What Are the Medicaid Eligibility Requirements?

Medicaid provides healthcare coverage to various groups, including low-income individuals and families. Determining your Medicaid eligibility can be complex, but understanding the basics can help you navigate the process. As such, here is a comprehensive list of the key eligibility requirements for Medicaid.


Your Medicaid Eligibility Can Depend On:

Specific coverage criteria depend on the state that you live in. Generally, your eligibility status depends on several factors, including:


1. Your Income

A primary factor in determining eligibility for Medicaid is your income level. The income thresholds vary by state and depend on various factors, such as the size of your household. Typically, your income must be below a certain percentage of the Federal Poverty Level (FPL). In Oklahoma, income eligibility is determined by calculating a household’s Modified Adjusted Gross Income (MAGI).


2. The Size of Your Household

Your household size directly impacts your Medicaid eligibility. This includes everyone living in your home, related or not, who you financially support or who supports you. This total number helps determine the income threshold applicable to you.


3. Your Citizenship and Residency Status

To qualify for Medicaid, you must be a U.S. citizen or a qualified non-citizen. Additionally, you need to be a resident of the state where you are applying for Medicaid.


4. If You Are Pregnant

Pregnant women are often eligible for Medicaid due to the increased need for medical care during pregnancy and childbirth. States typically have specific income thresholds for pregnant women to ensure they receive the necessary prenatal and postnatal care.


5. Your Age and Disability Status

Medicaid eligibility can also depend on age and disability status. Certain groups, such as children, elderly adults, and individuals with disabilities, have specific eligibility criteria. For instance, children under 19 often have different income limits compared to other groups.


Who Accepts Medicaid?

Once you qualify for Medicaid, you have access to a range of healthcare services. Not every medical provider accepts Medicaid. However, you can always access quality care at a Community Health Center.

Community Health Centers (CHCs) play a crucial role in ensuring that Medicaid recipients receive high-quality, affordable healthcare. Every Community Health Center accepts a variety of coverage options, including Medicaid, as well as those without insurance. These centers provide essential services, which can include primary care, dental and vision care, and even substance abuse treatment.


What to Do If You Do Not Qualify for Medicaid

If you are not eligible for Medicaid, there are other healthcare coverage options and resources available to Oklahoma residents. If you do not qualify, consider reaching out to organizations and programs such as:


1. Insure Oklahoma

This program helps employers provide health insurance to their employees. It is designed to bridge the gap for those who are working but still struggling to afford healthcare.


2. Health Insurance Marketplace

Through the Health Insurance Marketplace, you can discover various plans that fit your income and needs.


3. MyOKPlan

MyOKPlan provides assistance and resources to help you choose the right health insurance plan for your needs and income. It is a valuable resource for individuals who do not meet the eligibility criteria for Medicaid but still need affordable coverage.



Our team at the Oklahoma Primary Care Association would be happy to assist you in discussing your coverage options and guide you toward a CHC in your community, even if you do not have insurance.


Find Quality Healthcare for You and Your Family

If you are unsure about your eligibility for Medicaid, the Oklahoma Primary Care Association would love to help. We are committed to improving the health outcomes of Oklahoma communities by helping you find affordable and accessible healthcare. We can assist you in understanding the Medicaid requirements, the application process, and finding a provider that accepts Medicaid in your community. Likewise, our team would be happy to walk you through other coverage options if Medicaid is not an option.

Our network of member CHCs in Oklahoma is ready to provide comprehensive care, regardless of your financial and insurance status. Use our interactive map to find a Community Health Center near you, or reach out for guidance and support in navigating your healthcare options.