Who Qualifies for Medicaid?

In this article...
  • Learn about eligibility requirements for Medicaid and what happens if you qualify for Medicaid but don't want it. Find out when you can decline Medicaid.

Medicaid provides valuable benefits to millions of Americans who are unable to afford other healthcare. People must meet low-income requirements to be eligible for Medicaid. In many states, they must also qualify by age, disability or pregnancy. 

Income Requirements 

Medicaid income requirements are based on household size and household income. A person with a larger household can generally have a higher income and still qualify for benefits. A household usually consists of a tax filer, their spouse and any dependents. 

Income limits are set by each state based on a percentage of the federal poverty level (FPL). Because the limits are different in every state, you'll need to find out if your income and household size qualify in the state where you live. 

For example, to qualify for Medicaid in Indiana:

  • A single adult can have an income of no more than $17,774
  • A family of three can have an annual income of no more than $30,304
  • A family of three with an income between $30,304 and $87,840 won't qualify for Medicaid, but may qualify for lower premiums under the Affordable Care Act

Status Qualifications

Currently, many states have expanded Medicaid programs. In these states, residency and income are the only requirements to be eligible for benefits. That means even single adults without disabilities can obtain Medicaid.

In other states, applicants must also meet other requirements to enroll in Medicaid. Many states only make Medicaid benefits available to the following groups:

  • People with disabilities or certain chronic illnesses
  • Pregnant women
  • Children
  • Families with young children 

In these states, healthy adults may need to purchase their own plan regardless of income. 

I Qualify for Medicaid But Don't Want It 

Not everyone who qualifies for Medicaid wants the benefits, but there are some important things to consider before opting out. 

People have various reasons for not wanting Medicaid even though they qualify:

  • They believe they will only meet the low-income requirements for a short time and don't want the hassle of having to switch to other insurance.
  • They would prefer to get private insurance.
  • They don't want to deal with perceived administrative hassles of enrolling in Medicaid.
  • They don't want to accept government assistance.

In most cases, you don't have to accept Medicaid benefits, but there are some things to consider before declining. Medicaid can help you avoid massive medical bills if you get sick or are in an accident. Some people don't want Medicaid because they think they won't need it for long. However, if an employment opportunity falls through or you can't get private insurance as planned, you may be left without healthcare. 

You can usually have Medicaid and private insurance, so long as you otherwise qualify for Medicaid. Medicaid may cover services that the private plan won't, but you must pay for expenses associated with your private health insurance. When combined with other coverage, Medicaid is typically the "payer of last resort," which means the private insurance company must be billed first. 

Can You Decline Medicaid? 

You can decline Medicaid if you qualify for benefits but don't want them. You can purchase a private plan on the marketplace, but most people who qualify for Medicaid find paying for private health insurance challenging. You should also be aware that declining Medicaid won't let you get tax credits or reductions to use on a different insurance policy. 

There is no longer a federal penalty for not having health insurance. You can decline Medicaid coverage and not buy another plan without worrying about a federal penalty. However, some states impose penalties on those without health insurance. You may want to check if your state will impose a tax penalty or fee if you don't have insurance. 

How Do I Cancel My Medicaid?

If you end up with Medicaid coverage that you don't want, you can contact your state's health care department to cancel. Alternatively, you can visit your state's health insurance marketplace website to cancel online. Medicaid often requires a change in circumstances, like obtaining other health insurance, to cancel. But sometimes you may be able to cancel just because you no longer want Medicaid. 

Medicaid HMO plans are more difficult to cancel. If you're automatically enrolled in one of these plans, you will probably need to cancel within 90 days or for a qualifying reason. 

You'll want to select the correct date for coverage to end. If you're switching to a private plan, select dates to avoid a coverage gap. Remember that you are responsible for reporting changes in circumstances that affect your Medicaid eligibility. Confirmation of your cancellation will be sent in the mail.