Medicaid.
We do not sell Medicaid, and we will still tell you the truth about it. If you qualify, you should have it. If you do not, you should know what you can have instead.
Medicaid is a state program rather than a policy anyone writes, so no agent earns anything by pointing you toward it. That is precisely why the guidance you get about it is usually so poor. The rules differ enormously between states, they changed again this year, and most people who ask us about Medicaid discover they are looking at the wrong program entirely. Ten minutes here will tell you which one is actually yours.
Eligibility, and why your state decides it
Medicaid is funded jointly by the federal government and the states, but each state sets much of its own eligibility. That single fact explains why advice you read online so often does not match your experience: the same household can qualify comfortably in one state and not at all across the border.
The dividing line is whether your state expanded the program under the Affordable Care Act. Around forty states plus the District did. In those, any adult under sixty-five qualifies below roughly 138% of the federal poverty level, with no category test and no asset test.
Ten states did not expand. There, adults without dependent children generally cannot qualify at any income, and parents qualify only at thresholds frozen decades ago, in some states below a quarter of the poverty level. It is not a small difference. It is the difference between coverage and none.
The pathways most people never hear about
Adult income is only one route in. Children qualify at much higher incomes through Medicaid or CHIP, commonly two to three times the poverty level. Pregnancy has its own threshold, higher again, and it applies regardless of whether the state expanded. Eligibility linked to age, blindness or disability follows a separate pathway with its own limits and an asset test. Long-term care has yet another.
This is why a flat answer of "you earn too much" is so often wrong. The question is not whether you qualify. It is which door you were being measured against.
Nobody earns anything sending you here.
Which is exactly why so few people will take the time. If Medicaid is right for your household we will say so plainly and help you understand the process, and we will not have sold you anything. We would rather be the people who told you the truth.
See where I stand →New work requirements are being phased in
Federal law now requires adults aged nineteen to sixty-four who are covered through Medicaid expansion to complete at least eighty hours a month of work, job training, education or community service in order to keep their coverage.
States must implement this by the beginning of 2027, and several are starting considerably earlier. Exemptions exist for particular circumstances, and reporting requirements vary by state.
The practical consequence is that a number of households will lose Medicaid coverage over the next two years, many of them without expecting to. If that happens, the sixty-day window to move to a Marketplace plan begins immediately, and it is far easier to plan for than to react to.
Guidance with nothing riding on it.
There is no commission in Medicaid, so what you get here is simply an accurate answer. If it turns out you need something we do write, we will be glad. If not, you will still leave knowing where you stand.
We know your state
Thresholds, pathways and timing differ in every state and several changed this year. We work in all fifty and we keep track.
We check every pathway
Adult income is one route of several. Children, pregnancy, disability and long-term care each have their own, and each is checked.
We say it plainly
Including when the answer is that there is no good option. You will not be strung along to produce a sale that was never there.
We are here at renewal
With work requirements arriving, coverage will change for many households. Knowing in advance is worth a great deal more than reacting.
Medicaid, answered plainly
Who actually qualifies for Medicaid?+
It turns on three things: your household income measured against your state's threshold, your household size, and your immigration status. In the forty or so states that expanded the program, any adult under sixty-five qualifies below roughly 138% of the federal poverty level, with no asset test. In the ten that did not expand, adults without dependent children generally cannot qualify at any income at all.
What is the coverage gap?+
In non-expansion states, some people earn too much for Medicaid but under the federal poverty level, which is the floor for Marketplace subsidies. They qualify for neither. Roughly a million and a half people are in that position, and we will tell you honestly if you are one of them rather than pretend there is an easy answer.
Does MaliCare sell Medicaid plans?+
No. Medicaid is a state program and it is not something anyone sells. What we can do is tell you plainly whether you look likely to qualify, help you understand what your state asks for, and if you fall outside it, show you the coverage that does apply to you. That guidance costs nothing either way.
Do the new work requirements affect me?+
If you are an adult aged nineteen to sixty-four covered through Medicaid expansion, yes. Federal law now requires at least eighty hours a month of work, training, education or community service, with states phasing this in through the beginning of 2027 and several starting sooner. Exemptions exist for certain circumstances, and it is worth understanding yours before a renewal notice arrives.
I have a disability. Are the rules different?+
Yes, considerably. Eligibility linked to age, blindness or disability follows a separate pathway with its own income limit and, unlike expansion coverage, a strict asset test. Long-term care eligibility is different again. These pathways are worth walking through carefully with someone rather than reading a chart.
I earn slightly too much. What now?+
That is a better position than it sounds. Earning above the Medicaid threshold usually places you in the range where Marketplace subsidies apply, and the financial help there is substantial and largely unknown to the people entitled to it. It is worth seeing the actual numbers before assuming coverage is out of reach.
Can my children qualify even if I do not?+
Frequently, yes. Children's eligibility runs at much higher income levels than adults', through Medicaid or CHIP, commonly reaching two to three times the poverty level and higher in some states. A household where the parents are not eligible but the children are is very common, and worth checking.
What if I lose Medicaid coverage?+
Losing it opens a sixty-day Special Enrollment Period for Marketplace coverage, which is the door most people do not know exists. The important thing is not to wait: the window closes, and after it you would be uninsured until the next Open Enrollment. Come to us the day you receive the notice, not the day it takes effect.
ACA Marketplace Program
Four quick questions. Nothing here is a commitment, and we do not need personal details yet.
Where should we send your results?
A licensed MaliCare advisor will confirm your eligibility and walk you through the plans available in your county.
Your details are in good hands.
A licensed MaliCare advisor is reviewing your answers now and will reach out shortly to confirm your eligibility, answer every question, and complete the process with you.
Most people hear from us the same business day. Nothing is filed and nothing is final until you say so.