A Complete Guide to Medicaid: State Requirements and Coverage

Medicaid is a health insurance program aimed at low-income families and funded by federal and state governments. Eligibility requirements change from state to state but are based on age, income, disability, household size, and several other key factors.

The Medicaid program was established in 1965 and, while it is voluntary, all states participate. Efforts have been made to standardize Medicaid eligibility requirements, but in the last few years it has actually become more diverse.

In this guide, we’ll tell you everything you need to know about Medicaid coverage, including state by state requirements and details on how to apply.

What Does Medicaid Cover?

20% of Americans are covered by Medicaid and it covers a wide range of treatments and services. Your level of coverage will depend on your age and your reasons for eligibility. For instance:

Low-Income Families

Low-income households are provided with numerous Medicaid benefits, including emergency dental care, hospital visits, and essential treatments, like antibiotics. Children are also covered for dental care, vaccines, and speech/vision therapy.

Additionally, pregnant women are covered for prenatal care and all costs that accompany delivering a baby.

Individuals with Disability

Children with autism and cerebral palsy are provided with several Medicaid services, while adults suffering from HIV/AIDs and mental illnesses are also covered.

Elderly Individuals

Seniors can get help with nursing home costs. Furthermore, Medicaid can cover some Medicare premiums.

How to Apply for Medicaid

Once you meet Medicaid eligibility requirements, you can apply through HealthCare.gov or visit your state’s application page. You will be asked for some basic personal and financial information, including:

  • Identification – Including a driver’s license or birth certificate. Does not have to be a photo ID as it is only used as proof of age and US citizenship
  • Bank Statements – Copies of official statements sent to your address
  • Proof of Income – Including tax returns
  • Proof of Address – A copy of your mortgage or lease contract, or a utility bill
  • Medical Records – Used to prove a disability

Your state can take up to 45 days to process an application, but this extends to 90 days if it involves a disability.

State by State Medicaid Eligibility

As noted above, Medicaid requirements differ considerably depending on where you live. Here is a quick rundown covering those requirements as of 2020.

Medicaid in Alabama

  • Types of Coverage = Children in need, the elderly, disabled people, and care providers can all get basic health coverage through Medicaid.
  • Income Requirements = Care offered to children and pregnant women is limited to those earning between $1,520 and $3,133 a month. For caregivers and parents, it’s between $188 and $387.
  • Additional Programs = Additional medical care can be provided through Medicaid Plan First and Medicaid in the Nursing Home.

Medicaid in Alaska

  • Types of Coverage = Most coverage types are provided. These are available to people aged between 19 and 64 who are not eligible for other programs and earn less than 133% of the Federal Poverty Level (FPL).
  • Income Requirements = No more than $1,707 per month in modified adjusted gross income (MAGI) for an individual. Rate increases for every additional family member.

Medicaid in Arizona

  • Types of Coverage = There are Medicaid programs aimed at children, caretakers, pregnant women, and more, helping the Medicaid recipient with preventative, curative, and mental health services.
  • Income Requirements = Available to people who earn less than 133% of the Federal Poverty Level.
  • Additional Programs = Cancer screening programs are available and target both breast and cervical cancer.

Medicaid in Arkansas

  • Types of Coverage = Parents, children, disabled residents, the elderly, and pregnant women.
  • Income Requirements = An expansion program exists for residents earning less than 133% FPL.
  • Additional Programs = Alternative dental services, nursing home care, and other health care programs.

Medicaid in California

  • Types of Coverage = Medicaid in California, known as Medi-Cal, was expanded to cover all people earning less than 138% of the FPL. Many types of health care services are provided, helping the elderly, disabled, blind, and pregnant women, among others.
  • Income Requirements = $16,395 for a single-person household, with over $5,000 per additional member.
  • Additional Programs = Dental care and vision care services exist for families who meet specific requirements and pay a monthly fee.

Medicaid in Colorado

  • Types of Coverage = Programs exist for the elderly, disabled, and for pregnant women, caregivers, and adults earning less than 133% FPL.
  • Income Requirements = Capped at $15,800 for a single-person, with between 133% and 260% FPL for other eligible applicants. Very small co-payments are also required for some health care coverage, including just $2 for a checkup with a doctor.
  • Additional Programs = Family planning programs and assistance programs for disabled adults.

​​​​Medicaid in Connecticut

  • Types of Coverage = Multiple programs are available, covering a range of individuals and services up to 133% FPL.
  • Income Requirements = $16,643 for the Medicaid expansion group and up to $42,711 for pregnant women.
  • Additional Programs = Other programs are available for employees with disabilities.

Medicaid in Delaware

  • Types of Coverage = Covers a range of individuals and services up to 133% FPL.
  • Income Requirements = Under 200% FPL for pregnant women.
  • Additional Programs = Long-term care programs are available for patients with some terminal diseases, such as end-stage renal disease. Prescription drug assistance programs are also available.

Medicaid in DC

  • Types of Coverage = A wide range of programs covering a host of medical services for qualifying individuals.
  • Income Requirements = Available to residents earning up to 210% FPL, making it one of the most accessible Medicaid programs in the United States.
  • Additional Programs = Emergency medical assistance, nursing care, home care services, and other programs are available.

Medicaid in Florida

  • Types of Coverage = Florida’s Medicaid services do not expand to adults who do not have dependents but does cover children and disabled residents.
  • Income Requirements = Families earning 100% FPL and pregnant women earning up to 135%.
  • Additional Programs = Residents with high medical bills who don’t qualify for Medicaid may be covered through the state’s other programs.

Medicaid in Georgia

  • Types of Coverage = Disabled residents, pregnant women, blind, caretakers, parents, and needy children.
  • Income Requirements = $3,720 for a family of one; 220% FPL for pregnant women.
  • Additional Programs = Medicaid pays for emergency assistance for undocumented residents, as well as those defined as “medically needy” who have high medical bills but don’t meet the criteria for Medicaid.

Medicaid in Hawaii

  • Types of Coverage = Caregivers, children, pregnant women, and disabled residents.
  • Income Requirements = Goes as high as 313% FPL for children and 196% for pregnant applicants, but is fixed at 100% for the disabled.
  • Additional Programs = Multiple assistance programs exist in this state’s Medicaid program, including those aimed at the medically needy and emergency assistance for non-residents.

Medicaid in Idaho

  • Types of Coverage = Medicaid services expand to cover most residents in need, including children, caregivers, adults, and disabled residents.
  • Income Requirements = Available to all residents earning up to 133% less than the poverty line.

Medicaid in Illinois

  • Types of Coverage = Low-income adults, disabled residents, children, and pregnant women.
  • Income Requirements = $13,663 for single-member households.
  • Additional Programs = Insurance policies available to some families through the FamilyCare plan.

Medicaid in Indiana

  • Types of Coverage = The elderly, disabled, and more.
  • Income Requirements = Range from $2,513 to $4,989 depending on the applicant’s status.
  • Additional Programs = Family planning services, emergency care, and treatment for end-stage renal disease may be covered with other care plans.

Medicaid in Iowa

  • Income Requirements = Between $15,521 and $20,921 depending on the applicant and the type of coverage being provided.
  • Additional Programs = Families whose income exceeds the amount needed for Medicaid should look into the Children’s Health Insurance Program (CHIP).

Medicaid in Kansas

  • Types of Coverage = Basic care relating to behavioral health, pregnancy, inpatient hospital stays, and periodic screening, covering disabled residents, pregnant women, and other eligible individuals.
  • Income Requirements = No more than 171% of the poverty line.

Medicaid in Kentucky

  • Types of Coverage = Children under the age of 19, disabled residents, and pregnant applicants can get assistance with basic care costs.
  • Income Requirements = $16,394 for a single household, with higher limits for pregnant applicants and children.
  • Additional Programs = Employees can get additional care through Medicaid Works.

Medicaid in Louisiana

  • Income Requirements = 138% of the Federal Poverty Line.
  • Additional Programs = Health insurance coverage is offered to disabled children through Family Opportunity Act Medicaid, if their families earn more than the income requirements stated above.

Medicaid in Maine

  • Types of Coverage = Applications are only available to residents who are pregnant, disabled, over the age of 65, or a relative/caregiver.
  • Income Requirements = No more than $15,800 for a single-person household, with gradual increases for every additional member of the household.
  • Additional Programs = Further health programs can help individuals with learning disabilities and other cognitive issues.

Medicaid in Maryland

  • Types of Coverage = Most basic types of Medicaid cover are provided in the state of Maryland.
  • Income Requirements = 138% of the poverty line is the baseline, but there are higher requirements for pregnant women and children.
  • Additional Programs = Affordable insurance policies, and assistance with food and basic health services are available through alternative state programs.

Medicaid in Massachusetts

  • Types of Coverage = MassHealth combines the state’s Medicaid and CHIP programs, with varying coverage levels depending on the status of the applicant.
  • Income Requirements = $1,025 for an individual, with higher limits allowed for senior applicants seeking assistance with nursing facility care and other basic health services.
  • Additional Programs = Families with up to 400% of the poverty line can still become Medicaid beneficiaries as part of the MassHealth program.

Medicaid in Michigan

  • Types of Coverage = Blind, disabled, and pregnant residents can also get assistance, as can qualifying individuals under the age of 21.
  • Income Requirements = Up to 165% of the poverty line.
  • Additional Programs = Additional programs, with co-payments, are available for individuals who earn more than the limits outlined above.

Medicaid in Minnesota

  • Types of Coverage = Health services available through the state’s Medicaid program and its expansion program, known as Medical Assistance.
  • Income Requirements = Between 133% to 275% of the Federal Poverty Line.
  • Additional Programs = MinnesotaCare extends the benefits of Medicaid and provides additional health services to individuals earning up to 200%, assuming they do not meet the standard criteria.

Medicaid in Mississippi

  • Types of Coverage = Cover provided to children, as well as elderly, pregnant, and disabled residents.
  • Income Requirements = Children can qualify if they reside in a house that earns no more than 143% of the FPL, a figure that increases to 194% for infants under the age of 1.
  • Additional Programs = Medicaid managed care is provided through insurance companies via a service known as Mississippi Coordinated Access Network.

Medicaid in Missouri

  • Types of Coverage = MO HealthNet is the state’s main service and there is no expansion program.
  • Income Requirements = Elderly residents and disabled residents can qualify with up to $855 for an individual and $1,151 for a couple. Limits are also applied to personal assets.
  • Additional Programs = Additional family planning services are available, covering basics such as contraception.

Medicaid in Montana

  • Types of Coverage = An expansion program exists, and this provides cover for many individuals. However, a small co-payment is required covering up to 5% of the enrollee’s income.
  • Income Requirements = Adults earning up to 138% of the poverty line can qualify. For children, it is slightly higher, and for women diagnosed with cervical or breast cancer, it increases to 250%.

Medicaid in Nebraska

  • Types of Coverage = Disabled, pregnant, and elderly residents, along with qualifying children, can get cover for basic services such as checkups, treatments, physical therapy, and primary care.
  • Income Requirements = Go up to 194% for infants and pregnant women, with 133% to 145% for other applicants. 

Medicaid in Nevada

  • Income Requirements = Covers individuals earning up to 138% of the FPL.
  • Additional Programs = Checkup programs and other basic healthcare services are provided to children in households earning up to 200% FPL.

Medicaid in New Hampshire

  • Income Requirements = Covers individuals earning up to 138% of the FPL, with disabled children and pregnant women allowed to earn up to 194%.

Medicaid in New Jersey

  • Types of Coverage = The NJ FamilyCare program provides CHIP and Medicaid, covering a wide range of health services.
  • Income Requirements = Children are able to qualify if they reside in a home earning up to 355%, with more modest requirements (down to 138%) for other applicants.

Medicaid in​​​​ New Mexico

  • Types of Coverage = All adults requiring basic and emergency health services can get assistance through the New Mexico Medicaid health plan.
  • Income Requirements = Income of applicants must remain within 138% of the poverty line.
  • Additional Programs = Additional services are provided to individuals who have suffered from severe brain injuries, mental health problems, drug addictions, and other debilitating illnesses.

Medicaid in New York

  • Types of Coverage = All adults and children in need are provided with care services through New York’s Medicaid plan.
  • Income Requirements = Anyone earning within 138% FPL is covered by Medicaid in NY.
  • Additional Programs = Family planning services, screenings, insurance for kids, and other services. 

Medicaid in North Carolina

  • Types of Coverage = Elderly, disabled, pregnant, and blind residents can all qualify for Medicaid in NC, as can needy children.
  • Income Requirements = Income must stay within 100% of the poverty line for most applicants, with exceptions for disabled employees and families with infants.
  • Additional Programs = Health Choice can be used by families who do not qualify and cannot afford private insurance.

Medicaid in ​​​​North Dakota

  • Types of Coverage = All low-income adults are covered by the state’s Medicaid plans since its expansion.
  • Income Requirements = No more than $16,643 for a single-person household.
  • Additional Programs = Community-based services, screen services, and other essential health care is provided via alternative state programs.

Medicaid in Ohio

  • Types of Coverage = All low-income residents can qualify.
  • Income Requirements = Up to 133% of the FPL.
  • Additional Programs = There are additional plans available to anyone who fails to qualify for public health services due to immigration status.

Medicaid in Oklahoma

  • Types of Coverage = The state of Oklahoma chose not to expand its services to cover all needy adults. Its Medicaid is arranged through SoonerCare.
  • Income Requirements = Up to 210% for households with children and 133% for pregnant women.
  • Additional Programs = Women diagnosed with breast or cervical cancer can receive assistance through the Oklahoma Cares program.

Medicaid in Oregon

  • Types of Coverage = All low-income adults are covered via the Oregon Health Plan.
  • Income Requirements = Adults who earn less than 138% of the Federal Poverty Line can qualify for the Oregon Health Plan.
  • Additional Programs = Vaccines, mental health, and even marijuana services are provided in addition to the state’s standard Medicaid plan.

Medicaid in Pennsylvania

  • Types of Coverage = Medical Assistance was expanded to meet the needs of most low-income adults between 19 and 64.
  • Income Requirements = 133% of the poverty line.
  • Additional Programs = Additional services are available and include cover for screenings, mental health, breast cancer, dental services, and more.

Medicaid in Rhode Island

  • Types of Coverage = Rite Care, in addition to the state’s Medicaid expansion, provides a range of services for adults and children in need.
  • Income Requirements = 133% for most applicants, increasing to 253% for pregnant women.
  • Additional Programs = Through the Ryan White program, people living with HIV/AIDs can get help with an array of basic health and living costs.

Medicaid in South Carolina

  • Types of Coverage = Health Connections is the state’s Medicaid program and offers services such as screenings, family planning, checkups, and other basics for a host of SC residents.
  • Income Requirements = Between 100% and 194% of the FPL depending on the applicant.
  • Additional Programs = Numerous initiatives can help parents of babies born with birth defects, as well as parents of children on the autism spectrum.

Medicaid in South Dakota

  • Types of Coverage = Although SD’s program was not expanded, it still covers a wide range of individuals and benefits.
  • Income Requirements = Parents can apply for the state’s Medicaid program if they don’t earn more than $613 a month for one person and $1,421.

Medicaid in Tennessee

  • Types of Coverage = Program was not expanded but covers many needy adults and children.
  • Income Requirements = Disabled residents and elderly residents must not have an income higher than $750 or a resource limit of more than $2,000.
  • Additional Programs = Screening programs can help to detect breast and cervical cancer.

Medicaid in Texas

  • Types of Coverage = Program was not expanded but covers many needy adults and children, including individuals aged between 18 and 25 who were in foster care when they turned 18.
  • Income Requirements = Pregnant women can apply with an income of no more than $1,990, for a single-person household. 
  • Additional Programs = Screening programs for women.

Medicaid in Utah

  • Types of Coverage = All of the usual bases are covered, and the state’s expansion program provides additional cover to all low-income individuals.
  • Income Requirements = 133% of the FPL.

Medicaid in Vermont

  • Types of Coverage = Provides many Medicaid benefits to applicants who are elderly, pregnant, disabled, or blind, as well as to parents, caregivers, and children.
  • Income Requirements = 138% of the FPL.

Medicaid in Virginia

  • Types of Coverage = Historically, Virginia had one of the worst Medicaid programs in the state, but times have changed, and cover is now provided to most Americans in need.
  • Income Requirements = Single household applicants must earn less than $16,754.

Medicaid in Washington

  • Types of Coverage = One of the best Medicaid programs in the country, providing care for many needy adults and children, as well as low-income residents and other groups.
  • Income Requirements = No more than $16,640 for single-person households.
  • Additional Programs = Medicaid is offered to children in foster care until they turn 21. Those in receipt of it on their 18th birthday will continue to be eligible until they turn 26.

Medicaid in West Virginia

  • Types of Coverage = Underwent expansion during the Affordable Care Act (ACA) and now provides cover for a wide range of low-income and in-need Americans.
  • Income Requirements = No more than $16,632 per year for single applicants.

Medicaid in Wisconsin

  • Types of Coverage = Everyone under the poverty line is covered via the state’s “BadgerCare” program.
  • Income Requirements = $1,005 per month for a single household, increasing to $1,353 for two people and $1,701 for three.
  • Additional Programs = Foster children and seniors can access essential care through alternative programs.

Medicaid in Wyoming

  • Types of Coverage = No expansion program, but many low-income and needy residents are covered.
  • Income Requirements = No more than 154% FPL for pregnant women, 133% for children, and $529 for single parents.
  • Additional Programs = Additional care for nursing homes and assisted living facilities.