Medicaid eligibility depends on your income, household size, what state you live in, and which category you fall into, so there is no single dollar figure that applies to everyone. In states that expanded Medicaid under the Affordable Care Act, most adults qualify if their household income falls at or below 138 percent of the federal poverty level, which works out to roughly $21,597 for an individual or $44,367 for a family of four in 2025. In the handful of states that did not expand, the thresholds can be dramatically lower, and some adults without children cannot qualify at any income. Children, pregnant women, and older adults each face different rules, making the real answer a patchwork that varies enormously depending on who you are and where you live.
The Federal Poverty Level Is the Yardstick
Almost every Medicaid income limit is expressed as a percentage of the federal poverty level, or FPL. The FPL is updated each year by the Department of Health and Human Services and rises slightly with inflation. For 2025, 100 percent of FPL is $15,650 for a single person, $21,150 for a household of two, $26,650 for a household of three, and $32,150 for a household of four. When you see a state’s Medicaid threshold listed as “138% FPL,” you multiply the poverty-level number for your household size by 1.38 to get the actual dollar cutoff. Your household includes people who file taxes together or are claimed as dependents on the same return, not necessarily everyone living under your roof.
The income that counts is your Modified Adjusted Gross Income, or MAGI. That is basically your adjusted gross income from your tax return plus a few items like tax-exempt interest and certain foreign income. Importantly, MAGI-based Medicaid does not count assets like savings accounts or a car. You could have money in the bank and still qualify if your income is low enough. The asset-free approach applies to most adults, children, and pregnant women. Older adults and people applying through disability pathways face a different, stricter set of rules that can include asset limits.
Expansion States Versus Non-Expansion States
The single biggest factor in whether you can get Medicaid as a working-age adult is whether your state expanded the program under the ACA. As of 2025, 40 states plus Washington, D.C., have adopted the expansion, which covers adults ages 19 through 64 with household incomes up to 138 percent of FPL. That translates to about $21,597 for one person or roughly $36,776 for a family of three. In these states, you do not need to have children, be pregnant, or have a disability to qualify. Income is essentially the only test.
The ten states that have not expanded Medicaid tell a very different story. Eligibility in those states remains tied to older, pre-ACA rules that were designed primarily for parents with very low incomes, pregnant women, and people with disabilities. The median income limit for parents in non-expansion states is just 40 percent of FPL, which comes out to about $10,928 per year for a family of three. Texas has the lowest threshold in the country for parents, at 15 percent of FPL. A parent in a Texas family of three earning more than roughly $4,098 a year, or about $342 a month, is already over the limit.1KFF. How Much Do You Need to Make for Medicaid? That is an astonishingly low bar, well below what anyone could live on.
Even more striking, most non-expansion states do not offer Medicaid to adults without dependent children at all, regardless of how little they earn. With the exception of Wisconsin and Georgia, which provide coverage through federal waivers, childless adults in non-expansion states are simply locked out unless they qualify on the basis of a disability.1KFF. How Much Do You Need to Make for Medicaid? This creates a situation where you can be extremely poor and still not poor enough, or not the right category, to get help.
The Coverage Gap
In non-expansion states, a peculiar gap exists. People who earn too much for their state’s Medicaid limit but too little to qualify for subsidized marketplace insurance (which starts at 100 percent of FPL) fall into what is called the coverage gap. They have no affordable coverage option at all. About 78 percent of people stuck in this gap are adults without dependent children, the group most non-expansion states categorically exclude from Medicaid.1KFF. How Much Do You Need to Make for Medicaid?
If you live in one of these states and you are a single adult without children earning, say, $12,000 a year, you likely earn too much for your state’s Medicaid program yet fall below the income floor for marketplace subsidies. It is a Catch-22 that affects millions of people and was never supposed to exist. The ACA was designed with the assumption that all states would expand Medicaid, so marketplace subsidies were set to begin at 100 percent of FPL. When the Supreme Court made expansion optional in 2012, the gap opened and has persisted ever since in the states that declined.
Income Limits for Children and Pregnant Women
Children have always had far more generous Medicaid eligibility than adults, and that remains true today. Every state covers children in families with incomes at least up to 138 percent of FPL, but most go considerably higher through a combination of Medicaid and the Children’s Health Insurance Program, known as CHIP. The average state income threshold for children’s coverage is around 260 percent of FPL, which for a family of three means a household earning roughly $69,000 a year could still qualify.2PubMed. Medicaid/CHIP Income Thresholds And Health Services Use Among Children In Low-Income Households, 2016-23 Some states set the bar even higher. New York and other high-cost states extend coverage to children in families above 300 percent of FPL.
Pregnant women also qualify at higher income levels than other adults. Most states set pregnancy-related Medicaid eligibility at or above 200 percent of FPL, and some go as high as 300 percent or more. A study examining state eligibility during the COVID-19 pandemic found that the average income threshold for pregnant individuals across sampled states was 208 percent of FPL, compared to just 114 percent of FPL for other adults in those same states.3JAMA Health Forum. Continuous Medicaid Eligibility During the COVID-19 Pandemic and Postpartum Coverage, Health Care, and Outcomes For a single pregnant woman, 200 percent of FPL translates to about $31,300 in 2025. That is roughly double what a non-pregnant adult would need to stay under in a typical expansion state.
Pregnancy coverage traditionally ended 60 days after delivery, which created a sharp cliff for new mothers. A growing number of states have now extended postpartum Medicaid to a full 12 months, recognizing that maternal health needs do not stop at the two-month mark. If you are pregnant and wondering about eligibility, your state almost certainly has a more generous threshold than the one that applies to other adults in your household.
Older Adults, Disability, and the Asset Test
Medicaid eligibility for people age 65 and older works differently from the system that covers younger adults and children. Instead of using only MAGI-based income, most states apply both an income test and an asset test. The income limit for older adults is often pegged to the Supplemental Security Income level, which in 2025 is $967 per month for an individual, or about 74 percent of FPL. Some states set their threshold slightly higher, at 100 percent of FPL, but few go beyond that for the basic aged category.
The asset test is where things get particularly restrictive. Countable assets typically must fall below $2,000 for an individual or $3,000 for a couple, though some states have raised or eliminated these limits. Your home and one vehicle are usually excluded, but savings accounts, investments, and additional property all count. Research has shown that these rules exclude many older adults who are both financially and medically vulnerable, leaving them in a gray zone where their incomes and savings are too modest to cover care but too high to qualify for Medicaid.4PubMed Central. How Medicaid Financial Eligibility Rules Exclude Financially and Medically Vulnerable Older Adults
There are two main pathways into Medicaid for people over 65. The first is simply having low income and few assets throughout life. The second is becoming impoverished by large medical expenses, a process sometimes called “spending down.” Someone who earned a decent salary for decades can still end up on Medicaid after catastrophic health costs, particularly long-term care costs, drain their resources.5National Bureau of Economic Research. Medicaid and the Elderly The spend-down path is especially common among people entering nursing homes, where costs can easily exceed $8,000 to $10,000 a month and quickly exhaust even substantial savings.
Medicaid and Long-Term Care
Many people are surprised to learn that Medicaid, not Medicare, is the primary payer for long-term nursing home care in the United States. Medicare covers only short-term skilled nursing after a hospital stay, typically limited to 100 days. For the open-ended, custodial care that many older adults need, Medicaid is the main funding source, which means the program’s income and asset rules become the gatekeepers.
The process of qualifying for Medicaid-funded nursing home care involves meeting income thresholds that differ from those for community-based coverage. Many states allow a higher income limit for people in institutional settings, sometimes up to 300 percent of the SSI level (roughly $2,901 per month in 2025), because the assumption is that nearly all of that income will go toward the cost of care. The resident is allowed to keep a small personal-needs allowance, usually between $30 and $90 per month, while the rest goes to the facility.
States also apply a “lookback period” when you apply for Medicaid long-term care benefits. Caseworkers review financial transactions from the previous five years (60 months) to identify any assets that were given away or sold below market value. If you transferred assets during that window, you may face a penalty period during which Medicaid will not pay for your nursing home care, even if you are otherwise eligible. The rule exists to prevent people from sheltering wealth by giving it to family members shortly before applying. This is one reason some families work with elder law attorneys well in advance of a potential need for long-term care, to navigate these rules without triggering penalties.
What Happens When Your Income Changes
Because Medicaid eligibility is tied to income, any change in your earnings can shift your coverage. In expansion states, the line between Medicaid and subsidized marketplace insurance sits right at 138 percent of FPL. If you pick up extra shifts, get a raise, or add a second job that pushes you above that threshold, you may lose Medicaid and need to transition to a marketplace plan. The reverse happens if your income drops. Research has estimated that within a single year, roughly half of all adults with family incomes below 200 percent of FPL will experience a shift in eligibility between Medicaid and marketplace coverage, or the reverse. That translates to about 28 million people moving back and forth.6PubMed. Issues in health reform: how changes in eligibility may move millions back and forth between medicaid and insurance exchanges
This churning between programs is more than an administrative nuisance. People who cycle in and out of Medicaid often experience gaps in coverage, disruptions in care, and confusion about which doctors and prescriptions are covered under their current plan. Studies on this population have highlighted how adults near the eligibility threshold face particular instability, transitioning between Medicaid and subsidized marketplace insurance as their income fluctuates even modestly.7PubMed Central. Does Churning in Medicaid Affect Health Care Use? If you are close to the income cutoff, it is worth keeping an eye on your projected annual earnings and reporting changes promptly, because falling out of Medicaid does not automatically enroll you in a marketplace plan.
How Medicaid’s Rules Got This Complicated
The patchwork nature of Medicaid eligibility is not accidental. It reflects decades of incremental policy changes layered on top of one another. When Medicaid was created in 1965, coverage was tied to cash welfare programs. If you received welfare, you generally got Medicaid. Over time, Congress gradually detached the two, first for children and pregnant women, then more broadly. A pivotal moment came in 1996, when federal legislation replaced the old welfare program with Temporary Assistance to Needy Families and officially severed the link between Medicaid eligibility and cash assistance for children, pregnant women, and low-income parents.8KFF. Medicaid 101 – How Has Medicaid Evolved Over Time?
The ACA’s Medicaid expansion in 2014 was the most sweeping eligibility change in the program’s history, opening the door to all low-income adults regardless of parental status, disability, or other categorical requirements. But because the Supreme Court made expansion optional, what was intended as a uniform national floor became yet another layer of state-by-state variation. The result is a system where two people with identical incomes and family situations can face entirely different coverage realities depending on which side of a state border they live on. State-level policy differences extend beyond just the expansion decision to enrollment processes, benefit packages, and administrative requirements that affect who actually gets and keeps coverage.9PubMed Central. Trends In State Medicaid Eligibility, Enrollment Rules, And Benefits
Work Requirements and Their Potential Impact
A significant policy shift that could affect who qualifies for Medicaid is the introduction of work requirements. Federal legislation passed in 2025 authorizes states to require certain Medicaid enrollees to document a minimum number of hours of work, job training, or community service in order to maintain their coverage. The idea is that able-bodied adults should be working to keep their benefits. In practice, earlier state-level experiments with work requirements, particularly in Arkansas and New Hampshire, resulted in large numbers of people losing coverage, often not because they were not working but because they failed to navigate the reporting requirements.
A modeling study published in The Lancet estimated that newly enacted federal work requirements could lead to between 4.8 million and higher numbers of individuals losing Medicaid coverage, depending on how states implement the rules. The researchers projected that this scale of coverage loss could lead to thousands of excess deaths annually and tens of thousands of additional cases of uncontrolled chronic conditions like diabetes and high blood pressure.10The Lancet. Quantifying the mortality and morbidity impact of medicaid work requirements: a modeling study Whatever your view on the policy merits, work requirements add another layer of complexity to the question of who qualifies, because meeting the income threshold may no longer be sufficient on its own.
How to Check Your Own Eligibility
Given the number of variables involved, the most practical step is to apply and let your state’s Medicaid agency make the determination. You can do this through your state’s Medicaid website or through HealthCare.gov, which will route your application to the appropriate program. When you apply, the system checks your income, household size, age, pregnancy status, disability status, and state of residence, then tells you whether you qualify for Medicaid, CHIP (for children), or subsidized marketplace insurance.
A few practical tips if you are trying to gauge your chances before applying. First, remember that Medicaid uses projected annual income, not last year’s tax return. If you recently lost a job or had a drop in income, your current situation is what matters. Second, count your household correctly: for MAGI-based Medicaid, your household generally follows tax-filing rules, so a college student who is still claimed as a dependent on a parent’s return is part of that parent’s household, not their own. Third, you do not need to wait for open enrollment. Unlike marketplace plans, Medicaid accepts applications year-round, and coverage can begin as early as the month you apply or even retroactively for up to three months if you would have been eligible during that time.
If your income puts you over the Medicaid line, you may still qualify for substantial help. Marketplace premium subsidies are available to people earning between 100 and 150 percent of FPL at very low cost, sometimes with premiums as low as $0 per month, and cost-sharing reductions that cover most out-of-pocket expenses. The transition from Medicaid to a marketplace plan does not have to mean going without coverage, though it does often mean adjusting to a different provider network and benefit structure.
Common Situations That Trip People Up
Certain real-life scenarios cause more confusion than others when it comes to Medicaid income limits. Here are a few worth knowing about:
- Self-employment: If you work for yourself, your MAGI is your net self-employment income after business deductions, not your gross revenue. A freelancer who bills $40,000 but has $20,000 in legitimate business expenses has a MAGI of $20,000 for Medicaid purposes, which could easily fall below the threshold.
- Irregular income: Seasonal workers, gig workers, and people with variable hours often earn very different amounts from month to month. Medicaid looks at your projected annual total, so a few high-earning months do not automatically disqualify you if your yearly income still falls below the limit.
- Household composition changes: A divorce, a child aging out, or a new baby all change your household size and therefore your income threshold. A family of four at $40,000 might be under the limit; the same adult as a household of one at $25,000 after a divorce might be over it, depending on the state.
- Social Security income: Social Security benefits count as income for MAGI-based Medicaid. If you are collecting early retirement or disability benefits, those dollars count toward the threshold. However, Supplemental Security Income itself is not counted under MAGI rules, which can matter for people receiving both types of benefits.
One misconception worth addressing: many people assume that owning a home or having a retirement account automatically disqualifies them. For MAGI-based Medicaid, which covers most adults under 65 and all children, assets are not tested at all. Your house, your 401(k), and your car are irrelevant. Asset tests only come into play for older adults and people applying through disability or long-term care pathways, and even then, certain assets like a primary residence are usually exempt up to a specified equity value.