Non-disabled adults

Eligibility

Parents and caretaker relatives with dependent children are eligible for Medicaid, although typically at low-income thresholds that are often tied to historic eligibility standards for cash assistance. Under the welfare reform law of 1996, the link between Medicaid and cash assistance for families with children was severed. Today, Medicaid eligibility for these families is based on specified income standards—generally those that were in effect for cash assistance as of July 16, 1996, with state options to be more or less restrictive.  Click here for income eligibility levels for non-aged, non-disabled, non-pregnant adults.

Prior to the enactment of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), nondisabled adults without dependent children were generally excluded from Medicaid unless the state covered them under a Section 1115 waiver. The ACA extended Medicaid eligibility to all adults under age 65 (including parents and adults without dependent children) with incomes below 133 percent FPL.1 However, the Supreme Court ruling in June 2012 effectively made the expansion an option for states. As shown on this map, as of May 2018, 33 states and the District of Columbia have chosen to adopt the adult expansion, some through alternative approaches using Section 1115 waivers.  States can use these waivers to implement additional changes in Medicaid policies for newly eligible and other non-disabled adults including:

TABLE 1. Eligibility Pathways for Low-income Parents and Other Adults without Disabilities

Eligibility group Federal statutory and regulatory requirements State plan options
Parents and caretaker relatives Low-income families (also known as Section 1931 or AFDC-related coverage)

  • Parents and caretaker relatives must be covered up to the state’s 1996 AFDC level.

Transitional Medical Assistance (TMA)

  • States must cover families who would lose Medicaid because an increase in hours or earnings puts them above Section 1931 eligibility levels.
  • Families with incomes below 185 percent FPL receive TMA for 6 to 12 months.
Parent/caretaker relative coverage options

  • Other optional parents and caretaker relatives can be covered at higher income levels.
Adults without dependent children New adult group

  • Adults under age 65 without dependent children and parents who are not eligible under Section 1931, and who are not pregnant, and not eligible for Medicare with incomes up to 133 percent FPL.
  • Although this group appears as a mandatory population in the statute, the Supreme Court ruling in NFIB v. Sebelius effectively made coverage of this group optional for states.
Notes: FPL is federal poverty level. Aid to Families with Dependent Children (AFDC) is the cash assistance program that was replaced by Temporary Assistance to Needy Families (TANF) in 1996. ACA is Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended).
Source: MACPAC, 2017, Federal Requirements and State Options: Eligibility.

States may also choose to cover individuals with specific health needs. For example, states can provide Medicaid to individuals in need of treatment for breast or cervical cancer, with incomes up to 250 percent FPL. As of September 2016, all states and the District of Columbia have taken up this option (CDC 2017). States may also choose to cover family planning services and supplies for individuals who are not otherwise eligible for Medicaid with incomes up to the standard used for pregnant women in Medicaid or CHIP . Fifteen states have adopted this option, while an additional 12 states continue to provide these services and supplies under a Section 1115 waiver (Guttmacher 2017).

For more on Medicaid eligibility, see Federal Requirements and State Options: Eligibility

Learn more about policy issues affecting this population:

1The ACA also set a single income eligibility disregard equal to 5 percentage points of the FPL. For this reason, eligibility is often referred to at its effective level of 138 percent FPL, even though the federal statute specifies 133 percent FPL.