Key takeaways:
Medicaid is the joint federal-state health insurance program for people with low incomes.
You must be a resident of the state or territory to apply for its Medicaid program.
Eligibility varies based on the state or territory as well as whether your state has expanded its Medicaid program to include people with higher incomes.
Medicaid, the government health insurance program for people with low incomes, has seen record enrollment since the COVID-19 pandemic. Medicaid programs are operated by all states, Washington, D.C., and these five U.S. territories:
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Virgin Islands
Medicaid is jointly funded by the federal government and each state or territory. Rules in territories differ from rules in states. Typically, qualification varies based on whether the state expanded Medicaid under the Affordable Care Act (ACA).
Most states have expanded Medicaid
Medicaid expansion means that individuals can qualify solely based on having income below a certain threshold. As of May 2025, 40 states and D.C. have adopted Medicaid expansion. These 10 have not:
Alabama
Florida
Georgia
Kansas
Mississippi
South Carolina
Tennessee
Texas
Wisconsin
Wyoming
Who is eligible for Medicaid?
Generally, adults and children with low incomes qualify for Medicaid. Federal law requires states to cover certain individuals. Most people qualify for Medicaid based on financial eligibility, including factors such as income and household size. Others qualify for nonfinancial reasons, such as undergoing breast cancer or cervical cancer treatment. Eligibility rules differ depending on the state or territory.
People who are eligible for Medicaid include:
Families with low incomes
Qualified pregnant people
Newborns and older children from families with low incomes
Children and adolescents in foster care
Most older adults and people with disabilities who receive Supplemental Security Income
People who spend down their assets to qualify for Medicaid coverage of their long-term care
Medicaid expansion has allowed states to cover people with higher incomes, including adults without children.
Does Medicaid cover weight-loss medications? Your Medicaid plan may cover prescription treatments for weight loss, such as Ozempic and Wegovy, but you may be required to get prior authorization or do step therapy.
What to do if you lose Medicaid. Asking your prescriber for additional refills, switching to generic medications, and using GoodRx can help you save on prescriptions if you lose Medicaid coverage.
Does Medicaid cover incontinence supplies? Most Medicaid programs cover incontinence supplies for children and adults when deemed medically necessary, but requirements depend on coverage guidelines in your state or territory.
What are the income limits for Medicaid in your state?
Medicaid eligibility is based on the federal poverty level, which changes every year. The poverty level is the same for the contiguous 48 states and Washington, D.C., but higher in Alaska and Hawaii.
Because of the ACA, most Medicaid eligibility is determined by modified adjusted gross income (MAGI). Federal law specifies that you can qualify for Medicaid if your household income is below 133% of the federal poverty level. But because the poverty level is calculated with a 5 percentage point disregard, meaning income that is not counted toward Medicaid’s income limit, the income limit is effectively 138% of the federal poverty level.
If your state hasn’t expanded Medicaid, you may still be eligible if your income is below 138% of the federal poverty level. But adults in those states with incomes below 100% who don’t qualify for Medicaid because of disability, age, or other factors may not be eligible for this insurance, which means they fall into a coverage gap. Many of these people are low-wage workers and/or parents.
Read more like this
Explore these related articles, suggested for readers like you.
Here is a look at the 138% income limits in 2025 for Washington, D.C., and the 48 contiguous states:
Household size | 138% of the federal poverty level |
Individual | $24,826 |
Family of 2 | $33,562 |
Family of 3 | $42,297 |
Family of 4 | $51,032 |
Family of 5 | $59,768 |
Family of 6 | $68,503 |
What income is counted for Medicaid eligibility?
The income used to determine Medicaid eligibility is called MAGI. MAGI is different from adjusted gross income (AGI), which is everything you earned during the year minus allowable tax deductions. AGI appears on IRS tax forms. MAGI is specifically used to calculate eligibility for Medicaid, ACA premium tax credits, and other health insurance savings.
How to apply for Medicaid
You can find out how to apply for Medicaid in your state or territory by using the GoodRx Guide to Medicaid. You can also check out the state map on Medicaid.gov to find contact information for your state or territory.
There are two ways you can apply for Medicaid for yourself and your dependents:
Through an ACA marketplace: Fill out an application on healthcare.gov if your state uses the national marketplace or through your state marketplace. If anyone in your household qualifies for Medicaid or the Children’s Health Insurance Program, known as CHIP, a representative for the marketplace will forward your application to your state or territory agency so that you can enroll.
Through your state or territory Medicaid agency: In most cases, you can apply for Medicaid online, by phone, or in person (which may require an appointment).
GoodRx offers guides to help you apply for Medicaid in three states:
The bottom line
Medicaid is a public health insurance program for people with low incomes, typically below 138% of the federal poverty level. Medicaid expansion has enabled most states to cover people with higher incomes, including adults without children. Though funded by the federal government, programs are administered by states and territories. Federal law requires Medicaid programs to cover certain individuals, including qualified pregnant people, children and adolescents in foster care, and most older adults and people with disabilities who receive Supplemental Security Income.
Why trust our experts?
References
HealthCare.gov. (n.d.). Adjusted gross income (AGI). Centers for Medicare & Medicaid Services.
HealthCare.gov. (n.d.). Federal poverty level (FPL). Centers for Medicare & Medicaid Services.
HealthCare.gov. (n.d.). Medicaid & CHIP coverage. Centers for Medicare & Medicaid Services.
HealthCare.gov. (n.d.). Medicaid expansion & what it means for you. Centers for Medicare & Medicaid Services.
HealthCare.gov. (n.d.). Modified adjusted gross income (MAGI). Centers for Medicare & Medicaid Services.
HealthCare.gov. (n.d.). What to include as income. Centers for Medicare & Medicaid Services.
KFF. (2025). Status of state Medicaid expansion decisions.
Medicaid.gov. (n.d.). Eligibility policy. Centers for Medicare & Medicaid Services.
Medicaid.gov. (n.d.). List of Medicaid eligibility groups. Centers for Medicare & Medicaid Services.
Office of the Assistant Secretary for Planning and Evaluation. (n.d.). HHS poverty guidelines for 2025. U.S. Department of Health and Human Services.
Office of the Assistant Secretary for Planning and Evaluation. (n.d.2025). 2025 poverty guidelines: 48 contiguous states (all states except Alaska and Hawaii. U.S. Department of Health and Human Services.
