Eligibility

To qualify for Medicaid, children must meet certain eligibility rules. These include:

Income	State Medicaid programs must cover certain “mandatory” populations, including children under age 6 with family incomes below 133% of the federal poverty level (FPL) and children ages 6-18 with family incomes below 100% of the FPL (see federal poverty guidelines). States, however, have broad flexibility to expand Medicaid eligibility beyond the federal minimum standards. States can also establish an asset or resource requirement for children, but they have the option to eliminate it.
Age	States must cover children up to 18 years of age. States have the option to cover 19 and 20 year olds.
Insurance Status	Children generally do not have to be uninsured to obtain Medicaid coverage. Any private insurance an individual has is treated as a third party payer and is liable for the cost of care provided to the individual under the terms of the private plan. Medicaid "wraps around" the private insurance, providing care that otherwise would be uncovered and keeping cost sharing charges to the level allowed in Medicaid.
Citizenship/ Immigration Status	Medicaid covers citizens and certain legal immigrants. Federal funds may not be used to cover undocumented children (except for emergency or pregnancy-related services) or lawfully present immigrant children who have not been in the country for five years (with exceptions for refugees). Some states use state funding to provide coverage to legal immigrant children, no matter when they entered the country, and to children regardless of immigration status.
Renewal	Federal law generally requires states to review eligibility circumstances at least every 12 months. States can either review eligibility when financial circumstances change or they can enroll children for periods of up to 12 months, regardless of changes in income, through a continuous eligibility option.
Documentation	States have discretion in requiring families to provide documentation of income or other eligibility requirements. The only eligibility criteria that federal law requires families to document are citizenship and immigration status. States, however, are responsible for checking the accuracy of information through administrative means if it is not documented by families.
Parents and Adults	States must provide coverage to pregnant women with family incomes below 133% of the FPL and parents with incomes below states’ July 1996 welfare eligibility levels (often below 50% of the FPL). States have discretion to provide coverage to these groups above the minimums. Adults who are not disabled, pregnant, or elderly, and have no minor children generally cannot qualify for Medicaid.

See the CMS Directive page which provides details on new restrictions placed on states increasing coverage to children in families with income above 250% of the federal poverty level.