Medicaid income limits depend on your state and family size, not a single national number

There is no single income limit for Medicaid across the United States. Each state sets its own threshold based on a percentage of the federal poverty level, and that threshold changes each year. A single adult in one state might may have access to at $1,500 per month while the same person in another state would not may have access to until $900 per month. Your family size also matters — a household of four has a higher limit than a household of one.

The way your income is counted also varies by state and by which Medicaid program you are entering. Some programs count only your wages. Others include child support, Social Security, unemployment benefits, or rental income. Some states subtract certain costs — like child care or medical expenses — before comparing your income to the limit. You need to know your state's specific rules, not a national average.

Key Takeaways

  • Each state sets its own Medicaid income limit as a percentage of the federal poverty level, ranging from about 100% to 400% depending on the program and state.
  • Your state's Medicaid office or your local 211 service can tell you the exact income limit for your household size and situation.
  • Income limits change every year on January 1st when the federal poverty level updates, so a limit that applied last year may not apply this year.
  • Some types of income are not counted toward the limit, and some states subtract expenses before comparing your income to the threshold.
  • If you earn slightly more than the limit, you may still have other routes to coverage, such as Medicaid spend-down programs or marketplace insurance.

How states calculate the income limit

States express their Medicaid income limit as a percentage of the federal poverty level. The federal poverty level is set by the U.S. Department of Health and Human Services and changes each year. For 2024, the federal poverty level for a single adult is $14,600 per year, or about $1,217 per month. For a family of four, it is $30,000 per year, or about $2,500 per month.

A state might say its Medicaid limit is "138% of the federal poverty level." That means a single adult could earn up to $20,148 per year (138% of $14,600), or about $1,679 per month. Another state might set its limit at 100% of poverty, meaning a single adult could earn only $14,600 per year. The percentage varies by state and by which Medicaid program you are entering — traditional Medicaid, Medicaid expansion, or a special category like pregnancy or disability.

Because the federal poverty level changes each January 1st, income limits also change on that date. A limit that may have access to you in December may disqualify you in January, or vice versa. Your state's Medicaid office publishes the new limits each year, usually in late December or early January.

Income limits by state and program type

Medicaid has several different programs, and each has its own income limit. Traditional Medicaid (for low-income adults, children, and families) typically has a lower limit — often 100% to 138% of poverty, depending on the state. Medicaid expansion (available in about 40 states) covers adults up to 138% of poverty. Medicaid for pregnant people often goes higher, sometimes 200% to 300% of poverty. Medicaid for people with disabilities may have different rules altogether.

To find your state's exact limits, contact your state Medicaid office directly or call 211 and ask for Medicaid information. They can tell you the limit for your household size and which program you might enter. You can also visit your state's Medicaid website — most states publish income limit tables by family size and program type. The Centers for Medicare & Medicaid Services (CMS) also maintains a list of state Medicaid offices on its website.

What counts as income and what does not

Not all money you receive counts toward the Medicaid income limit. Wages and salary always count. Social Security benefits, unemployment insurance, child support, and rental income usually count. But some types of income are excluded. Supplemental Security Income (SSI) is often not counted in certain Medicaid programs. Some states exclude the first $65 of monthly earnings plus half of the remainder for people with disabilities. Food stamps (SNAP), housing vouchers, and tax refunds typically do not count.

Your state may also allow you to subtract certain costs before your income is compared to the limit. Medical expenses, child care costs, and work-related expenses are sometimes deductible. A few states allow you to subtract rent or utilities. These deductions vary widely, so ask your state Medicaid office whether your situation qualifies for any deductions. A deduction can mean the difference between may have access to and not may have access to.

What happens if you earn slightly more than the limit

If your income is above the Medicaid limit but not by much, you may still have coverage options. Some states run Medicaid spend-down programs, which allow you to "spend down" your excess income on medical bills. For example, if you earn $200 over the limit each month, you can set aside $200 in medical expenses (copays, prescriptions, doctor visits), and that amount reduces your countable income. Once your countable income falls below the limit, you become Medicaid-may be able to access.

Another option is marketplace insurance through the Affordable Care Act. If you earn between 100% and 400% of poverty, you may be able to purchase a plan on the marketplace and receive a tax credit that lowers your monthly premium. The tax credit amount depends on your income and your state. You can also ask your state Medicaid office about medically needy programs, which exist in some states and work similarly to spend-down.

How to report income changes to Medicaid

If you are already on Medicaid and your income changes, you must report it to your state Medicaid office. Most states require you to report within 10 to 30 days of the change. If your income rises above the limit, your Medicaid coverage will end, usually at the end of the month in which you reported the change. If your income drops, you may become newly may be able to access or move to a different Medicaid program.

You can report income changes by phone, mail, online portal, or in person at your local Medicaid office. Keep records of the change — a pay stub, a letter from your employer, or a notice from Social Security. Your Medicaid office will ask you to verify the change before processing it. If you do not report a change and your income was actually above the limit, you may be asked to repay benefits you received while ineligible, though this varies by state.

Frequently Asked Questions

Does my spouse's income count toward my Medicaid limit?

It depends on your state and which Medicaid program you are entering. In most traditional Medicaid programs, spouses' income is counted together if you live in the same household. In Medicaid expansion programs, some states count only your individual income. Ask your state Medicaid office whether your spouse's income will be included in the calculation.

What if I am self-employed or have irregular income?

Self-employment income counts toward the Medicaid limit. Most states average your income over the past three months or use your most recent tax return to determine your monthly income. If your income is seasonal or irregular, ask your Medicaid office how they will calculate it — some states may average over a longer period or use a different method.

Can I hide income to stay under the Medicaid limit?

No. Medicaid fraud is a federal crime. You must report all income truthfully. If you are caught underreporting income, you may be required to repay all benefits you received while ineligible, face criminal charges, or be banned from Medicaid for a period of time. If your income is genuinely above the limit, explore spend-down programs or marketplace insurance instead.

Do I lose Medicaid immediately if I earn more than the limit?

No. Medicaid coverage usually continues through the end of the month in which you report the income change. Some states have a grace period of one or two months. After that, your coverage ends unless you report a new change that brings you back under the limit. Your state Medicaid office will send you a notice before your coverage ends.

How often do income limits change?

Income limits change every January 1st when the federal poverty level updates. Your state Medicaid office publishes the new limits in late December or early January. If you are currently on Medicaid, your may be able to access is usually reviewed once per year, often on the anniversary of when you enrolled. If your income has not changed, you will likely remain covered.