Medicaid Eligibility & How to Apply

Medicaid provides free or low-cost health coverage to adults and families with low income. It is the largest source of health coverage in the United States, covering over 90 million Americans.

Who qualifies for Medicaid?

Eligibility varies by state, but in most states that have expanded Medicaid under the Affordable Care Act, adults with income up to 138% of the Federal Poverty Level (FPL) qualify. That is roughly $20,700/year for a single person or $35,000/year for a family of three (2025).

Key eligibility factors:

• Income at or below 138% FPL in expansion states (40 states + D.C.)
• Non-expansion states have narrower eligibility — primarily children, pregnant women, and people with disabilities
• Children are typically covered through CHIP up to 200–300% FPL
• Immigration status affects eligibility — lawfully present immigrants may qualify after a 5-year waiting period
• No asset test in most expansion states

What does Medicaid cover?

Medicaid covers a wide range of services, including:

• Doctor visits and preventive care
• Hospital stays (inpatient and outpatient)
• Prescription drugs
• Mental health and substance use treatment
• Maternity and newborn care
• Long-term care and nursing home services
• Dental and vision (varies by state)

The estimated value of Medicaid coverage is $400–$600 per person per month, though actual out-of-pocket costs to you are typically very low or zero.

What documents do I need?

• Proof of identity (driver's license, passport, or birth certificate)
• Social Security number
• Proof of income (pay stubs, tax return, or award letters)
• Proof of residency (utility bill, lease, or bank statement)
• Immigration documents if applicable

How to apply for Medicaid

You can apply for Medicaid through your state Medicaid agency, through Healthcare.gov, or in person at your local Department of Social Services. Coverage can start immediately upon approval in many states — and can sometimes be backdated up to 3 months.

Unlike private insurance, Medicaid has no open enrollment period — you can apply any time of year.

Apply for Medicaid at Healthcare.gov →

Common questions

What is the difference between Medicaid and Medicare?

Medicare is a federal insurance program for people 65+ or with certain disabilities. Medicaid is an income-based program available at any age. Some people qualify for both ("dual eligible").

Can I get Medicaid if I'm working?

Yes. Medicaid eligibility is based on income level, not employment status. Many working adults qualify, especially in expansion states.

Does Medicaid cover dental?

Dental coverage varies by state. Most states cover emergency dental for adults; some cover preventive and restorative care. Children enrolled in Medicaid or CHIP receive comprehensive dental coverage.

My state didn't expand Medicaid. What are my options?

If your income is below 100% FPL in a non-expansion state, you may fall into the "coverage gap." You can explore subsidized marketplace plans at Healthcare.gov, community health centers (FQHCs), or state-specific assistance programs.