New York Medicaid income limits 2025
Last verified: June 2026
Figures reflect January 2025 federal poverty guidelines (GIS 25 MA/01)
Income limits for adults (ages 19–64) under ACA expansion
New York expanded Medicaid under the ACA. Adults 19–64 qualify at 138% of the Federal Poverty Level (FPL). The table below uses the 2025 federal poverty guidelines as published in the NY DOH income standards document (GIS 25 MA/01, rev. November 27, 2024).
| Household size | Annual limit (138% FPL) | Monthly limit |
|---|---|---|
| 1 person | $20,783 | $1,732/mo |
| 2 people | $28,208 | $2,351/mo |
| 3 people | $35,632 | $2,970/mo |
| 4 people | $43,056 | $3,588/mo |
| 5 people | $50,481 | $4,207/mo |
| 6 people | $57,905 | $4,826/mo |
| 7 people | $65,330 | $5,445/mo |
| 8 people | $72,754 | $6,063/mo |
Source: NY DOH GIS 25 MA/01, Attachment 1 — New York State Income and Resource Standards for MAGI Population, effective January 1, 2025 (rev. November 27, 2024). Add $7,425/year per additional person above 8.
Income limits by coverage group (2025)
| Coverage group | FPL threshold | Monthly limit (1 person) |
|---|---|---|
| Adults 19–64 (ACA expansion) | 138% FPL | $1,732/mo |
| Pregnant individuals | 223% FPL | $2,799/mo |
| Children under 1 year | 223% FPL | $2,799/mo |
| Children ages 1–5 | 154% FPL | $1,933/mo |
| Children ages 6–18 (Medicaid) | 138% FPL | $1,732/mo |
| Children under 19 (Child Health Plus/CHIP) | Up to 400% FPL | See CHIP page |
| SSI recipients | SSI limit | Automatic eligibility |
| Medicaid Buy-In for Working People with Disabilities (MBI-WPD) | 250% FPL | $3,138/mo |
| Essential Plan (not Medicaid — see note) | 139%–250% FPL | ~$1,733–$3,138/mo |
Source: NY DOH GIS 25 MA/01 (MAGI and Non-MAGI tables), effective January 1, 2025. Essential Plan figures are approximate; exact thresholds set by NY State of Health annually.
What happens if your income is over 138% FPL?
Adults with income between 139% and 250% FPL do not qualify for Medicaid but can enroll in New York's Essential Plan through NY State of Health. Premiums are $0 or $20/month depending on income level. The Essential Plan covers most medical, behavioral health, and pharmacy needs — it is not Medicaid, but it substantially reduces out-of-pocket costs for this income band.
Adults above 250% FPL can purchase qualified health plans through NY State of Health with premium tax credits, depending on income. No state-level coverage bridge exists above 250% FPL.
Pregnancy coverage extends to 223% FPL — higher than the adult standard
Pregnant individuals in New York qualify for Medicaid up to 223% FPL, a significantly higher threshold than the standard adult rate of 138% FPL. A single pregnant person earning up to $2,799/month (as of January 2025) qualifies. Coverage continues through the end of the month in which the 60th day post-delivery falls, regardless of income changes after delivery.
The newborn receives guaranteed Medicaid eligibility for one full year if the mother was enrolled at delivery. Hospitals can make presumptive eligibility determinations for pregnant individuals on-site, enabling coverage to begin before the formal application is processed.
No asset test for most New York Medicaid — long-term care is different
How income is counted: MAGI rules
New York uses Modified Adjusted Gross Income (MAGI) for most Medicaid programs — the same methodology as ACA marketplace coverage. Because there is no asset test, savings accounts, a home, and vehicles are not counted.
Counts as income (MAGI)
- Wages, salaries, tips
- Self-employment net income
- Unemployment compensation
- Social Security (taxable portion)
- Capital gains and dividends
- Alimony received (pre-2019 divorces)
Does not count as income (MAGI)
- Child support received
- SSI payments
- Veterans' disability compensation
- Gifts and inheritances
- SNAP/food stamps benefits
- Workers' compensation
Long-term care Medicaid (nursing home, MLTC) uses a different Non-MAGI track with a resource limit of $31,175 for a single person. The MAGI no-asset-test rule does not apply to LTC applications.
New York's full coverage ladder: Medicaid to marketplace
New York is unusual in having a near-seamless coverage ladder from $0 to well above the ACA marketplace subsidy range. The Essential Plan eliminates most of the gap other states have at the 138% FPL cliff.
| Income range (single adult) | Program | Monthly cost |
|---|---|---|
| $0 – $1,732/mo (138% FPL) | New York Medicaid | $0 |
| $1,733 – $2,202/mo (139–175% FPL) | Essential Plan | $0 |
| $2,203 – $3,138/mo (175–250% FPL) | Essential Plan | $20/mo |
| $3,139+/mo (above 250% FPL) | Marketplace plans (ACA subsidies may apply) | Varies |
Approximate 2025 figures for a single adult. Essential Plan is not Medicaid — it does not provide LTC benefits or the same MLTC pathway. Apply at nystateofhealth.ny.gov for any of these programs.