Medicaid income limits by household size (2025)

Last verified: June 2026

Medicaid income limits are tied directly to the Federal Poverty Level (FPL), a figure HHS publishes every January. In the 40 states plus DC that have expanded Medicaid under the Affordable Care Act, the standard cutoff is 138% of FPL — roughly $20,120 per year for a single adult in 2025. That number rises with household size. States that have not expanded Medicaid use narrower criteria, and most childless adults in those states do not qualify at all, regardless of income.

These limits apply only to MAGI-based groups: children, pregnant women, parents, and non-elderly adults. Seniors and people with disabilities follow separate rules — SSI income methodologies replace MAGI, and asset limits can apply. More on that below.

2025 FPL table: 100% and 138% thresholds

The table below shows the 2025 HHS poverty guidelines for the 48 contiguous states and DC, along with 138% FPL — the Medicaid expansion cutoff. Monthly figures are rounded to the nearest dollar.

Note: The 138% FPL threshold reflects ACA expansion language. The statute references 133% FPL, but a 5% income disregard built into federal rules effectively raises the threshold to 138% per CMS guidance.

How MAGI determines your countable income

For most Medicaid applicants, eligibility is based on Modified Adjusted Gross Income (MAGI). This is not the same number that appears on your tax return. MAGI starts with your adjusted gross income (AGI) and adds back three specific items: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.

Supplemental Security Income (SSI) payments are excluded from MAGI. Child support received is generally excluded too. Per healthcare.gov, MAGI-based rules apply to children, pregnant women, parents, and non-elderly adults — all groups evaluated under the ACA expansion framework.

One practical consequence: a retiree under 65 who lives on tax-exempt municipal bond interest might have very little taxable income, but that interest income still counts toward Medicaid eligibility under MAGI rules. Social Security retirement benefits are handled differently depending on whether they are taxable — the non-taxable portion gets added back into MAGI.

No asset test applies to MAGI-based groups. Per CMS rules, states cannot require children, pregnant women, or non-elderly adults to pass a resource or asset test as a condition of MAGI-based Medicaid eligibility. A family with significant savings but low income can qualify. This distinction matters — many applicants incorrectly assume their bank account will disqualify them.

Medicaid income limits in expansion vs. non-expansion states

In a non-expansion state, a 35-year-old with no children earning $14,000 per year would likely not qualify for Medicaid even though that income falls below the 100% FPL threshold. No Marketplace subsidy would be available either — the so-called "coverage gap" affects roughly 1.5 million people as of a 2024 KFF estimate. This is not a hypothetical edge case; it is the actual situation for a significant portion of low-income adults in those states.

Expansion states extended Medicaid to adults with income at or below 133% FPL (effectively 138% with the disregard). The federal government pays 90% of the cost for expansion adults — a matching rate built into the ACA that applies permanently for that population. States that have not expanded can still do so at any time, per medicaid.gov.

For children, the income floor is higher everywhere. The ACA requires all states to cover children to at least 133% FPL (138% with the disregard). Many states go well beyond that — for example, states operating CHIP programs typically cover children from families earning 200–300% FPL.

Income limits for seniors and people with disabilities

Adults aged 65 and older — and those eligible due to blindness or disability — are evaluated under SSI income methodologies, not MAGI. This means asset limits apply. The general resource limit for a single person is $2,000 in most states, though this figure varies by state and by program type.

For married couples where one spouse needs nursing facility care, federal law protects a portion of assets for the community spouse — the spouse remaining at home. The Community Spouse Resource Allowance (CSRA) allows the at-home spouse to retain up to $154,140 in countable resources in 2025, per CMS annual adjustments. States can set a lower floor of no less than $29,724.

Income limits for long-term care Medicaid are separate from the income limits used for regular adult Medicaid coverage. A person applying for nursing facility benefits who earns more than the income standard may still qualify through a spend-down or by using a Qualified Income Trust (also called a Miller Trust) in states that allow it. Without that mechanism, income above the limit disqualifies the applicant even if their care needs are severe.

So-called "209(b) states" — a reference to Section 209(b) of the Social Security Act — have the option to apply eligibility criteria that are more restrictive than current SSI rules but no more restrictive than the criteria in effect on January 1, 1972. About a dozen states have elected this option. It affects primarily the aged, blind, and disabled populations.

Medicaid spend-down: when your income exceeds the limit

Not qualifying based on income alone does not always mean no path exists. States may offer a "medically needy" program — often called a spend-down — that allows people with income above the Medicaid threshold to qualify once they incur enough medical expenses to bring their countable income down to the state's medically needy income standard.

Spend-down programs are not available in every state. As of 2025, about 35 states offer a medically needy pathway, but the income standards they use vary widely. Spend-down programs typically apply to seniors, people with disabilities, and sometimes children — not to the general adult population.

Example (hypothetical): A 70-year-old in a spend-down state has Social Security income of $1,800 per month. The state's medically needy income standard is $600 per month. To qualify, she must incur medical expenses totaling $1,200 per month — the difference — before Medicaid coverage activates for that period. Receipts from unpaid medical bills count toward meeting the spend-down obligation.

State-specific income limits: what to know before you apply

Federal rules set the floor. States set their own limits above that floor for various groups. Pregnant women routinely qualify at higher income levels than non-pregnant adults. Children's income thresholds are almost always higher than adult thresholds in the same state. Some states have obtained waivers to cover additional groups at higher incomes.

Ohio Medicaid covers adults to 138% FPL under expansion. Indiana expanded Medicaid through a Section 1115 waiver — the Healthy Indiana Plan — with income limits also set at 138% FPL but with additional requirements such as monthly contributions. Michigan Medicaid, known as MI Health Link and Healthy Michigan Plan, covers adults to 138% FPL. California's Medi-Cal eliminated the asset test for all groups in January 2024, making it one of the most accessible programs in the country regardless of savings.

The percentage thresholds are stable. The dollar amounts they translate to change each January when HHS publishes new poverty guidelines. The 2025 figures above are current. For 2026 determinations, HHS released updated guidelines in early 2026 — for a single-person household, 100% FPL rose to $15,960 per healthcare.gov. States began transitioning to those figures for Medicaid eligibility determinations in early 2026.

Always verify current limits directly with your state Medicaid agency before applying. The state pages on this site include program-specific information for each state's income thresholds and program names.

Retroactive Medicaid coverage and look-back rules

Medicaid can cover medical bills incurred up to three months before the month you apply, provided you would have been eligible during that period per CMS eligibility rules. This matters for people who receive significant medical care before they know they might qualify.

For long-term services and supports, a separate rule applies. Any transfer of assets for less than fair market value within the five years before applying for LTSS coverage can trigger a penalty period — a stretch of time during which Medicaid will not pay for nursing facility care. The length of the penalty period is calculated by dividing the value transferred by the average monthly cost of nursing home care in your state. This five-year look-back does not apply to regular Medicaid coverage for acute care.