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Benefits for Young People

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    Benefits for Young People

    Medicaid Eligibility for Young People

    Medicaid helps people with low income pay for their visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services.

    Medicaid's eligibility rules depend on whether you are:

    How to apply for Medicaid

    You can apply for Medicaid:

    If you use an application form, you can also apply for other benefits at the same time, such as Adult Public Assistance (APA), SNAP (formerly Food Stamps), and the Alaska Temporary Assistance Program (ATAP). If you apply for Medicaid online, you have to apply for other benefits separately.

    Medicaid if You Are 18 or Younger

    If you are 18 or under, you may qualify for Medicaid if:

    1. Your family has low income, regardless of whether you have a disability, or
    2. You have a disability and low resources, and your family has low income.

    Income-Based Medicaid

    Whether or not you have a disability, when you apply for Medicaid, Medicaid will first check to see if you qualify for health coverage based on your household's Modified Adjusted Gross Income (MAGI).

    If you are 18 or younger and your family’s income is at 208% of the Federal Poverty Guidelines (FPG) or less ($6,761 per month or less for a family of four), you may qualify for Medicaid, which is also called Denali KidCare (DKC). It doesn't matter how much your family has in resources.

    Check whether your family's income is low enough for you to get Denali KidCare (DKC) Medicaid coverage:

    Health Coverage Income Limits for Your Family
    Is the income limit for Denali KidCare (DKC) 203% or 208% of FPG?

    You may see the children's income limit for Denali KidCare (DKC) listed as 203% of the Federal Poverty Guidelines (FPG). However, when Medicaid counts your income, they’ll knock 5% of FPG off your household income if you make more than 203% FPG. That's why we say that you can make up to 208% of FPG, because it more accurately shows how much income you could have and still get Denali KidCare (DKC) coverage if you are under 19.

    Disability-Based Medicaid

    If you don't qualify for income-based Medicaid, Medicaid checks to see if you qualify for Medicaid based on having a disability. The eligibility rules for disability-based Medicaid are more complicated than for income-based Medicaid.

    If you are 18 or younger, there are two main ways you can qualify for disability-based Medicaid. One way is if you already get Supplemental Security Income (SSI) benefits: by getting SSI, you have a disability that meets Medicaid's standards and you also have low enough income and resources. Note: You still have to apply for Medicaid, even if you get SSI.

    If you don't get SSI, you may still qualify for Medicaid based on a ruled call TEFRA that helps children 18 years old or younger who have high level of care needs. To get Medicaid this way, you must meet all of the following requirements:

    Getting Medicaid coverage through SSI 1619(b)

    If you get SSI, but then stop getting SSI benefits because your earned income goes up, a rule called 1619(b) lets you get Medicaid coverage automatically. With 1619(b), you can make up to $86,438 per year without losing your Medicaid.

    1619(b) means that you can get Medicaid while earning way more than the program’s normal income limit, but your resources have to stay below SSI’s $2,000 resource limit. If your resources go over that limit and you're 18 or older, look into the Working Disabled Medicaid Buy-In, which has a $10,000 resource limit ($15,000 for couples).

    Learn more about the Working Disabled Medicaid Buy-In.

    Medicaid if You Are 19 or Older

    If you are 19 or older, you may qualify for Medicaid if:

    1. Your family has low income, regardless of whether you have a disability, or
    2. You have a disability and low resources, and your family has low income (this way of qualifying is called "APA-related Medicaid").

    If you have a disability, work, and earn too much for Medicaid, you may qualify for the Working Disabled Medicaid Buy-In instead.

    Income-Based Medicaid

    If you are 19 or older and your household's Modified Adjusted Gross Income (MAGI) is 138% of the Federal Poverty Guidelines (FPG) or less ($2,164 per month or less if you are single), you may qualify for income-based Medicaid (also called "MAGI Medicaid"). It doesn't matter how much your family has in resources.

    If you are pregnant or gave birth within the last 12 months, you can have income up to 230% of FPG ($4,896 per month if you are single and pregnant with your first child; the baby counts as a family member according to Medicaid).

    Check whether your income is low enough for you to get income-based Medicaid:

    Health Coverage Income Limits for Your Family
    Is the adult income limit for income-based Medicaid 133% or 138% of FPG?

    You may see the adult income limit for income-based Medicaid listed as 133% of the Federal Poverty Guidelines (FPG) in some places. However, when Medicaid counts your income, they’ll knock 5% of FPG off your income if you make more than 133% of FPG. That's why we say that you can make up to 138% of FPG, because it more accurately shows how much income you could have and still get Medicaid. For pregnant women, this means we show 230% of FPG as the limit, rather than 225%.

    Learn more about income-based Medicaid for adults in DB101's How Health Benefits Work article.

    APA-Related Medicaid

    If you don't qualify for income-based Medicaid, Medicaid checks to see if you qualify for APA-related Medicaid. If you get Supplemental Security Income (SSI) or Adult Public Assistance (APA) benefits, you will qualify for APA-related Medicaid, because getting those benefits shows that you meet APA-related Medicaid's rules.

    But you may qualify for APA-related Medicaid even if you don't get SSI or APA. To qualify for APA-related Medicaid even though you don't get SSI or APA, you must:

    • Have a disability that meets the Social Security Administration's adult definition of disability
    • Have less than $2,000 in resources if you are single ($3,000 for couples)
      • Some resources don’t count towards APA-related Medicaid’s resource limit, like the home you live in and one car.
      • Money you have in an ABLE account is not counted as resources.
    • Have less than $1,751 per month in countable income if you're single ($2,593 for couples)
      • Most SSI income rules, such as the Student Earned Income Exclusion (SEIE) for students under the age of 22, also apply to Medicaid.
      • If you are living with others, some of their income may be counted when your application is reviewed for APA-related Medicaid.

    You can use DB101's Benefits and Work Estimator to see whether you qualify for Medicaid. If you live alone, get a quick estimate of your countable income for APA-related Medicaid:

    Your Countable Income:

    If you currently have APA-related Medicaid coverage and your income or resources go up, you may be able to switch to income-based Medicaid or to the Working Disabled Medicaid Buy-In.

    Learn more about APA-related Medicaid for adults in DB101's How Health Benefits Work article.

    Individual plans on HealthCare.gov

    If you don’t qualify for Medicaid or the Working Disabled Medicaid Buy-In, look into other health coverage options on HealthCare.gov. Learn more about private health insurance.

    Learn more

    Supplemental Security Income (SSI)

    SSI and Adult Public Assistance (APA) give cash benefits to people with disabilities and seniors who have low income and low resources.

    Disability-Based Medicaid

    Medicaid for people who have low income and low resources, and have a disability or are over age 65.

    Medicare

    Medicare is public health coverage for people with disabilities and seniors.