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Medically Approved

How do you qualify for Medicaid?

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Qualifying FactorsIf you're deniedSummary
The rules of your home state determine if you are eligible for Medicaid. It is usually based on your income level, but other factors may apply. Help is available, even if you are initially denied Medicaid.
Medically reviewed by Alana Biggers, M.D., MPH
Updated on

Medicaid is a government health insurance program for people and families with limited or low incomes. 

The eligibility requirements for Medicaid depend on many factors, including income, household size, family status, and whether or not you have a disability.

If children need health insurance, a partner program called the Children’s Health Insurance Program (CHIP) may be able to help. CHIP offers low cost health coverage to children whose parents don’t qualify for Medicaid.

You can apply for Medicaid any time of the year through your state’s Medicaid program. You can also create an account and complete an application with the Health Insurance Marketplace that’s run by the federal government.

What are the Medicaid qualifying factors?

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Qualifying Medicaid factors vary from state to state, but generally, if your income is below 138% of the federal poverty level (FPL), you qualify for Medicaid.

Some states expand their coverage to include all adults who have an income below 133% of the FPL.

The FPL is a measure of income issued every year by the Department of Health and Human Services. Specialists use it to determine eligibility for several government programs, including Medicaid and CHIP.

In 2023, the FPL is $14,580 for one person and $24,860 for a family of three.

Once you’re eligible for Medicaid, coverage begins on the date you applied, or the first day of the month you applied.

If you were eligible for Medicaid in the 3-month period before you applied, the plan may offer retroactive coverage, where they would allow for past treatment to be covered under the plan.

If you become ineligible for Medicaid coverage, coverage will typically stop at the end of that month.

Who does Medicaid help?

The federal government requires states to offer healthcare coverage to low income families, qualified pregnant people and children, and people receiving Supplemental Security Income.

Certain states have additional coverage, like those who receive home and community-based services and children in foster care.

What to do if you’re denied Medicaid

If you’re denied Medicaid, it could be because your yearly income is above the FPL level. In these cases, some other options include:

  • Reapplying: There is no limit to the number of times you can apply for Medicaid or CHIP. You can visit the Medicaid website to reapply.
  • Trying the Marketplace: The Health Insurance Marketplace offers low cost health insurance plans. Savings will depend on your household size and income level. Note that the following states and Washington, D.C. run their own marketplaces: California, Colorado, Connecticut, Idaho, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, and Washington.
  • Medicare: You may qualify for Medicare if you are 65 years or older, or have a specific medical condition. You can visit the Medicare website for more information on eligibility.

Other ways to get help

Government funding for healthcare has expanded to support community health centers. Here you can get care without insurance on a sliding scale based on your income.

Contact your state health department to find a community health center in your area.

Help with prescriptions

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If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Follow the links on drug names for savings on that medication, or search for a specific drug here.

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Medicaid supports individuals and families with low incomes based on the latest federal poverty levels. 

You can find out whether you qualify for Medicaid by calling your state agency or applying online. They’ll contact you if you’re eligible, and someone will help with the enrollment process. 

If you don’t qualify for Medicaid, you can apply again or try other options, such as a Healthcare Insurance Marketplace plan or community health centers that offer healthcare on a sliding scale.

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.

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