Can I Get Medicaid If I Have a Job? Understanding Eligibility When Employed

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You can qualify for Medicaid even if you have a job. Employment, whether full-time or part-time, doesn’t automatically disqualify you from this vital health coverage program.

Eligibility depends on a combination of factors:

• Your household income
• Household size
• Your state of residence
• Personal circumstances (pregnancy, dependent children, age, or disability status)

This article explains how Medicaid works, the key eligibility factors for working individuals and families, and how to find out if you qualify.

What is Medicaid? Your Health Coverage Safety Net

Medicaid is a cornerstone public health insurance program in the United States, providing free or low-cost health coverage to millions of Americans. Established in 1965 alongside Medicare under Title XIX of the Social Security Act, its fundamental purpose is to serve as a health coverage safety net.

Medicaid reaches eligible low-income adults, children, pregnant individuals, elderly adults, and people with disabilities. In fact, Medicaid is the single largest source of health coverage in the country.

The program doesn’t provide cash payments directly to individuals. Instead, it pays health care providers for covered medical services. Depending on your state’s rules and income level, you might need to pay a small co-payment for some services.

How Medicaid is Structured

Medicaid operates through a joint federal and state partnership. Both levels of government contribute funding.

The federal government, primarily through the Centers for Medicare & Medicaid Services (CMS), sets broad national guidelines. Each state designs and administers its own Medicaid program.

Federal law requires states to cover certain populations, known as mandatory eligibility groups:

• Qualified low-income families
• Pregnant women
• Children
• Individuals receiving Supplemental Security Income (SSI)

States can also choose to cover additional groups beyond these requirements.

This state-level administration means there isn’t one single Medicaid program, but rather 50+ distinct programs across states, DC, and territories. As a result, eligibility rules, covered services, and care delivery vary considerably from state to state.

A person with a specific job and income might qualify for Medicaid in one state but not in a neighboring one. This variability makes understanding your specific state’s rules essential.

The program has evolved significantly since 1965, with major changes introduced by the Affordable Care Act (ACA) in 2010, which allowed states to expand coverage to more low-income adults.

Who Can Qualify for Medicaid? Key Factors Beyond Just Income

While income is central to Medicaid eligibility, it’s not the only factor. Several non-financial requirements must also be met. Because rules are complex and differ by state, applying is often the most reliable way to determine if you qualify.

Here are the key non-financial factors considered:

State Residency

Applicants must be residents of the state where they apply for Medicaid benefits. This generally means living in the state with the intention to remain, even if you’ve moved recently.

Individuals in U.S. territories generally cannot use state-based Marketplaces or state Medicaid programs unless they also qualify as residents of one of the 50 states or DC. Territories have their own health program structures.

Citizenship and Immigration Status

Generally, applicants must be U.S. citizens or qualified non-citizens. Qualified non-citizens include:

• Lawful permanent residents (LPRs or green card holders)
• Refugees
• Asylees
• Other specific categories

Often, LPRs must wait five years after receiving qualified status before becoming eligible for Medicaid. However, states have options to waive this waiting period for children and pregnant individuals.

Importantly, applying for Medicaid or CHIP for eligible children or other eligible household members does not negatively affect the immigration status of parents or other family members who may not be eligible themselves.

Household Size

The number of people in your household is critical for determining the applicable income limit. For most Medicaid applicants (those subject to MAGI rules, explained later), the household generally consists of:

• The individual filing taxes
• Their spouse (if filing jointly)
• Anyone claimed as a tax dependent

Specific rules apply for those who don’t file taxes or are claimed as dependents by someone else.

Age

Medicaid has specific eligibility pathways based on age:

• Children (generally under age 19, though some states cover up to 21)
• Adults (ages 19-64)
• Seniors (age 65 and older)

There are also special provisions ensuring coverage for youth aging out of foster care, often until age 26.

Disability Status

Individuals who meet specific disability criteria often qualify for Medicaid. The disability determination frequently aligns with the standards used by the Social Security Administration (SSA) for programs like SSI or Social Security Disability Insurance (SSDI).

This involves physical or mental impairments that limit activities and are expected to last at least 12 months. However, states may have pathways for individuals with disabilities who work (see Medicaid Buy-In section below).

Family Status (Pregnancy, Parent/Caretaker)

Being pregnant triggers a specific eligibility category in all states, often with higher income limits than for other adults.

Similarly, being a parent or other caretaker relative living with and responsible for a dependent child under 18 (or sometimes 19) creates another potential pathway to eligibility. Income limits vary significantly by state, especially in states that haven’t expanded Medicaid.

The interplay of these factors is crucial. A person working a low-wage job might not qualify as a single, non-disabled adult based on income alone. However, that same person, with the same job and income, could become eligible if they become pregnant, have a child for whom they are the caretaker, or meet the state’s disability criteria.

Eligibility is not static and can change based on these life circumstances.

How Income Affects Medicaid Eligibility When You Work

While non-financial factors set the stage, income is typically the deciding factor for most people applying for Medicaid. States determine financial eligibility by comparing a household’s income to limits based on the Federal Poverty Level (FPL).

Federal Poverty Level (FPL)

The FPL is a measure of income issued each year by the U.S. Department of Health and Human Services (HHS). FPL levels vary depending on the number of people in a family or household.

Medicaid income eligibility limits are usually expressed as a percentage of the FPL (e.g., income at or below 138% FPL). For example, the ACA allowed states to expand Medicaid to adults with incomes up to 138% FPL.

The table below shows the 2025 FPL amounts (annual and approximate monthly) for households in the 48 contiguous states and DC at common Medicaid-related percentages. Alaska and Hawaii have higher FPL amounts.

2025 Federal Poverty Level (FPL) Guidelines (48 Contiguous States & DC)

Source: Based on data from HHS Poverty Guidelines and common percentage calculations.

These concrete dollar figures help individuals quickly gauge whether their earnings might fall within potentially eligible ranges for their household size.

Modified Adjusted Gross Income (MAGI)

To standardize income counting for Medicaid, CHIP, and Marketplace subsidies, the ACA introduced the Modified Adjusted Gross Income (MAGI) methodology. MAGI is now the basis for determining financial eligibility for most Medicaid applicants, including:

• Children
• Pregnant individuals
• Parents and caretaker relatives
• The ACA expansion adult group

MAGI Calculation Simplified

MAGI is not a line item on your tax return. The calculation starts with your Adjusted Gross Income (AGI), which is found on Line 11 of IRS Form 1040. AGI is your gross income minus certain “above-the-line” deductions like student loan interest or traditional IRA contributions.

To get your MAGI, you take your AGI and add back three specific types of income if you receive them:

• Untaxed foreign earned income
• Tax-exempt interest (like from municipal bonds)
• Non-taxable Social Security benefits (the portion of your Social Security income that isn’t taxed)

For many people, their MAGI will be identical or very close to their AGI.

Income Included in MAGI

Common types of income that are generally counted towards MAGI include:

• Wages, salaries, tips
• Net income from self-employment
• Unemployment compensation
• Taxable Social Security benefits (including SSDI)
• Pensions, retirement account withdrawals (most types)
• Taxable interest and dividends
• Capital gains
• Alimony received (only for divorce/separation agreements finalized before January 1, 2019)

Income Excluded from MAGI

Certain income sources are not counted in MAGI. Crucially, Supplemental Security Income (SSI) is excluded. Other exclusions typically include:

• Child support payments received
• Workers’ compensation benefits
• Veteran’s benefits (most types)
• SNAP (food stamps) and TANF (cash assistance) benefits
• Gifts and inheritances
• Scholarships/fellowships used for tuition and fees (not living expenses)

Also, money deducted pre-tax from your paycheck for things like health insurance premiums, 401(k) contributions, or flexible spending accounts generally does not count toward MAGI because it already reduces your AGI.

No Asset Test for MAGI Groups

A significant feature of the MAGI-based methodology is that it generally does not include an asset or resource test. This means things like savings accounts, cars, or other assets typically do not affect eligibility for children, pregnant individuals, parents, or expansion adults applying under MAGI rules.

This is a major departure from older Medicaid rules and benefits working families who may have accumulated modest savings.

Non-MAGI Rules (for Aged, Blind, Disabled)

It’s important to know that MAGI rules do not apply to everyone seeking Medicaid. Individuals whose eligibility is based on being age 65 or older, blind, or having a disability generally fall under non-MAGI financial methodologies.

These rules are often based on the income and resource methodologies of the Supplemental Security Income (SSI) program. Crucially, these non-MAGI pathways often include asset or resource limits.

For example, states may limit countable resources (like bank accounts, stocks, bonds, second vehicles, or property other than a primary home) to a certain amount, such as $2,000 for an individual or $3,000 for a couple. Specific limits and what counts as a resource vary by state and program.

MAGI vs. Non-MAGI Eligibility Groups: Key Differences

*Long-Term Services and Supports

The use of MAGI intended to simplify and align eligibility processes, particularly between Medicaid/CHIP and the Marketplace. However, the continued use of separate, complex non-MAGI rules (often including asset tests) for some of the most vulnerable populations—seniors and people with disabilities—means that two distinct systems for determining financial eligibility coexist within Medicaid.

Understanding which set of rules applies is critical for applicants.

Working Adults & The Medicaid Expansion Difference

One of the most significant developments affecting Medicaid eligibility for working adults was the expansion option offered to states under the Affordable Care Act (ACA). The ACA aimed to cover nearly all non-elderly adults with household incomes up to 138% of the FPL (approximately $21,597 per year for a single individual in 2025).

This was revolutionary because, historically, Medicaid eligibility for adults was largely restricted to specific categories like very low-income parents, pregnant individuals, the elderly, or those with disabilities. Childless adults, regardless of how low their income, were typically excluded.

However, a 2012 Supreme Court decision made adopting this Medicaid expansion optional for states. This pivotal decision created a major divergence in Medicaid eligibility across the country.

As of April 2025, 41 states (including the District of Columbia) have adopted the Medicaid expansion, while 10 states have not. An individual’s ability to qualify for Medicaid while working, particularly if they don’t have dependent children or a qualifying disability, now largely depends on whether their state has chosen to expand.

Eligibility in Expansion States

In states that have implemented the ACA Medicaid expansion, the pathway to coverage for working adults is much broader. Generally, adults aged 19-64 qualify if their household MAGI is at or below 138% FPL.

For a single person in 2025, this means earning up to about $1,800 per month; for a family of three, it’s about $3,065 per month (see FPL table above). This provides coverage for many individuals in low-wage jobs.

Eligibility in Non-Expansion States

In the 10 states that have not expanded Medicaid, eligibility for working adults remains very limited, similar to the rules before the ACA.

Parents/Caretaker Relatives: May qualify, but only if their income is extremely low. The median income limit for parents in non-expansion states was just 38% FPL in January 2023 – equivalent to only about $840 per month for a family of three in 2025. Even working part-time at minimum wage could easily push income above this very low threshold.

Adults Without Dependent Children: Are generally not eligible for Medicaid at all, no matter how low their income is, unless they qualify based on disability or another specific category.

The “Coverage Gap”

This stark difference between expansion and non-expansion states creates what is known as the “coverage gap”. This gap traps individuals in non-expansion states whose income is too high to qualify for their state’s restrictive Medicaid program, but too low to qualify for financial assistance (premium tax credits) to buy private insurance through the Health Insurance Marketplace (Healthcare.gov). Marketplace subsidies generally start at 100% FPL.

For example, a single adult working part-time in a non-expansion state might earn $12,000 per year (about 77% FPL in 2025). They wouldn’t qualify for Medicaid (as a childless adult) and wouldn’t qualify for Marketplace subsidies (because their income is below 100% FPL). They fall into the coverage gap with no affordable health insurance options.

As of 2023, an estimated 1.4 million uninsured adults were caught in this gap, predominantly in Southern states. This situation highlights how a state’s policy decision on expansion directly determines whether low-income employment leads to affordable health coverage or leaves workers uninsured.

Medicaid Eligibility for Working Adults (Ages 19-64): Expansion vs. Non-Expansion States (Typical Rules)

Can I Get Medicaid If I Work Part-Time or Earn Low Wages?

Yes, working part-time or having low wages does not prevent Medicaid eligibility; in fact, it often makes qualification more likely, particularly in states that have expanded Medicaid.

Eligibility boils down to whether your total household income, calculated using the MAGI rules for most adults, falls below the specific income limit set by your state for your eligibility category (e.g., expansion adult, parent).

Income from part-time employment or jobs paying minimum wage or slightly above often falls below the 138% FPL threshold used in Medicaid expansion states. For instance, an individual working 20 hours per week at the federal minimum wage ($7.25/hour) earns approximately $7,540 annually, well below the 138% FPL threshold of $21,597 for a single person in 2025. Even in states with higher minimum wages, part-time hours can keep earnings within Medicaid-eligible ranges.

The reality for many people enrolled in Medicaid is that they are working, often in sectors like service industries, retail, agriculture, or for small businesses. These jobs frequently offer:

• Low wages
• Inconsistent or variable hours
• Limited or no affordable employer-sponsored health insurance

Nearly half of Medicaid workers are employed by firms with fewer than 50 employees, which are generally not required by the ACA to offer coverage. For these workers, Medicaid is not a barrier to employment but rather a crucial support that provides access to necessary health care, allowing them to maintain their health and continue working.

Low wages are often the reason an individual qualifies for and needs Medicaid coverage.

It is worth noting that there has been policy debate around requiring Medicaid recipients to work or document work activities as a condition of eligibility. However, data consistently show the vast majority of non-disabled, working-age Medicaid adults are already working, caregiving, in school, or face significant health barriers to employment.

Attempts to implement such requirements have faced legal challenges and have been shown to cause eligible individuals to lose coverage primarily due to complex reporting rules and administrative burdens, rather than a lack of work effort. As of early 2025, such requirements are extremely limited nationally.

What if I Have a Disability and Work? The Medicaid Buy-In Option

For individuals with disabilities who are working or want to work, traditional Medicaid income and asset limits can sometimes pose a barrier. Earning “too much” could risk the loss of essential health coverage.

Recognizing this challenge, federal law allows states to offer Medicaid Buy-In programs specifically for working people with disabilities. These programs, authorized under laws like the Ticket to Work and Work Incentives Improvement Act (TWWIIA) and the Balanced Budget Act (BBA), are an optional pathway for states.

As of recent data, 46 states offer some form of Medicaid Buy-In. Their purpose is to allow individuals with disabilities to engage in employment, earn higher incomes than typically allowed by Medicaid, and still maintain access to critical Medicaid health care services and supports.

While specific rules vary significantly by state, general eligibility criteria often include:

Having a Qualifying Disability

Applicants must meet the state’s definition of disability, which often mirrors the medical criteria used by the Social Security Administration (SSA). However, unlike SSA disability benefits, Buy-In programs generally do not consider an individual’s work activity or earnings level (Substantial Gainful Activity – SGA) when determining if they meet the medical disability standard.

You typically do not need to be receiving SSI or SSDI to qualify for a Buy-In program.

Being Employed

Applicants must be engaged in paid work. This usually includes part-time work and self-employment. Most programs do not require a minimum number of work hours. Proof of employment or earnings is typically required.

Meeting Age Requirements

These programs are generally targeted at working-age adults, often ages 16 through 64.

Meeting Income Limits

Buy-In programs allow participants to earn significantly more than traditional Medicaid pathways. Income limits vary widely by state, sometimes set as a percentage of FPL (e.g., 250% FPL in Ohio and Mississippi, 450% FPL in Colorado) or as specific dollar amounts (e.g., NY allows gross income up to $79,284 for an individual in 2025).

States often use special income counting rules that disregard a portion of earned income.

Meeting Resource Limits

While some asset limits may apply, they are typically much higher than those for other disability-related Medicaid categories. For example, Alaska’s limit is $10,000 for an individual ($15,000 couple), while New York’s is $32,396 ($43,781 couple) in 2025.

Critically, many Buy-In programs do not count retirement savings like IRAs or 401(k)s toward the resource limit, further supporting work and long-term financial planning.

Many, though not all, Buy-In programs require participants to pay a monthly premium based on their income, often using a sliding scale. For example, Ohio requires premiums for those with income over 150% FPL, while Colorado has a tiered premium structure based on income relative to FPL. Some states, like New York, may currently have a temporary halt on collecting premiums.

Medicaid Buy-In coverage can often supplement other insurance, like Medicare or employer-sponsored plans, helping to cover costs or services the other insurance doesn’t.

These programs represent a vital policy tool, acknowledging that standard eligibility rules could inadvertently discourage work for people with disabilities. By adjusting income and asset rules and incorporating premiums, Buy-Ins aim to make work and health coverage compatible.

If you have a disability and are working or considering work, checking your state Medicaid agency’s website for details about a potential Buy-In program is highly recommended.

Can My Children Get Medicaid/CHIP Even if My Job Income is Too High for Me?

Yes, this is a very common scenario. Children in a working family often qualify for Medicaid or the Children’s Health Insurance Program (CHIP) even when their parents’ income is too high for the parents themselves to be eligible for Medicaid.

This is possible because states have established significantly higher income eligibility limits for children compared to adults. While adult eligibility (especially for parents in non-expansion states or even expansion adults) might cap at 138% FPL or lower, children’s eligibility often extends much higher.

Federal law requires states to cover children through Medicaid up to at least 133% FPL (effectively 138% with disregards), but nearly all states go well beyond this minimum. Many states cover children in families with incomes up to 200% FPL, 250% FPL, 300% FPL, or even higher through a combination of Medicaid and CHIP.

Eligibility is based on the child’s status and the household’s MAGI compared against the children’s income standards for that state.

What is CHIP?

The Children’s Health Insurance Program (CHIP) works closely with Medicaid and is specifically designed to provide low-cost, comprehensive health coverage for children (and in some states, pregnant individuals) in families who earn too much to qualify for Medicaid but cannot afford private insurance.

Like Medicaid, CHIP is administered by states within federal guidelines. Benefits are comprehensive, covering services like:

• Doctor visits
• Immunizations
• Hospital care
• Dental and vision care
• Prescriptions

Depending on the family’s income level, CHIP coverage might be free, or it might involve low monthly premiums and/or co-pays.

Examples of Children’s Income Limits

The income limits for children vary by state. Here are a few examples (note that specific $ amounts change annually with FPL updates):

These examples clearly show that children can often qualify for coverage at income levels well above where adult eligibility ends. This reflects a strong policy focus on ensuring children have access to health care, recognizing that even if parents are working, affording family coverage can be challenging.

Therefore, parents should always apply for their children, regardless of their own perceived eligibility based on their job income. Applying through the Health Insurance Marketplace (Healthcare.gov) or directly with the state agency will automatically assess children for both Medicaid and CHIP.

How Can I Check if I Might Qualify? Tools and Resources

Figuring out Medicaid eligibility can feel daunting given the varying rules. While the only way to get a definitive answer is to formally apply, several online tools and resources can help you get a preliminary idea of whether you or your family members might qualify.

Healthcare.gov Tools

The federal Health Insurance Marketplace website, Healthcare.gov, offers resources that screen for potential Medicaid and CHIP eligibility alongside Marketplace plans:

Eligibility & Savings Screener: This tool asks for your state, household size, and estimated annual household income to provide a quick check on whether you might qualify for Medicaid, CHIP, or savings (premium tax credits) on a Marketplace plan. You can access it directly here: Healthcare.gov Savings Screener

Full Marketplace Application: Completing a full application on Healthcare.gov serves as a formal screening process. Based on the information you provide (income, household size, state, etc.), the system determines potential eligibility for all programs.

If it appears anyone in your household qualifies for Medicaid or CHIP, the Marketplace securely transmits your application information to your state’s Medicaid agency for a final determination and enrollment.

State Medicaid Agency Websites

Because Medicaid is administered at the state level, your state’s official Medicaid agency website is the most authoritative source for detailed, state-specific information. These websites provide:

• Precise eligibility requirements for all available Medicaid programs in your state
• Details on covered benefits
• Information about specific state programs, like Medicaid Buy-In for working people with disabilities
• Access to the state’s own online application portal (if available)
• Contact information for state and local offices

You can find your state’s Medicaid agency contact information and website through the official directory on Medicaid.gov or via the state program finder on USA.gov.

Here are links to the primary Medicaid agency websites for several states:

Other Helpful Resources

InsureKidsNow.gov: Operated by HHS, this site provides specific information about Medicaid and CHIP for children and teens, including state-specific program details and contacts. Visit InsureKidsNow.gov.

Local Assistance: Healthcare.gov offers a tool to find local assisters (sometimes called Navigators or Certified Application Counselors) who provide free, impartial help with understanding options and completing applications. Find help at Healthcare.gov/find-assistance.

While federal portals like Healthcare.gov offer convenient starting points and screening, the state-specific nature of Medicaid means that engaging directly with your state’s agency website or local resources is crucial for getting the most accurate information.

How Do I Apply for Medicaid? General Steps

Applying for Medicaid or CHIP can be done at any time of the year. Unlike the Health Insurance Marketplace, there is no restricted “Open Enrollment” period for these programs. If your circumstances change and you become eligible, you can apply immediately.

There are several common ways to submit an application:

Online via the Health Insurance Marketplace (Healthcare.gov)

This is often the fastest way. Create an account or log in at Healthcare.gov and complete the application. The system will assess eligibility for both Marketplace plans with savings and Medicaid/CHIP.

If you appear eligible for Medicaid/CHIP, your information will be securely transferred to your state agency.

Online Directly with Your State Medicaid Agency

Most states offer their own online application portals accessible through their official Medicaid websites (found via links in the section above). Examples include Pennsylvania’s COMPASS or North Carolina’s ePASS.

By Phone

You can apply over the phone by calling the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) or by calling your state Medicaid agency’s helpline.

By Mail

Paper applications can usually be downloaded from Healthcare.gov or your state Medicaid agency’s website. Completed forms are mailed to the designated state or local county office.

In Person

You can typically apply in person at your local county social services or human services office (often called County Assistance Office (CAO) or Department of Social Services (DSS)). Some hospitals and federally qualified health centers may also offer application assistance.

Information Typically Needed

While specific requirements vary by state, be prepared to provide the following information for yourself and household members applying for coverage:

• Full legal names and dates of birth
• Social Security Numbers (SSNs) (if available; providing SSNs helps verify income and speeds processing)
• Home and mailing addresses
• Information about job and income sources (e.g., pay stubs, W-2 forms, tax return information)
• Information about citizenship or eligible immigration status (documentation may be required if not verifiable electronically)
• Policy numbers for any current health insurance coverage
• Information about any job-related health insurance available to the household

If applying under non-MAGI rules (e.g., based on disability or age 65+), you may also need to provide information about assets and resources (bank accounts, stocks, property other than your home, etc.).

After You Apply

Once submitted, your application will be reviewed by your state Medicaid agency. They will contact you if they need additional information or verification documents. You will receive a formal notice indicating whether you (or your family members) are eligible and when coverage begins.

In some situations, Medicaid coverage can be retroactive for up to three months prior to the application date if you were eligible during that time and had medical expenses.

It is advisable to wait for this final eligibility determination before canceling any existing coverage, such as a Marketplace plan, to avoid a potential gap in coverage.

Applying for Medicaid involves providing detailed personal information, but multiple application methods offer flexibility. Preparing necessary documents in advance can help ensure a smoother process. Remember, having a job does not exclude you, and exploring your eligibility is worthwhile for potentially securing affordable health coverage.

Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.