National Medicaid minimum eligibility level

There is no national Medicaid minimum eligibility level. Instead, each state sets its own eligibility requirements. However, the Affordable Care Act (ACA) of 2010 expanded Medicaid eligibility to adults with income up to 138% of the federal poverty level (FPL) in all states that chose to do so. As of 2023, 37 states and the District of Columbia have expanded Medicaid.

In states that have not expanded Medicaid, eligibility for adults is typically much lower. For example, in Texas, the eligibility level for adults is 100% of the FPL, which is about $12,880 for an individual in 2023.

If you are not sure if you are eligible for Medicaid, you can contact your state’s Medicaid office.

The Affordable Care Act of 2010, signed by President Obama on March 23, 2010, creates a national Medicaid minimum eligibility level of 133% of the federal poverty level ($29,700 for a family of four in 2011) for nearly all Americans under age 65. This Medicaid eligibility expansion goes into effect on January 1, 2014 but states can choose to expand coverage with Federal support anytime before this date-see related Federal Policy Guidance and states that have expanded Medicaid prior to 2014. See Eligibility Provisions in the Affordable Care Act.

Other Eligibility Criteria

There are other non-financial eligibility criteria that are used in determining Medicaid eligibility. In order to be eligible for Medicaid, individuals need to satisfy federal and state requirements regarding residency, immigration status, and documentation of U.S. citizenship.

Retroactive Eligibility

Medicaid coverage may start retroactively for up to 3 months prior to the month of application, if the individual would have been eligible during the retroactive period had he or she applied then. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

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