◢ Editor-reviewed guide
Medicaid Income Limits 2026: Federal Floor + State Variations + Auto-Qualify Paths
Verified 2026 Medicaid income limits by household size and category, expansion vs non-expansion state map, MAGI vs SSI rules, the 5 auto-qualify paths, and what to do if your income is just over the limit.
The short answer
The 2026 Medicaid income limit for working-age adults in the 40 expansion states (plus DC) is 138% of the Federal Poverty Level: about $1,836/month for a single person and $3,795/month for a family of four. Children, pregnant women, and seniors qualify under different rules with higher limits. 10 states have not expanded Medicaid and apply much lower limits, often shutting out childless adults entirely. Roughly 78 million Americans are enrolled in Medicaid or CHIP today. If denied, apply for healthcare.gov subsidies or your state's medically needy program. Most applications process within 45 days, and coverage can be backdated up to 3 months prior to your application date.
The 2026 Medicaid income limit for adults under 65 in expansion states is 138% of the Federal Poverty Level — about $1,800 per month for a single person and $3,700 per month for a family of four.
Children, pregnant women, and seniors qualify under different rules with higher limits. 10 states have not expanded Medicaid and apply much lower limits for childless adults, sometimes near zero. Roughly 78 million Americans are enrolled in Medicaid or CHIP today (Medicaid.gov).
This guide covers the verified 2026 limits by household size and category, the difference between MAGI Medicaid (working-age adults and families) and SSI Medicaid (seniors and disabled), state-by-state variation, the 5 paths to auto-qualify, and what happens if you go over the limit by a small amount.
The 2026 Federal Medicaid Income Limit (Floor)
For adults aged 19 to 64 in the 40 states (plus DC) that have expanded Medicaid under the Affordable Care Act, the income limit is set at 138% of the Federal Poverty Level (FPL). This is the federal expansion floor.
| Household size | Monthly limit (138% FPL) | Annual limit |
|---|---|---|
| 1 person | $1,836 | $22,032 |
| 2 people | $2,489 | $29,868 |
| 3 people | $3,142 | $37,704 |
| 4 people | $3,795 | $45,540 |
| 5 people | $4,448 | $53,376 |
| 6 people | $5,101 | $61,212 |
| Each additional person | +$653/mo | +$7,836/yr |
Source: 2026 HHS Federal Poverty Guidelines applied to Medicaid expansion (NJ FamilyCare 2026 chart; ASPE poverty guidelines). Limits are slightly higher in Alaska and Hawaii.
Income Limits by Category (Children, Pregnant, Parents, Adults)
Medicaid is not one program — it is a federal-state partnership with several eligibility doors. Each door has its own income limit, and you only need to qualify under one to be enrolled.
| Category | Federal floor | Most states cover up to |
|---|---|---|
| Infants 0-1 | 185% FPL | 200-260% FPL |
| Children 1-5 | 133% FPL | 150-260% FPL |
| Children 6-18 | 133% FPL | 138-260% FPL |
| Pregnant women | 138% FPL | 185-300% FPL |
| Parents with dependent children | varies (about 30-138% FPL) | 138-200% FPL |
| Adults 19-64 (expansion states) | 138% FPL | 138% FPL (the cap) |
| Adults 19-64 (non-expansion states) | varies (often below 50% FPL) | varies; some states zero for childless adults |
| Seniors 65+ and disabled (SSI) | SSI level: $994/mo single | often higher with state supplement |
Children and pregnant women always have the highest limits because of federal mandates. If you are over the income limit for adult Medicaid, your kids likely still qualify under CHIP — apply for them anyway through the same state portal.
Expansion vs Non-Expansion States: Why the Limit Varies
The Affordable Care Act of 2010 created an option for states to expand Medicaid coverage to all adults under 65 with income up to 138% FPL. As of 2026, 40 states plus DC have expanded, while 10 states have not.
The non-expansion states are: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In those 10 states, childless adults usually do not qualify for Medicaid at all, regardless of how low their income is. This is called the “Medicaid coverage gap.”
Parents in non-expansion states can still qualify, but the limit is much lower — sometimes 17% to 50% of FPL (for example, $323/month for a single parent in Alabama). If you live in a non-expansion state and earn between 100% and 138% FPL, you usually qualify for fully subsidized Marketplace coverage instead. Apply at healthcare.gov if Medicaid denies you.
State-by-State Medicaid Income Limit Snapshot
The table below shows the published adult income limit for the 25 largest states. Numbers reflect the most recently published 2025-2026 program-year figures. For exact dollar amounts in your county, check your state Medicaid agency portal.
| State | Expanded? | Adult limit (single) | Apply at |
|---|---|---|---|
| California (Medi-Cal) | Yes | 138% FPL ($1,836/mo) | coveredca.com |
| Texas | No | none for childless adults | yourtexasbenefits.com |
| Florida | No | none for childless adults | myflfamilies.com |
| New York | Yes | 138% FPL + state supplements | nystateofhealth.ny.gov |
| Pennsylvania | Yes | 138% FPL ($1,836/mo) | compass.state.pa.us |
| Illinois | Yes | 138% FPL ($1,836/mo) | abe.illinois.gov |
| Ohio | Yes | 138% FPL ($1,836/mo) | benefits.ohio.gov |
| Georgia | No | parents to 30% FPL only | gateway.ga.gov |
| North Carolina | Yes (since 2023) | 138% FPL ($1,836/mo) | epass.nc.gov |
| Michigan | Yes | 138% FPL (Healthy Michigan) | michigan.gov/mibridges |
| New Jersey | Yes | 138% FPL ($1,836/mo) | njfamilycare.org |
| Virginia | Yes | 138% FPL ($1,836/mo) | commonhelp.virginia.gov |
| Washington | Yes | 138% FPL (Apple Health) | wahealthplanfinder.org |
| Arizona | Yes | 138% FPL (AHCCCS) | azahcccs.gov |
| Massachusetts | Yes | 138-200% FPL (MassHealth) | mahealthconnector.org |
| Tennessee | No | parents to 100% FPL only | tn.gov/tenncare |
| Indiana | Yes | 138% FPL (HIP) | in.gov/fssa |
| Missouri | Yes (since 2021) | 138% FPL ($1,836/mo) | mydss.mo.gov |
| Maryland | Yes | 138% FPL ($1,836/mo) | marylandhealthconnection.gov |
| Wisconsin | No | parents to 100% FPL via BadgerCare | access.wisconsin.gov |
| Colorado | Yes | 138% FPL ($1,889/mo with disregard) | healthfirstcolorado.com |
| Minnesota | Yes | 138% FPL (MA + MinnesotaCare) | mn.gov/dhs |
| South Carolina | No | parents to 67% FPL only | scdhhs.gov |
| Alabama | No | parents to 18% FPL only | medicaid.alabama.gov |
| Louisiana | Yes | 138% FPL ($1,836/mo) | ldh.la.gov |
Medicaid for Seniors (65+) and People with Disabilities
If you are 65 or older or qualify for Social Security Disability, your Medicaid eligibility is determined under different rules. The income test uses the SSI (Supplemental Security Income) methodology, not MAGI.
The 2026 SSI federal payment standard is $994/month for a single individual and $1,491/month for a couple. Most states use this figure as the income limit, often with a small state supplement that raises the threshold by $20 to $200 per month.
Seniors and disabled Medicaid applicants also face an asset test that working-age MAGI applicants do not. The federal asset limit is $2,000 for a single person and $3,000 for a couple. Excluded: your home (up to $730,000 in equity in 2026 in most states), one car, personal possessions, burial plot, and life insurance under $1,500 face value.
If your income is over the SSI level but you have high medical bills, you may still qualify through your state’s Medically Needy / spenddown program. 36 states plus DC offer this path. You “spend down” by incurring medical expenses that bring your countable income below the medically needy level (Medicaid.gov).
5 Ways to Auto-Qualify for Medicaid (Skip the Income Test)
You do not need to apply or prove income if you fit one of these categories. Coverage is automatic or near-automatic:
- You receive SSI. Approval for Supplemental Security Income automatically enrolls you in Medicaid in 32 states. The other 18 states (called “209(b) states”) require a separate Medicaid application but use SSI methodology.
- You are a child in foster care or aged out of foster care. Foster youth are auto-enrolled. Former foster youth up to age 26 qualify regardless of income (federal mandate, no income test).
- You receive TANF cash assistance. All TANF recipients are categorically eligible for Medicaid in every state.
- You are pregnant and meet your state’s pregnancy income limit. Coverage starts immediately upon application and continues through 60 days postpartum (12 months in 35 states under recent ACA expansions).
- You are a child receiving SSI or in an adoption assistance agreement. Title IV-E adoption assistance recipients are auto-enrolled regardless of family income.
If any of these apply, you do not need to fill out the long Medicaid application. Tell the state agency about your status and ask them to enroll you on the auto-qualify path.
How MAGI Income Is Calculated (What Counts and What Does Not)
For working-age adults and families, Medicaid uses Modified Adjusted Gross Income (MAGI). This is your IRS-defined adjusted gross income plus a few add-backs.
What counts as income: wages, salaries, tips, self-employment net income, Social Security retirement and disability benefits, unemployment compensation, taxable interest, dividends, capital gains, rental income, alimony (for pre-2019 divorces), and most retirement plan distributions.
What does NOT count: SSI payments, child support received, scholarship and fellowship grants used for tuition, veterans’ disability benefits, gifts and inheritances, workers’ compensation, and most non-taxable interest. SNAP and LIHEAP benefits are also excluded.
A common point of confusion: even though Social Security retirement benefits count, they are counted as gross before any Part B premium deduction. So if your SSA check is $1,800 and Medicare deducts $202.90, your Medicaid-counted income is $1,800, not $1,597.
What to Do If Your Income Is Just Over the Limit
If you earn between 100% and 138% FPL in a non-expansion state, or just barely over 138% FPL anywhere, you have three workarounds before giving up:
1. Check the medically needy program. 36 states plus DC let you “spend down” by incurring medical bills. If you have monthly medical expenses (prescription costs, doctor visits, COBRA premiums) that bring your effective income below the spenddown threshold, you qualify for full Medicaid that month.
2. Apply for marketplace coverage with subsidies. Households between 100% and 400% FPL qualify for premium tax credits on healthcare.gov. At your income level, premiums for a Silver plan are typically $0 to $50 per month with cost-sharing reductions that mimic Medicaid (low copays, low deductible).
3. Apply for a Medicare Savings Program if you are 65+ or disabled. Even if you do not qualify for full Medicaid, you may qualify for an MSP, which pays your Medicare Part B premium ($202.90/mo in 2026) and sometimes deductibles. Income limits go up to about $1,816/mo single. See our Medicare Savings Programs guide.
How to Apply for Medicaid in 2026
You apply through your state Medicaid agency, never through the federal government. There are three application paths in every state:
- Online via your state portal (fastest). Each state runs its own application website — see the table above.
- Online via healthcare.gov. If you apply for Marketplace coverage and your income falls below the Medicaid limit, healthcare.gov forwards your application to your state Medicaid office automatically.
- By phone or mail or in person. Every state operates a customer service line and a network of county or community offices that take walk-ins.
Documents to gather first: photo ID, Social Security card or number, proof of citizenship or qualified immigration status, last 4 weeks of pay stubs (or your most recent tax return if self-employed), a current utility bill or lease showing your address, and bank statements if applying for senior or disabled Medicaid (asset test).
Most states process applications within 45 days for MAGI Medicaid and within 90 days for senior and disabled Medicaid (which requires the full asset workup). Federal regulation 42 CFR 435.912 sets these deadlines.
When Medicaid Coverage Starts
Once approved, Medicaid coverage is effective either on the date you applied or the first of the month you applied. Your state will tell you which.
You can also request retroactive coverage for up to 3 months prior to your application date if you would have been eligible during that period. This is critical if you had a hospital stay or expensive prescriptions during the prior 90 days that you have not yet paid — Medicaid will cover those bills.
Coverage continues until your annual recertification (once per year in most states), or until you report a change that takes you over the income limit. You must report household changes within 10 days in most states.
Related Programs to Apply For
If you qualify for Medicaid, you almost certainly qualify for several other low-income benefits:
- SNAP (food assistance) — Same general income range. Apply through the same state portal in most states.
- LIHEAP (utility assistance) — Income up to 150% FPL or 60% State Median Income. See our LIHEAP income limits guide.
- WIC (food for pregnant women, infants, and children under 5) — Up to 185% FPL.
- Section 8 Housing Choice Voucher — 50% of Area Median Income. See our Section 8 application guide.
- Lifeline phone discount — Free for Medicaid enrollees. Apply at lifelinesupport.org.
The state agency handling your Medicaid application can usually take all of these in one combined application. Ask the caseworker.
Bottom Line
The 2026 Medicaid income limit for working-age adults in expansion states is 138% FPL: about $1,836/month for a single person and $3,795/month for a family of four. Children and pregnant women have higher limits. Seniors and disabled people use SSI rules with a $2,000 asset test.
10 states still have not expanded — in those states, childless adults are usually shut out regardless of income, and parents face much lower limits. If denied, apply for healthcare.gov subsidies or your state’s medically needy program. Most applications process within 45 days, and coverage can be backdated up to 3 months.
Frequently asked questions
For working-age adults in the 40 expansion states plus DC, the 2026 Medicaid income limit is 138% of the Federal Poverty Level: about $1,836/month ($22,032/yr) for a single person and $3,795/month ($45,540/yr) for a family of four. Children and pregnant women have higher limits. Seniors and disabled people use SSI rules instead, with a $994/month single limit and a $2,000 asset cap.
As of 2026, 10 states have not expanded: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In those states, childless adults usually do not qualify for Medicaid at all regardless of income, and parents face much lower limits, sometimes as low as 17% to 50% FPL. North Carolina expanded in 2023, and Missouri expanded in 2021 after voter ballot initiatives.
For working-age adults and families, Medicaid uses Modified Adjusted Gross Income (MAGI). This is your IRS adjusted gross income plus a few add-backs. Wages, Social Security retirement, unemployment, and dividends count. SSI payments, child support received, scholarship funds for tuition, veterans' disability, gifts, workers' comp, SNAP, and LIHEAP do not count. For seniors 65+ and disabled adults, Medicaid uses SSI methodology, not MAGI.
Yes. Federal Medicaid law allows up to 3 months of retroactive coverage prior to your application date if you would have been eligible during that period. This can wipe out hospital bills, prescription costs, and other medical debt incurred before you applied. When you submit your application, explicitly request retroactive coverage and list the months. Some states have waivers limiting retroactive coverage; ask your state agency.
Three options. First, check if your state has a medically needy or spenddown program (36 states plus DC do). If you incur enough monthly medical expenses, you can spend down to eligibility. Second, apply for Marketplace coverage at healthcare.gov; subsidies cover most or all of the premium for households between 100% and 400% FPL. Third, if you are 65+ or disabled, apply for a Medicare Savings Program, which has higher limits and covers Medicare premiums.
Federal regulation 42 CFR 435.912 sets the deadline at 45 days for MAGI Medicaid (working-age adults and families) and 90 days for senior or disabled Medicaid (which requires the asset workup). Most states meet these deadlines, but processing can run longer during open enrollment periods and after natural disasters. If your case has not been decided in 45 days, call your state Medicaid office and ask for an expedited decision.
It depends on which Medicaid you are applying for. For MAGI Medicaid (under 65), there is no asset test at all. Only your income matters. For senior or disabled Medicaid, there is a $2,000 asset limit single ($3,000 couple). Excluded: your home (up to about $730,000 in equity), one car, personal possessions, burial plot, and life insurance under $1,500 face value. IRA and 401(k) balances generally count, depending on whether you're drawing from them.
Yes. This is called dual coverage. Medicaid acts as a secondary payer, covering costs your private insurance does not cover. Medicaid will pay your private health insurance premium for you in some cases, through a program called the Health Insurance Premium Payment (HIPP) program. Apply for both, and tell your state Medicaid office about your private coverage.
Medicare is a federal health insurance program primarily for people 65 and older or those with certain disabilities, regardless of income. Medicaid is a joint federal-state program for low-income people of any age. Many seniors qualify for both at once (called dual-eligibles); about 12 million Americans have both. If you have Medicare, ask about Medicare Savings Programs and Extra Help for additional cost relief.
Photo ID, Social Security card or number, proof of citizenship or qualified immigration status, last 4 weeks of pay stubs (or your most recent tax return if self-employed), a current utility bill or lease showing your address, and bank statements if applying for senior or disabled Medicaid (which has an asset test). If you are pregnant, bring proof of pregnancy. If you have children, bring their Social Security numbers and birth certificates.
Sources
Every claim in this guide is cited to its primary source below. Click through to verify, that's our standing commitment.
- 01Medicaid.gov Eligibility Policy
www.medicaid.gov/medicaid/eligibility-policy/index.html
- 02ASPE 2026 Federal Poverty Guidelines
aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines
- 03NJ FamilyCare 2026 income limits
njfamilycare.dhs.state.nj.us/who_eligbl.aspx
- 04Idaho Health & Welfare Medicaid Program Income Limits 2026
healthandwelfare.idaho.gov/medicaid-program-income-limits
- 05Health First Colorado eligibility chart
www.healthfirstcolorado.com/apply-now/do-you-qualify/
- 06NC Medicaid Eligibility
medicaid.ncdhhs.gov/eligibility
- 07Medicaid.gov: Effective Date of Coverage (3-month retroactive)
www.medicaid.gov/medicaid/eligibility-policy/index.html
- 0842 CFR 435.912 Medicaid application processing deadlines
www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-435/subpart-J/section-435.912
Editorial fact-check
This guide was verified on May 15, 2026.
Every eligibility rule, dollar amount, and deadline in this article was cross-checked against its primary source listed above before publication, and will be re-verified within 30 days under our editorial policy. Spotted something off? Tell us, corrections typically ship within 48 hours.
By Subha, Public Benefits Writer at GrantsHubUSA · Reviewed by GrantsHub Editorial Team · Category: Healthcare
Not legal, tax, or financial advice. GrantsHubUSA is an independent editorial blog, we're not a government agency and we don't administer these programs. Always confirm current eligibility and deadlines with the administering agency before applying. See our full disclaimer.
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