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 the federal poverty level, and that threshold varies by household size. A family of three in one state might earn $500 more per month than the same family in another state and still stay within limits. Your state's Medicaid program publishes its current income limits, and they change once per year, usually in January.

The federal government sets a baseline — the federal poverty level — and states can choose to cover people at 100% of that level, 138% of that level, or somewhere in between. Some states have set their own limits higher or lower than the federal baseline allows. This means you need to check your specific state's current numbers, not rely on what you heard about another state or what was true last year.

Income limits also differ by category: children, pregnant people, parents, elderly people, and people with disabilities may each have different thresholds in the same state. A child might be covered at a higher income level than a parent in the same household.

Key Takeaways

  • Medicaid income limits are set by each state and based on the federal poverty level, so you must check your state's current numbers rather than using a national figure.
  • The same household income can may have access to in one state and not in another, and limits change yearly, usually in January.
  • Different household members — children, parents, elderly people — may have different income thresholds in your state.
  • Your state's Medicaid website or a 211 call can tell you the exact limit for your situation without requiring you to guess or calculate.

How states calculate the income limit

States use the federal poverty level as their starting point. For 2024, the federal poverty level for a family of four is set by the U.S. Department of Health and Human Services. Your state then decides what percentage of that level to use for Medicaid coverage. If your state covers at 138% of the federal poverty level, a family of four earning up to 138% of the poverty threshold qualifies.

Some states expanded Medicaid under the Affordable Care Act and cover adults at 138% of the federal poverty level. Other states did not expand and cover adults at a lower percentage — sometimes as low as 50% of the federal poverty level. This is the biggest reason income limits vary so widely between states.

The income calculation itself usually counts gross income before taxes. Self-employment income, wages, Social Security, child support, and other regular money coming in all count. Some types of income are excluded — for example, certain disability payments or food assistance — but the default is that income counts unless your state specifically excludes it.

What counts as income for Medicaid

Medicaid counts most money your household receives regularly. This includes wages, self-employment income, Social Security, unemployment benefits, child support, alimony, rental income, and interest or dividends. The program looks at gross income, meaning before taxes are taken out.

Some income does not count. Supplemental Security Income (SSI) is excluded in most states. Food assistance (SNAP) does not count. Some states exclude certain disability payments or workers' compensation. Your state's Medicaid program has a list of what it excludes, and it is worth checking because exclusions vary.

Medicaid typically looks at income for the current month or the past month, depending on your state's rules. If your income changes — you lose a job, get a raise, or have a one-time payment — you may need to report it. Some states use a three-month average, which smooths out irregular income.

How family size affects your income limit

The higher your household size, the higher your income limit. A single person has a lower threshold than a family of four. Medicaid counts people living with you and related to you — spouses, children, parents — as part of your household for income purposes. Some states count unrelated people living in your home; others do not.

If you are pregnant, some states count the unborn child as a household member for income purposes, which raises your limit. If you have adult children living with you, they usually count as separate household members, which increases your total household size and your income limit.

The exact definition of household varies by state and by the Medicaid category you are applying under. A parent applying for Medicaid may have a different household definition than a child applying for the same program. Your state's Medicaid office can tell you how they count your specific household.

Income limits for different Medicaid categories

Medicaid covers different groups of people, and each group may have a different income limit. Children often have the highest income limits — a state might cover children up to 200% of the federal poverty level while covering parents at 100%. Pregnant people and newborns typically have higher limits than other adults. Elderly people and people with disabilities may have their own thresholds.

Some states have separate programs for specific groups. A state might have one income limit for Medicaid covering children and a different one for Medicaid covering parents. If you are applying for coverage for multiple household members, each person may may have access to under a different income limit.

The income limit for long-term care or nursing home coverage is often different from the limit for regular medical coverage. If you are looking into coverage for institutional care, ask your state whether the income threshold differs from community-based Medicaid.

How to find your state's current income limit

Your state's Medicaid website publishes income limits for each household size and category. Search "[your state] Medicaid income limits" and look for the official state health department or Medicaid agency page. The limits are usually in a table showing income by family size.

You can also call 211 — a free helpline — and give them your state, household size, and the category you are asking about (child, parent, elderly, disabled). They can tell you the current limit and whether your household income falls within it. This takes a few minutes and requires no paperwork.

Your state's Medicaid application itself will ask about income and tell you whether you are within the limit. If you are close to the threshold, it is worth applying anyway — the program will calculate your exact may be able to access based on your specific situation, and some states have rules that can work in your favor.

What happens if your income changes

If your income goes up after you are enrolled in Medicaid, you may lose coverage. Most states require you to report income changes within 30 days. If you get a raise or a new job, contact your Medicaid office to report it. Some states will end your coverage immediately; others will let you keep it through the end of the month.

If your income goes down — you lose a job or have hours cut — you may become newly may be able to access or your coverage category may change. Report this change to your Medicaid office as well. A lower income can sometimes move you into a higher-coverage category or make you newly may be able to access if you were previously over the limit.

Some states have a grace period or a process called "continuous enrollment" that keeps you covered for a set time even if your income changes. Ask your state's Medicaid program what happens if your situation changes and how quickly you need to report it.

Frequently Asked Questions

Is there a national Medicaid income limit I can use to check myself?

No. Each state sets its own limit based on the federal poverty level, and they vary widely. A household that qualifies in one state may not may have access to in another. You must check your specific state's current numbers on the state Medicaid website or by calling 211.

Does my spouse's income count if we are not married but living together?

It depends on your state. Most states count only spouses and relatives living in your home. If you are not married, your partner's income usually does not count unless your state has a specific rule about unrelated household members. Ask your state's Medicaid program about your situation.

What if my income is irregular or I am self-employed?

Medicaid typically averages self-employment income over a period of time — often three months or the past year — to smooth out ups and downs. Bring tax returns or recent pay stubs when you apply. If your income varies a lot, ask whether your state uses an average, because a good month might not disqualify you if the average is lower.

Can I be over the income limit and still get Medicaid?

In most cases, no. However, some states have special programs for people slightly over the limit, and some categories (like coverage for long-term care) have different rules. If you are close to the limit, apply anyway — the program will calculate your exact situation, and there may be options you do not know about.

When do income limits change?

Income limits usually change once per year, in January, when the federal poverty level is updated. Some states may adjust them at other times. Check your state's Medicaid website in December or January to see if the limits have changed, especially if you were previously over the limit.