Medicaid income limits are set by your state, not by the federal government, and they change based on family size and type of coverage

Medicaid does not have one national income limit. Each state decides how much money a household can earn and still receive coverage. A family of three in one state might earn $2,000 per month and may have access to, while the same family in another state might need to earn less than $1,500. Some states use the federal poverty line as their baseline; others set limits higher or lower. Your state's Medicaid program publishes its current limits, and they are the only numbers that matter for your situation.

Income limits also depend on which type of Medicaid you are looking at. Traditional Medicaid (for families, children, pregnant people, and seniors) has different thresholds than Medicaid for people with disabilities. Some states have expanded Medicaid to cover adults earning up to 138% of the federal poverty line; others have not. The only way to know your state's actual limit is to check your state Medicaid office website or call them directly.

Key Takeaways

  • Each state sets its own Medicaid income limits, so the number that matters is your state's limit, not a federal one.
  • Income limits are based on household size and type of coverage (families, children, pregnant people, seniors, or people with disabilities).
  • Some states have expanded Medicaid to cover adults earning up to 138% of the federal poverty line; others have not.
  • Your state Medicaid office publishes current income limits on its website and can tell you in one call whether your household income falls within the range.

How states calculate income and what counts toward the limit

States count gross monthly income — the money you earn before taxes are taken out. This includes wages from a job, self-employment income, Social Security, unemployment benefits, child support, and some types of pension or retirement income. The exact list varies by state, but most Medicaid programs count nearly all regular income sources.

Some income does not count. Supplemental Security Income (SSI) is usually excluded in states that use SSI rules. Food stamps (SNAP) do not count. In some states, a portion of child support received is excluded. Student loans and grants do not count as income. The state Medicaid office can tell you which income sources they count and which they do not.

States also apply deductions or disregards before comparing your income to the limit. For example, some states disregard the first $65 of monthly earnings, or allow a deduction for work-related expenses. These reduce the income amount that is actually counted. Again, the rules vary by state, so you need to check with your state program to see what deductions apply to you.

Income limits for different family sizes

Medicaid income limits scale with household size. A single person has a lower limit than a family of four. Most states publish their limits in a table that shows the maximum monthly or annual income for each family size. For example, a state might say a family of one can earn up to $1,500 per month, a family of two up to $2,000, a family of three up to $2,500, and so on.

The definition of "family size" or "household" also varies. Most states count you, your spouse (if you are married), and any children under 18 or 19 who live with you. Some states count adult children or other relatives. If you are unsure whether someone in your home counts as part of your household for Medicaid purposes, ask your state Medicaid office — the answer affects your income limit directly.

How to find your state's current income limits

Your state Medicaid office publishes income limits on its website. Search "[your state] Medicaid income limits" or go directly to your state health or human services department website. Most states have a page that lists the current limits by family size and category (families, children, seniors, people with disabilities, pregnant people).

If you cannot find the limits online, call your state Medicaid office. They can tell you the exact limit for your household size and type of coverage in under five minutes. You can also contact a local community health center or a 211 referral service; both can look up your state's limits and tell you whether your income falls within the range. Having your household size and monthly income ready when you call will speed up the conversation.

What happens if your income is above the limit

If your household income exceeds your state's Medicaid limit, you do not may have access to for traditional Medicaid through that income category. However, you may have other options. Some states run separate programs for people who earn slightly above the Medicaid limit. Some employers offer health insurance. You may be able to purchase coverage through the Affordable Care Act marketplace, where you might receive a tax credit or subsidy based on your income.

If your income drops later — because you lose a job, hours are cut, or a household member moves out — you can reapply for Medicaid. Many states allow you to report a change in income between annual renewals, and coverage can start the month after you report the change. Keep your state Medicaid office contact information so you can report income changes quickly.

Income limits for seniors and people with disabilities

Medicaid for seniors (age 65 and older) and for people receiving Supplemental Security Income (SSI) often has different income limits than Medicaid for families. Many states use the SSI federal benefit rate as their income limit for these groups, which is currently $943 per month for an individual (though this amount changes yearly). Some states set their limit higher.

People with disabilities who do not receive SSI may fall under a different category with its own income limit. Some states have programs specifically for working people with disabilities that allow higher income limits. If you are applying for Medicaid as a senior or person with a disability, ask your state Medicaid office which income limit applies to your situation, because it may be different from the family Medicaid limit.

Medicaid expansion and how it changed income limits in some states

In 2014, states were given the option to expand Medicaid to cover adults earning up to 138% of the federal poverty line, regardless of disability or family status. As of now, 38 states plus Washington D.C. have adopted this expansion. In expansion states, a single adult can earn significantly more and still may have access to for Medicaid. In non-expansion states, adults without children or disabilities still cannot may have access to for Medicaid based on income alone, no matter how low their earnings.

If you live in a non-expansion state and your income is above the traditional Medicaid limit, you may still have coverage options through the Affordable Care Act marketplace. If you live in an expansion state, your income limit for Medicaid is likely much higher than it would be in a non-expansion state. Knowing whether your state has expanded Medicaid is one of the first things to check when you are trying to understand your coverage options.

Frequently Asked Questions

Does Medicaid count my spouse's income if we are married?

Yes, in most states Medicaid counts the income of both spouses when determining whether a household qualifies. Some states have different rules for seniors or people with disabilities. Check with your state Medicaid office to confirm whether your spouse's income is counted and, if so, how.

What if my income changes during the year?

Most states allow you to report income changes between annual renewals. If your income drops, you can reapply or report the change, and coverage can start the following month. If your income rises above the limit, your coverage may end at the next renewal or when the state processes the change, depending on your state's rules.

Do child support payments count as income for Medicaid?

Child support is usually counted as income, though some states exclude a portion of it. The rules vary by state. Contact your state Medicaid office to find out whether and how much child support counts toward your income limit.

Can I get Medicaid if I am self-employed?

Yes. Self-employment income counts toward the Medicaid income limit. Most states count your gross self-employment income (before business expenses), though some allow deductions for business costs. Ask your state Medicaid office how they calculate self-employment income.

What is the federal poverty line, and how does it relate to Medicaid income limits?

The federal poverty line is a yearly income threshold set by the federal government. It changes each year and varies by family size. Some states use the poverty line as their Medicaid income limit; others set limits higher or lower. Your state's actual limit is what matters for your coverage.