United States Benefit

Medicaid

Medicaid provides free or low-cost health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.

At a Glance

  • In states that expanded Medicaid, adults under 65 withincome up to 138% FPL qualify.
  • Must be a resident of the state where applying.
  • Must be a U.S. citizen, U.S. national, or qualified immigrant.
  • Cannot be currently incarcerated.
  • + 1 more requirements below

Eligibility Requirements

Income (Adults)

Required

In states that expanded Medicaid, adults under 65 withincome up to 138% FPL qualify.

household_income_fpl 138 percent

State Residency

Required

Must be a resident of the state where applying.

state_residency exists

Citizenship/Immigration

Required

Must be a U.S. citizen, U.S. national, or qualified immigrant.

citizenship_status in [us_citizen, us_national, qualified_alien]

Not Incarcerated

Required

Cannot be currently incarcerated.

is_incarcerated = false

Eligibility Category

Required

Must fall into an eligible category.

eligibility_category in [low_income_adult, pregnant, child_under_19, parent_caretaker, elderly_65_plus, disabled, blind]

Exempt if any:

  • OR age < 19
  • OR is_pregnant = true
  • OR age 65
  • OR has_disability = true
  • OR age between

Ruleset effective: 2024-01-01

View as JSON
{"service_id":"medicaid","effective_date":"2024-01-01","rules":[{"id":"income-adults","key":"household_income_fpl","operator":"less_than_or_equal","value":138,"unit":"percent","requirement":"required","label":"Income (Adults)","description":"In states that expanded Medicaid, adults under 65 with\nincome up to 138% FPL qualify.\n","source_url":"https://www.medicaid.gov/medicaid/eligibility/index.html"},{"id":"residency","key":"state_residency","operator":"exists","requirement":"required","label":"State Residency","description":"Must be a resident of the state where applying."},{"id":"citizenship","key":"citizenship_status","operator":"in","values":["us_citizen","us_national","qualified_alien"],"requirement":"required","label":"Citizenship/Immigration","description":"Must be a U.S. citizen, U.S. national, or qualified immigrant.\n"},{"id":"not-incarcerated","key":"is_incarcerated","operator":"equals","value":false,"requirement":"required","label":"Not Incarcerated","description":"Cannot be currently incarcerated."},{"id":"categorical-eligibility","key":"eligibility_category","operator":"in","values":["low_income_adult","pregnant","child_under_19","parent_caretaker","elderly_65_plus","disabled","blind"],"requirement":"required","label":"Eligibility Category","description":"Must fall into an eligible category.","any_of":[{"id":"cat-child","key":"age","operator":"less_than","value":19,"description":"Children under 19"},{"id":"cat-pregnant","key":"is_pregnant","operator":"equals","value":true,"description":"Pregnant individuals"},{"id":"cat-elderly","key":"age","operator":"greater_than_or_equal","value":65,"description":"Adults 65 and older"},{"id":"cat-disabled","key":"has_disability","operator":"equals","value":true,"description":"Individuals with disabilities"},{"id":"cat-adult-expansion","key":"age","operator":"between","min":19,"max":64,"description":"Adults 19-64 (expansion states)"}]}]}

Quick Info

Agency
CMS
Category
Healthcare
Last Verified
2026-01-13

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