAGI rules build the household from the tax return. A taxpayer who is not claimed by anyone forms a household with every person he or she expects to claim as a dependent. A person who is claimed as a dependent is generally counted in the household of the taxpayer who claims him or her, with exceptions for some relatives and for children of divorced or separated parents. People who neither file nor are claimed are counted with the spouse, the children under 19 (or under 21 if full-time students) and, for a young person, the parents and siblings who live with them. The regulation lists every case.
Two practical consequences follow. A pregnant woman counts herself plus each baby she expects, so a woman living alone is a household of two, which raises her income line. And income that MAGI leaves out never enters the test: scholarships used for education, certain American Indian and Alaska Native payments, and SSI. A lump sum counts only in the month it arrives. Non-taxable Social Security benefits, on the other hand, are added back.
Renewals, back coverage and work rules from 2027
Four changes from the 2025 law target adults in the expansion group, the 19- to 64-year-olds covered up to 138% of poverty because their state adopted the ACA expansion:
- Renewals every 6 months. Section 71107 requires a new eligibility check twice a year for renewals scheduled on or after January 1, 2027, the first day of the first quarter after December 31, 2026. The rule also covers people enrolled through a waiver with equivalent coverage. Indians and Urban Indians are exempt.
- Less back coverage. Medicaid traditionally paid for care received in the three months before the month of application. For applications made from January 1, 2027, section 71112 limits it to the month before for expansion adults and to the two months before for all other groups. CHIP back coverage, where a state offers it, may not reach further than the second month before the application either.
- Community engagement. From the same date, or earlier if the state chooses, expansion adults aged 19 to 64 must show 80 hours a month of work, community service, a work program or half-time education, unless an exemption applies. The rule, its exemptions and the income alternative are explained in Medicaid work requirements.
- Copays. From October 1, 2028, expansion adults above the poverty line will pay cost sharing set by the state, capped per service and at 5% of family income, with primary care and mental health exempt (section 71120).
None of these four applies to children, to pregnant women or to people covered through age or disability. In a state without expansion they mostly do not apply at all, because the group does not exist there, except for adults covered by a waiver that mirrors it.
How to apply
Apply with your state's Medicaid agency. Many states use their own name for the program: Medi-Cal in California, AHCCCS in Arizona, TennCare in Tennessee, Apple Health in Washington, MassHealth in Massachusetts and Oregon Health Plan in Oregon. Each state page gives the name, the agency and the link to apply, and shows the CHIP program that covers children above the Medicaid line. Keep pay stubs or a recent tax return, proof of address and immigration documents at hand, since the agency verifies what you declare. A denial comes with a written notice and the right to a fair hearing.
If your income is above the Medicaid line, the next option is a Marketplace plan with the premium tax credit; the ACA subsidy calculator gives the 2026 amount. In the 10 states that did not expand Medicaid, adults below the poverty line can end up with neither, a situation described in Medicaid expansion states.