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Who Qualifies for Medicaid?


To qualify for Medicaid, you have to meet certain income requirements. This is a federally run health insurance program designed to help the needy access quality healthcare. Eligibility varies by state, but you have to meet some general conditions. This article will explain all you need to know about Medicaid and who qualifies for the program. A financial advisor can also help you determine if you qualify for Medicaid and other benefits.

Do I Qualify for Medicaid?

The easiest way to check if you’re eligible for Medicaid is to visit the Medicaid website in your state. Generally speaking, however, you can expect to qualify for a Medicaid program in your state if you make less than between 100% and 200% of the federal poverty level. For a three-person household, the 2023 federal poverty line rests at $24,860. Medicaid eligibility is based on you or your family’s modified adjusted gross income (MAGI). Your state likely offers a Medicaid program you qualify for if you meet income requirements and if you’re one of the following:

  • Parent or caretaker
  • Pregnant
  • Elderly
  • Disabled

Below, we lay out the 2023 federal poverty guidelines based on household size.

2023 Federal Poverty Levels

  Household SizePoverty Line

Furthermore, most Medicaid programs are exclusively available to U.S. citizens, legal immigrants and permanent residents.

Changes to Medicaid

Medicaid was established in 1965. But it doesn’t necessarily exist the way it did back then. For instance, 13 states now have a work requirement to receive Medicaid: Kentucky, Indiana, Arkansas, New Hampshire, Maine, Wisconsin, Michigan, Ohio, Utah, Arizona, Nebraska, Georgia and South Carolina.

While the federal government does not require states to expand Medicaid eligibility, some have.

How to Apply for Medicaid

who qualifies for medicaid

If you qualify for Medicaid, the application process is generally straight-forward. Most states run Medicaid websites, where you can print and fill out an application. You can drop it off directly at the local Medicaid office.

You can also visit to see if you qualify. The website will also let you know if your state recently expanded coverage.

What Does Medicaid Cover?

Medicaid coverage varies by state, but it generally includes both short- and long-term services. However, the federal government requires states to provide mandatory medical services. These include the following:

  • Inpatient hospital services
  • Outpatient hospital services
  • EPSDT: Early and periodic screening, diagnostic, and treatment services
  • Nursing facility services
  • Home health services
  • Physician services

Some states may also offer optional services. These may include the following:

  • Prescription Drugs
  • Clinic services
  • Physical therapy
  • Occupational therapy
  • Speech, hearing and language disorder services
  • Respiratory care services

As you can see, not all Medicaid programs cover prescription drugs. Nonetheless, the program in your state may pay the premium for Medicare Part D, a prescription drug plan.

Alternatives to Medicaid

If you don’t qualify for Medicaid, you can purchase a health insurance plan on the market place. However, you must do this during open enrollment unless you meet an exemption such as the loss of a job.

And while the individual mandate in the Affordable Care Act no longer requires you to get health insurance to avoid a tax penalty, you should still get covered. You can also access a private plan from an insurance company.

The Takeaway

who qualifies for medicaid

Medicaid is a federal health insurance program designed to make sure those with low income still have access to healthcare when they need it. Eligibility requirements vary by state, so the best decision you can make is to check with the Medicaid website for your state. If you qualify, you can expect to be covered for doctor visits, hospital expenses, laboratory services and more.

Tips on Navigating the Health Insurance System

  • If you plan on entering your golden years before the rest of the pack, check out our guide on how to get health insurance when you retire early.
  • If you don’t qualify for Medicaid, don’t fret. A financial advisor can offer valuable insight and guidance. Finding one doesn’t have to be hard. If you don’t have a financial advisor yet, finding one doesn’t have to be hard. SmartAsset’s free tool matches you with up to three vetted financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now

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