Medicaid income limits determine whether a person or family may qualify for free or low-cost health coverage through Medicaid. However, there is no single Medicaid income limit that applies to everyone in the United States.
Medicaid eligibility depends on several factors, including your state, household size, household income, age, pregnancy status, disability status, and the type of Medicaid coverage you are applying for.
For many children, pregnant women, parents, and adults under age 65, Medicaid uses Modified Adjusted Gross Income (MAGI) rules to determine financial eligibility. States can have different Medicaid income limits for different eligibility groups.
This guide explains Medicaid income limits by state, household size, income level, and eligibility category, including how the Federal Poverty Level (FPL) is used to determine Medicaid eligibility.
Medicaid Income Limits at a Glance
Medicaid income limits are generally expressed as a percentage of the Federal Poverty Level (FPL) rather than as one fixed dollar amount.
For example, a state may set Medicaid eligibility for a particular group at 133% of the Federal Poverty Level. Another eligibility category in the same state may have a substantially higher or lower income limit.
The applicable income limit can therefore depend on whether the applicant is:
- An adult
- A child
- A pregnant woman
- A parent or caretaker relative
- Age 65 or older
- Blind or disabled
- Eligible through another Medicaid category
Most states have expanded Medicaid to cover many low-income adults under age 65, although Medicaid expansion rules differ between states.
What Is the Medicaid Income Limit?
The Medicaid income limit is the maximum amount of countable household income a person or family can generally have to qualify for a particular Medicaid eligibility category.
There is not one universal Medicaid income limit because Medicaid is administered jointly by the federal government and individual states.
Income limits can be based on:
- Federal Poverty Level percentages
- Modified Adjusted Gross Income (MAGI)
- State-specific income standards
- SSI-related income rules
- Medically needy or spend-down rules
- Other eligibility methodologies
The rules used for most children, pregnant women, parents, and adults are different from the rules used for people who qualify based on age, blindness, or disability.
Medicaid Income Limits by State
Medicaid income eligibility can vary significantly from one state to another.
The table below shows why it is important to check the specific eligibility category instead of relying on one nationwide income limit.
| State | Adult Medicaid Expansion | Children | Pregnant Women | Parent/Caretaker Rules |
|---|---|---|---|---|
| Alabama | No | Varies by age | State-specific | Very limited |
| Alaska | Yes | Higher income limits may apply | State-specific | State-specific |
| Arizona | Yes | Higher than adult limit | State-specific | State-specific |
| Arkansas | Yes | Higher than adult limit | State-specific | State-specific |
| California | Yes | Higher income limits | State-specific | State-specific |
| Colorado | Yes | Higher income limits | State-specific | State-specific |
| Connecticut | Yes | Higher income limits | State-specific | State-specific |
| Florida | No | Higher income limits | State-specific | Limited |
| Georgia | No | Higher income limits | State-specific | Limited |
| Illinois | Yes | Higher income limits | State-specific | State-specific |
| Louisiana | Yes | Higher income limits | State-specific | State-specific |
| Michigan | Yes | Higher income limits | State-specific | State-specific |
| New York | Yes | Higher income limits | State-specific | State-specific |
| North Carolina | Yes | Higher income limits | State-specific | State-specific |
| Ohio | Yes | Higher income limits | State-specific | State-specific |
| Pennsylvania | Yes | Higher income limits | State-specific | State-specific |
| Texas | No | Higher income limits | State-specific | Limited |
| Virginia | Yes | Higher income limits | State-specific | State-specific |
| Washington | Yes | Higher income limits | State-specific | State-specific |
| Wisconsin | No traditional expansion | Higher income limits | State-specific | State-specific |
The exact income percentage for each group can differ considerably. CMS publishes state-level Medicaid and CHIP eligibility standards showing separate income levels for children, pregnant women, parents and caretaker relatives, and adults.
Medicaid Income Limits by Household Size
Household size is an important part of determining Medicaid eligibility.
For MAGI-based Medicaid, household composition and income are evaluated under federal rules. Household size is then compared with the applicable income standard for the person’s eligibility category.
A larger household generally has a higher income threshold because the Federal Poverty Level increases as household size increases.
For example, a household of one person and a household of four people will not normally have the same Medicaid income limit.
Common searches include:
- Medicaid income limit for 1 person
- Medicaid income limit for 2 people
- Medicaid income limit for 3 people
- Medicaid income limit for 4 people
- Medicaid income limit for 5 people
- Medicaid income limit for 6 people
- Medicaid income limit for a family of 4
- Medicaid income limit for a family of 3
- Medicaid income limit for a family of 5
- Medicaid income limits by household size
How the Federal Poverty Level Is Used for Medicaid
The Federal Poverty Level (FPL) is an important part of Medicaid eligibility.
Instead of simply saying that someone qualifies if their income is below a certain dollar amount, Medicaid eligibility standards are often expressed as a percentage of the FPL.
For example:
100% FPL = the federal poverty guideline itself
133% FPL = 1.33 times the applicable federal poverty guideline
150% FPL = 1.50 times the applicable federal poverty guideline
200% FPL = twice the applicable federal poverty guideline
The percentage used depends on the Medicaid eligibility category and state.
This is why searches for Medicaid income limits by FPL, Medicaid 138% FPL, Medicaid 133% FPL, and Medicaid eligibility percentage of poverty level are commonly connected to Medicaid eligibility research.
Medicaid Income Limits for Adults
Adult Medicaid eligibility depends heavily on the state.
In states that expanded Medicaid under the Affordable Care Act, many adults under age 65 can qualify based primarily on income under the adult expansion category.
The standard is commonly associated with 138% of the Federal Poverty Level, although the actual eligibility calculation includes the federal 5% FPL income disregard and state-specific implementation.
States that have not adopted the expansion may have much more restrictive Medicaid eligibility rules for adults who are not elderly, disabled, pregnant, or caring for children.
This creates major differences in Medicaid eligibility from state to state.
Medicaid Income Limits for Children
Children can qualify for Medicaid at income levels that are considerably higher than the adult Medicaid limit in many states.
States establish different income standards based on the child’s age and the applicable Medicaid or CHIP category.
CMS data show separate eligibility standards for:
- Infants
- Children ages 1–5
- Children ages 6–18
- CHIP-eligible children
In many states, children with household income above the Medicaid limit may still qualify for CHIP (Children’s Health Insurance Program).
Therefore, being over the Medicaid income limit does not necessarily mean that a child has no access to government-sponsored health coverage.
Medicaid Income Limits for Pregnant Women
Pregnant women may qualify for Medicaid at higher income levels than adults applying under the standard adult Medicaid category.
Each state establishes its own income standard for pregnancy-related Medicaid coverage.
Pregnancy can also affect household size when determining MAGI-based eligibility. Federal Medicaid rules allow states to use specific methods for counting a pregnant household member and the children expected to be born.
This means that a pregnant applicant should not automatically use the standard household-size calculation used by another adult applicant.
Medicaid Income Limits for Seniors
Medicaid eligibility for people age 65 and older generally does not use the same MAGI methodology used for most children, pregnant women, and adults under age 65.
Instead, eligibility is generally determined using SSI-related methodologies, although states can have additional rules and, in some cases, more restrictive eligibility standards.
Seniors may also qualify for Medicaid through programs that help pay Medicare premiums and other Medicare cost-sharing expenses.
For this reason, a senior should not assume that the standard adult Medicaid income limit applies to their situation.
Medicaid Income Limits for People With Disabilities
People who qualify for Medicaid based on disability may also be subject to different income and resource rules.
MAGI generally does not apply to individuals whose Medicaid eligibility is based on being:
- Blind
- Disabled
- Age 65 or older
Instead, SSI-related or other non-MAGI methodologies may apply.
Some states also offer Medicaid programs for people with disabilities that have different income, asset, or medical eligibility requirements.
What Income Counts for Medicaid?
For most MAGI-based Medicaid categories, income is determined using federal tax-based rules.
MAGI is used for many Medicaid, CHIP, and Marketplace financial assistance determinations.
Depending on the individual’s circumstances, income that may be relevant can include:
- Wages
- Salaries
- Self-employment income
- Interest
- Dividends
- Capital gains
- Rental income
- Unemployment compensation
- Taxable Social Security income
- Certain other taxable income
The exact treatment of income can depend on the Medicaid category and applicable rules.
Self-Employment Income and Medicaid
Self-employed individuals should pay particular attention to how business income is calculated.
Medicaid generally does not simply use gross business revenue as household income under MAGI rules. Tax-based income calculations can affect the amount considered for eligibility.
Someone who operates a business, freelances, drives for a delivery company, sells online, or earns other self-employment income may therefore need to calculate income differently from an employee receiving a W-2.
Does Medicaid Look at Assets?
For most MAGI-based Medicaid eligibility groups, there is no asset or resource test under the MAGI methodology.
This is an important distinction between MAGI-based Medicaid and certain Medicaid programs for seniors or people with disabilities.
For example, the financial rules for an adult applying through a MAGI Medicaid category may be substantially different from the rules for an individual applying for Medicaid based on age or disability.
Medicaid Income Limit vs. CHIP Income Limit
Medicaid and CHIP are related but separate programs.
A child may be above the income limit for Medicaid but still qualify for CHIP because CHIP generally has higher income eligibility limits.
This is particularly important for families comparing:
Medicaid vs. CHIP income limits
Medicaid eligibility for children
CHIP income limits by household size
children’s health insurance income limits
Medicaid and CHIP eligibility
CMS publishes separate income standards for Medicaid and CHIP eligibility groups.
Medicaid Eligibility and Household Income
Household income is only one part of Medicaid eligibility.
Other factors can include:
- State residency
- Citizenship
- Qualified immigration status
- Age
- Pregnancy
- Disability
- Household composition
- Eligibility category
- Other program-specific requirements
Medicaid beneficiaries generally must be residents of the state where they receive coverage and must meet applicable citizenship or qualified immigration-status requirements.
Medicaid Income Limits and the 5% FPL Disregard
One reason Medicaid income limits can appear confusing is that MAGI-based Medicaid rules generally include a 5% Federal Poverty Level income disregard.
The published eligibility percentage and the effective income calculation can therefore appear different when someone compares Medicaid rules with a simple FPL calculation.
This is one reason it is better to use the state’s Medicaid eligibility system rather than assuming that multiplying the FPL by a percentage will produce the final eligibility decision.
Medicaid Income Limits Can Change
Medicaid income standards are not permanent.
Federal poverty guidelines are updated periodically, and states can also change their Medicaid eligibility policies through approved state plans, waivers, and other program changes.
As a result, a household that qualifies during one eligibility period may not necessarily have the same income limit in a later period.
This article is designed as a general guide to Medicaid income limits and eligibility rules. Always check the current rules for your state before applying or making a decision about health coverage.
How to Check Your Medicaid Eligibility
The most reliable way to determine whether you may qualify is to apply through your state’s Medicaid agency or the official health coverage application system.
When applying, you may need information about:
- Household members
- Household income
- Employment
- Self-employment
- Tax filing status
- Social Security numbers
- Immigration or citizenship status
- Current health coverage
- Pregnancy, disability, or age-related eligibility
The state Medicaid agency makes the official eligibility determination.
Medicaid Income Limits by State: Why the Numbers Are Different
The biggest reason Medicaid income limits differ across the country is that Medicaid is a joint federal-state program.
Federal law establishes required eligibility groups and gives states options for covering additional populations. States can therefore have different eligibility standards for adults, parents, children, pregnant women, and other groups.
For example, a household that exceeds the adult Medicaid income limit in one state may qualify in another state under that state’s eligibility rules.
This is why searches such as Medicaid income limits by state, Medicaid eligibility by state, and Medicaid income guidelines by state are important when researching coverage.
Medicaid Income Limits: Key Points
The most important things to remember are:
- There is no single Medicaid income limit for the entire country.
- Medicaid income limits vary by state and eligibility category.
- Household size affects the applicable income threshold.
- MAGI is used for many children, pregnant women, parents, and adults.
- Children often have higher Medicaid income limits than adults.
- Pregnant women may qualify at higher income levels.
- CHIP may cover children whose household income is too high for Medicaid.
- Seniors and people with disabilities generally use different financial eligibility methodologies.
- Most MAGI-based Medicaid groups do not have an asset test.
- State residency and other non-financial requirements also apply.
- Medicaid income limits and eligibility rules can change over time.
Because Medicaid rules and income standards can change, readers should verify current eligibility requirements with their state Medicaid agency before applying.