Medicaid Eligibility

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

If you get Supplemental Security Income (SSI) benefits or used to get SSI benefits and now qualify for SSI's 1619(b) status, you get Medicaid coverage automatically and do not need to worry about the eligibility information discussed here.

If you don't get SSI benefits, Medicaid's eligibility rules depend on whether you are:

You can apply for Medicaid:

For help with your application, visit or call your local county human services agency or call the Medicaid Beneficiary Help Line at 1-800-642-3195 or 1-866-501-5656 (TTY).

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 (this way of qualifying is called "SSI-related Medicaid").

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 217% of the Federal Poverty Guidelines (FPG) or less ($54,467 per year or less for a family of four), you may qualify for either Medicaid's Healthy Kids or MIChild program. It doesn't matter how much your family has in resources.

Check whether your family's income is low enough for you to get Medicaid coverage:

Health Coverage Income Limits for Your Family
Is the income limit for MIChild 212% or 217% of FPG?

You may see the children's income limit for MIChild listed as 212% 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 212% of FPG. That's why we say that you can make up to 217% of FPG, because it more accurately shows how much income you could have and still get MIChild coverage if you are under 19.

SSI-Related Medicaid

If you don't qualify for income-based Medicaid and don't get SSI benefits, Medicaid checks to see if you qualify for SSI-related Medicaid. The eligibility rules for SSI-related Medicaid are much more complicated than for income-based Medicaid.

To qualify, you must:

Because your countable income isn't the same as your total income, speak with a Benefits Planner to get an idea of whether you qualify for SSI-related Medicaid.

SSI, Medicaid, and DAC

When you turn 18, you may begin to get Disabled Adult Child (DAC) benefits. If this causes you to stop getting Supplemental Security Income (SSI), you can keep getting SSI-related Medicaid coverage through a special rule documented in the state's Bridges Eligibility Manual. If you are in this situation and you lose your Medicaid coverage, there may have been a mistake and you should talk to a Benefits Planner.

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 keep your automatic SSI-related Medicaid coverage. With 1619(b), you can make up to $36,552 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, look into Freedom to Work, which has a $7,560 resource limit when you apply (the limit goes up to $75,000 after your coverage starts).

Learn more about Freedom to Work.

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 "SSI-related Medicaid").

If you have a disability, work, and earn too much for Medicaid, you may qualify for Freedom to Work instead.

Income-Based Medicaid

If you are 19 or older and your household's Modified Adjusted Gross Income (MAGI) is 138% of FPG or less ($16,753 per year 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.

Note: If you are 21 or older and your household's income is between 100% of FPG and 138% of FPG, you may have to pay a small premium for income-based Medicaid (probably $26 per month or less). The Healthy Michigan Plan website has more information about premium (contribution) amounts.

If you are pregnant, you can have income up to 200% FPG ($32,920 per year 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 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 200% of FPG as the limit, rather than 195%.

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

SSI-Related Medicaid

If you don't qualify for income-based Medicaid, Medicaid checks to see if you qualify for SSI-related Medicaid. To qualify, 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 SSI-related Medicaid’s resource limit, like the home you live in and one car.
  • Have less than $1,012 per month in countable income if you're single ($1,372 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 SSI-related Medicaid.

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

Your Countable Income:

If you currently have SSI-related Medicaid coverage and your income or resources go up, you may be able to switch to income-based Medicaid or to Freedom to Work.

Learn more about SSI-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 Freedom to Work, look into other health coverage options on Healthcare.gov. Learn more about private health insurance.