Medicaid Eligibility

Medicaid is a health insurance program for certain groups of people based on both financial and non-financial criteria.

There are multiple Medicaid plans and programs that cover specific needs, people, families, and more. Most programs have specific eligibility and income limits or guidelines. In addition, many specific Medicaid services and care programs have additional eligibility.

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People Who Qualify

You may qualify for a free or low-cost program even if you earn as much as $97,000 a year for a family of four. 

  • A child under the age of 21.
  • A parent living with a child under the age of 18.
  • A woman who is pregnant
  • A child in foster care, subsidized guardianship, or subsidized adoption (up to age 21).
  • A child formerly in foster care.
  • A person in need of treatment for breast or cervical cancer or its precancerous conditions
  • A person who is elderly (age 65 or older)
  • A person who is disabled according to Social Security standards.
  • An adult between the ages of 19 and 64 and whose income is at or below 133% of the FPL.
  • A person who is blind or disabled.
  • A person who is a resident of Iowa and a U.S. citizen or qualified alien; non-qualified aliens may be eligible for limited Medicaid for emergency services only.
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Eligibility by Population

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Special Circumstances 

Some circumstances may impact eligiblity for Medcaid programs. These include:

Presumptive Eligibility

Presumptive Eligibility (PE) provides Medicaid coverage for a limited time while HHS makes a formal Medicaid eligibility determination. The goal of the PE process is to offer immediate healthcare coverage to people likely to be Medicaid eligible, before there has been a full Medicaid determination. 

PE is based on a household’s statements regarding their circumstances and income. A qualified entity* enters the applicant’s information into the Medicaid Presumptive Eligibility Portal to determine if the applicant qualifies. If determined to be eligible, the applicant will have temporary Medicaid eligibility during the PE period.

Individuals who may be eligible for PE include: 

  • Children under 19
  • Pregnant women
  • Parents and caretakers of children under 19
  • Adults aged 19-64
  • Former foster care children under age 26
  • Individuals screened and diagnosed through BCCEDP and needing treatment for breast or cervical cancer

Incarcerated Individuals 

Incarcerated individuals are only eligible for Medicaid when they are admitted to a non- correctional facility medical institution, such as a hospital. Payment is limited to inpatient hospital services only.

Non-citizens 

Non-citizens may be Medicaid eligible, with certain immigration status. The following list outlines those details. More details about eligible immigration status from CMS can be found online for adults and children.  

Qualified Non-citizens

  • Child under 21 lawfully present in the U.S.
  • Asylee
  • Refugee
  • Cuban or Haitian entrant
  • Conditional entrant granted pre-1980
  • Trafficking victim and spouse, child, sibling, or parent or person with pending application for trafficking victim visa
  • Granted withholding of deportation
  • Member of a federally recognized Indian tribe or American Indian born in Canada
  • Compacts of Free Association (COFA) States of the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia

Unqualified Non-citizens

At all ages: 

  • Undocumented alien in the U.S. without papers or status documentation 

Only at age 21 or older: 

  • Lawful permanent residents do not have eligible immigration status for five years.
  • Battered non-citizen, spouse, child, or parent do not have eligible immigration status for five years.
  • Paroled into the U.S. for at least one year do not have eligible immigration status for five years.
  • Non-qualified alien lawfully admitted to the U.S. in any other alien status.
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