Medicaid Eligibility - Qualifying for Medicaid

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 Do I Qualify for Medicaid?

There are numerous Medicaid programs in each state that vary depending state laws, income and family size. Medicaid is generally available in all states to those who earn less than 100%-200% of the FPL (federal poverty level) in their state along with having a disability, pregnancy, are themselves elderly or are a caretaker of a child. In some states the guidelines for Medicaid have been expanded and now include coverage of all low-income households below a particular threshold. You can check here to find out if you qualify for Medicaid based on income alone.

Is My State Expanding Medicaid?

To find out if you qualify for Medicaid you should first find out if your state is expanding Medicaid. This will tell you which programs will work for your current situation. Use the guide below to find out if your state has adopted expanded Medicaid.

*Note. The guide below consists of states that have/have not adopted expanded Medicaid through 2019. Some states may have adopted expanded Medicaid, though they have yet to implement the expansion.

State                                                Medicaid Expansion 

Alabama

  • Not Adopted
Alaska
  • Adopted
Arizona
  • Adopted
Arkansas 
  • Adopted
California
  • Adopted
Colorado
  • Adopted
Connecticut
  • Adopted
Delaware 
  • Adopted
District of Columbia
  • Adopted
Florida
  • Not Adopted
Georgia
  • Not Adopted
Hawaii
  • Adopted
Idaho
  • Adopted
Illinois
  • Adopted
Indiana
  • Adopted
Iowa
  • Adopted
Kansas
  • Not Adopted
Kentucky
  • Adopted
Louisiana
  • Adopted
Maine
  • Adopted
Maryland
  • Adopted
Massachusetts 
  • Adopted
Michigan
  • Adopted
Minnesota
  • Adopted
Mississippi
  • Not Adopted
Missouri
  • Not Adopted
Montana
  • Adopted
Nebraska
  • Adopted - *Not Implemented
Nevada
  • Adopted
New Hampshire
  • Adopted
New Jersey
  • Adopted
New Mexico
  • Adopted
New York
  • Adopted
North Carolina
  • Not Adopted
North Dakota
  • Adopted
Ohio
  • Adopted
Oklahoma
  • Not Adopted
Oregon
  • Adopted
Pennsylvania
  • Adopted
Rhode Island
  • Adopted
South Carolina
  • Not Adopted
South Dakota
  • Not Adopted
Tennessee
  • Not Adopted
Texas
  • Not Adopted
Utah
  • Adopted
Vermont
  • Adopted
Virginia
  • Adopted
Washington
  • Adopted
West Virginia
  • Adopted
Wisconsin
  • Not Adopted
Wyoming
  • Not Adopted

A majority of states have chosen to expand Medicaid coverage. If your state has not done so as of now, it can chose to expand Medicaid at any time. Once you find out whether your state has expanded Medicaid or not, you can then continue on with the process of determining your eligibility.

Federal law requires all states to participate in Medicaid to a certain extent. It requires all states to offer coverage to select mandatory groups such as individuals receiving SSI (Supplemental Security Income), some pregnant women and children, and low income families. Some select states offer coverage not listed in the mandatory groups list provided in the link above.

Also note that some states may have different names for Medicaid. You can check what your state's program is called here.

How is Medicaid Eligibility Determined?

The process for determining Medicaid eligibility relies on your MAGI (modified adjusted gross income). The process used to take in to account your income, net worth and assets, though after the Affordable Care Act was implemented it has changed. The majority of cases will be determined using MAGI.

When filling out an application through Marketplace you will need to have an estimate for your expected household income for the year you need Medicaid coverage, not the previous year's income. The income you will be noting here is your MAGI.

MAGI is used to determine eligibility for adults, pregnant women, children and parents. Your MAGI accounts for all of your taxable income, as well as select deductions. These deductions can include everything from your non-taxable social security benefits, retirement contributions and your tax exempt interest. For most people the number is generally very close to, if not the same as your adjusted taxable income which you can find on your tax return.

You will not be able to see your MAGI directly on your tax return. You must calculate this number yourself. For most situations the household income will include the tax filer, their spouse and any tax dependents (including those who do not need coverage). You can find out more about what is considered household income here. You can estimate your MAGI by finding out the total of the figures below:

  • Your total AGI (adjusted gross income) on your most recent federal tax return. You can find this on line 7 of the 1040 IRS form.
  • Excluded foreign income (if applicable).
  • Tax exempt Social Security interest.
  • Non Taxable Social Security Benefits - Including Tier 1 Railroad Retirement Benefits
  • *Note. Your MAGI does not include (SSI) Supplemental Security Income.
  • Expected changes - You must adjust your estimate for any changes you may expect. Things to consider here are expected pay raises, new job/employment changes, work schedule changes, Social Security or investment changes or gaining or losing dependents. All of these can alter your income significantly.

After taking into consideration all of the factors above, the total number you are left with will be your MAGI. You will use this number when applying for Medicaid through Marketplace or your state agency.

Medically Needy Medicaid Coverage

Some states have implemented coverage for the medically needy. This program extends Medicaid coverage to those with health needs that have income too high to qualify for the standard Medicaid program.

You may also still become eligible for the standard Medicaid by "spending-down" the amount of income that is above your state's MNIL (medically needy income limit) listed in the table below. You may "spend down" by accruing expenses for medical care for which you do not have health insurance to cover. After the accrued medical expenses become larger than your state's medically needy income level, you may then be eligible for Medicaid.

For example, if you live in a state that has the Medicaid medically needy program your state will have a spend-down time period, typically around 6 months. During that period the state will look at your income and medical expenses to see if you qualify. If you have enough medical expenses during that time to satisfy your spend-down, you may then qualify for coverage. If the spend-down limit is met, you will then be eligible for coverage for the remainder of the time period. You will have to meet the spend-down MNIL again once the time period is over.

*Note. The numbers provided in the table below are through 2019.

State               Indiv. Monthly Income Limit

Spend-Down Program

Alabama

  • NA
NA
Alaska
  • NA
NA
Arizona
  • NA
NA
Arkansas 
  • $108
Yes
California
  • $600
Yes
Colorado
  • NA
NA
Connecticut
  • $523
Yes
Delaware 
  • $652
Yes
District of Columbia
  • NA
Yes
Florida
  • $180
Yes
Georgia
  • $317
Yes
Hawaii
  • $469
Yes
Idaho
  • NA
NA
Illinois
  • $1,012
Yes
Indiana
  • NA
NA
Iowa
  • $483
Yes
Kansas
  • $475
Yes
Kentucky
  • $235
Yes
Louisiana
  • $100
Yes
Maine
  • $315
Yes
Maryland
  • $350
Yes
Massachusetts 
  • $522
Yes
Michigan
  • $1,012
Yes
Minnesota
  • $810
Yes
Mississippi
  • NA
NA
Missouri
  • NA
NA
Montana
  • $525
Yes
Nebraska
  • $392
Yes
Nevada
  • NA
NA
New Hampshire
  • $591
Yes
New Jersey
  • $367
Yes
New Mexico
  • NA
NA
New York
  • $842
Yes
North Carolina
  • $242
Yes
North Dakota
  • NA
Yes
Ohio
  • NA
NA
Oklahoma
  • NA
NA
Oregon
  • NA
NA
Pennsylvania
  • $425
Yes
Rhode Island
  • $903
Yes
South Carolina
  • NA
NA
South Dakota
  • NA
NA
Tennessee
  • $241
Yes
Texas
  • $104
NA
Utah
  • $1,012
Yes
Vermont
  • $1,041
Yes
Virginia
  • $493
Yes
Washington
  • $750
Yes
West Virginia
  • $200
Yes
Wisconsin
  • $592
Yes
Wyoming
  • NA
NA


Medicaid Health Insurance Guides

Benefit Guide About
Medicaid ApplicationTips & advice on applying for Medicaid health insurance
Medicaid BenefitsWhat you get with your Medicaid health insurance
Medicaid EligibilityRead the GuideThe current article you are reading
Government Benefits GuidesLists of most common government benefits, requirements to qualify and how to apply

Medicaid Health Insurance Guides

Benefit Guide About
Medicaid ApplicationTips & advice on applying for Medicaid health insurance
Medicaid BenefitsWhat you get with your Medicaid health insurance
Medicaid EligibilityRead the GuideThe current article you are reading
Government Benefits GuidesLists of most common government benefits, requirements to qualify and how to apply