Medicaid Eligibility: Income Limits by State (2025 Guide)

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Your Guide to Medicaid Income Eligibility

What is Medicaid?

Medicaid is a cornerstone government health coverage program in the United States, created to help certain groups of people pay for healthcare. It functions as a partnership between the federal government and each individual state government.

Because of this joint structure, who qualifies for Medicaid and what services are covered can differ significantly from one state to the next, even though federal guidelines provide a baseline. Across the nation, Medicaid represents the single largest provider of health coverage, assisting over 77.9 million Americans according to recent figures.

Who Does Medicaid Help?

Medicaid primarily serves individuals and families who have low incomes. The program has historically focused on specific populations and continues to do so today. These key groups generally include:

• Children
• Pregnant women
• Parents and other relatives who are responsible for caring for dependent children
• Seniors (individuals aged 65 and older)
• Individuals living with disabilities

Federal regulations mandate that states participating in the Medicaid program must provide coverage to certain “mandatory” populations. Examples of these mandatory groups include qualifying low-income families, eligible pregnant women and children, and people who receive Supplemental Security Income (SSI) payments due to disability or age. Beyond these required groups, states have the flexibility to extend Medicaid coverage to other populations as well.

Purpose of This Guide

Figuring out if you or your family might be eligible for Medicaid often hinges on your household income. This guide provides a clear explanation of how income is considered for Medicaid eligibility. It breaks down the income limits state by state for the most common eligibility categories, using the income rules applicable for 2025.

The goal is to make this often-confusing information understandable and accessible, providing direct links to official state resources so you can verify details for your specific situation.

Understanding Medicaid Income Eligibility

The Role of the Federal Poverty Level (FPL)

Medicaid eligibility is fundamentally linked to a standard measure known as the Federal Poverty Level, or FPL. The U.S. Department of Health and Human Services (HHS) sets the FPL each year, establishing income thresholds based on the number of people in a family or household.

Instead of using fixed dollar amounts for income limits (which would quickly become outdated), Medicaid eligibility thresholds are typically expressed as a percentage of the FPL. For instance, a state might set the income limit for children at 200% FPL. This percentage-based system allows the actual income limits (in dollars) to adjust automatically each year when HHS releases the updated FPL figures.

Using FPL percentages provides a standardized method for comparing the relative generosity of income limits across different states and various assistance programs. However, it’s crucial to remember that the actual dollar amount corresponding to a specific FPL percentage will change based on the size of your household and the particular FPL year a program is using. States and programs may also adopt the newly updated FPL guidelines at slightly different times, typically early in the calendar year, which can occasionally cause temporary confusion for applicants whose income is very close to the limit.

To translate the percentage limits discussed throughout this guide into actual dollar figures, you first need to know the 100% FPL amount for your household size and location (Alaska and Hawaii have separate, higher FPLs than the 48 contiguous states and DC).

Table: 2025 Federal Poverty Level (FPL) Guidelines (Annual Income)

Persons in Family/Household	100% FPL (48 Contiguous States & DC)	100% FPL (Alaska)	100% FPL (Hawaii)
1	$15,650	$19,550	$17,990
2	$21,150	$26,430	$24,320
3	$26,650	$33,310	$30,650
4	$32,150	$40,190	$36,980
5	$37,650	$47,070	$43,310
6	$43,150	$53,950	$49,640
7	$48,650	$60,830	$55,970
8	$54,150	$67,710	$62,300
For each additional person	+$5,500	+$6,880	+$6,330

Source: U.S. Department of Health and Human Services (HHS), ASPE

How Income is Counted: MAGI vs. Non-MAGI

Medicaid uses two main methods for counting income and determining household size:

1. Modified Adjusted Gross Income (MAGI):

For the majority of people applying for Medicaid – including infants, children, pregnant women, parents/caretaker relatives, and adults covered through the Affordable Care Act (ACA) expansion – eligibility is determined using financial rules based on Modified Adjusted Gross Income (MAGI).

What is MAGI? MAGI is derived from federal income tax definitions. It starts with your Adjusted Gross Income (AGI), which is found on line 11 of your IRS Form 1040 federal tax return. To get MAGI, you add back certain types of income that are not typically taxed, such as:

• Untaxed foreign earned income
• Tax-exempt interest
• Non-taxable Social Security benefits

What’s Not Counted? Importantly, Supplemental Security Income (SSI) payments are excluded from MAGI calculations. Certain scholarships used for education (not living expenses) and specific income types for American Indians and Alaska Natives may also be excluded. Pre-tax contributions to things like employer-sponsored health insurance, 401(k)s, or certain childcare accounts are generally already subtracted from your wages and thus not included in the AGI starting point.

Household Size: MAGI rules also define who counts as part of your household, generally based on tax filing relationships (who you claim as a dependent, whether you file jointly, etc.).

No Asset Test: A significant feature of MAGI-based Medicaid is that there is typically no limit on assets (like savings accounts, cars, or property). Eligibility is based primarily on income.

The 5% Disregard: A standard feature of MAGI calculations for Medicaid is a 5% FPL income disregard. This means that an amount equal to 5% of the FPL for your household size is effectively subtracted from your calculated income before comparing it to the eligibility limit. This disregard can help people whose income is slightly above the standard limit to qualify. It’s the reason why the ACA Medicaid expansion limit, often stated as 133% FPL in the law, effectively functions as a 138% FPL limit in practice. The income limits presented in the state-by-state section of this guide generally incorporate this 5% disregard where applicable, showing the effective upper income threshold.

2. Non-MAGI Rules:

A different set of income (and asset) rules apply to individuals who qualify for Medicaid based on being:

• Age 65 or older
• Blind
• Having a qualifying disability

These are referred to as “non-MAGI” rules.

SSI-Based Methods: Non-MAGI income counting is generally based on the methods used by the Supplemental Security Income (SSI) program, which is administered by the Social Security Administration. These rules can be more complex than MAGI rules, sometimes involving different types of countable income or specific disregards (amounts of income not counted).

Asset Limits: Unlike MAGI pathways, non-MAGI eligibility pathways almost always include asset limits. This means applicants must have savings, investments, and other countable resources below a certain threshold (often $2,000 for an individual, but varying by state and program) in addition to meeting the income requirements.

Complexity and Variation: Non-MAGI rules are inherently more complex and can vary substantially between states and even between different non-MAGI eligibility pathways within the same state. These pathways often connect individuals to long-term services and supports (LTSS). (See Section VI for more details.)

The fundamental difference between MAGI and non-MAGI rules represents a split in how Medicaid eligibility works. MAGI aims for simplification for the largest groups by aligning with tax rules and eliminating asset tests, which is particularly helpful for accessing primary and acute care coverage. Non-MAGI retains older, more intricate rules, including asset tests, often tailored to populations with potentially higher healthcare costs or needs for long-term care.

Key Medicaid Eligibility Groups (MAGI-Based)

Medicaid eligibility isn’t uniform; it’s targeted toward specific groups. Federal law requires states to cover some populations, while allowing states the option to cover others. For the groups whose eligibility is based on MAGI income rules, the specific income limit (expressed as a % FPL) can vary significantly depending on the state. This guide focuses on the following key MAGI groups, whose income limits are detailed in the state-by-state section:

Infants (Under Age 1): States typically set their highest income eligibility limits for infants, recognizing the critical nature of healthcare in the first year of life.

Children (Ages 1-18): Income limits for children often differ based on age group (e.g., ages 1-5 might have a higher limit than ages 6-18). Many states provide Medicaid coverage to children at higher income levels compared to adults. Above certain income thresholds, children might transition from Medicaid to the state’s Children’s Health Insurance Program (CHIP), which often has slightly different rules or cost-sharing.

Pregnant Women: Recognizing the importance of prenatal and maternal health, income limits for pregnant individuals are generally higher than for other adults. Coverage typically continues for a significant postpartum period (often 12 months after the pregnancy ends) to support maternal health. Some states utilize their CHIP program, rather than Medicaid, to provide coverage to pregnant individuals.

Parents/Caretaker Relatives: This category includes parents or other relatives (like grandparents or aunts/uncles) who are the primary caregivers for dependent children living in their home. Income limits for this group are frequently much lower than those for children or pregnant women, especially in states that haven’t adopted the ACA Medicaid expansion. In some states, eligibility for this group may still be linked to outdated, very low income standards based on the former Aid to Families with Dependent Children (AFDC) program.

Adults (ACA Expansion Group): This group consists of adults under age 65 who don’t qualify for Medicaid under another category (like being pregnant, disabled, or a caretaker relative meeting the income limit). Their eligibility primarily depends on whether their state chose to expand Medicaid under the Affordable Care Act.

Medicaid Expansion and Adult Eligibility

The Affordable Care Act (ACA) Impact

A transformative change introduced by the Patient Protection and Affordable Care Act (ACA) in 2010 was the option for states to significantly expand Medicaid eligibility. The ACA allowed states to cover nearly all adults aged 19-64 with household incomes at or below 133% of the FPL (which, with the standard 5% income disregard, effectively means up to 138% FPL).

This was a major shift because, before the ACA, non-disabled adults without dependent children were generally ineligible for Medicaid, no matter how low their income was. The federal government offered states significantly enhanced funding (an increased federal matching rate, or FMAP) to cover the costs of this newly eligible population.

State Expansion Decisions

However, a 2012 Supreme Court decision (National Federation of Independent Business v. Sebelius) made adopting this Medicaid expansion optional for states. This ruling created a significant divergence across the country. Some states moved forward with expansion, while others chose not to. This state-level decision has become the single most important factor determining whether low-income adults—especially those without dependent children or qualifying disabilities—can access Medicaid coverage.

The Coverage Gap

In states that have not expanded Medicaid, a critical issue known as the “coverage gap” exists. Many adults in these states earn too much to qualify for Medicaid under their state’s very restrictive traditional eligibility rules (income limits for parents can be extremely low, often below 50% FPL, and childless adults often remain completely ineligible). Yet, their income is too low (below 100% FPL) to qualify for the premium tax credits (subsidies) available to help purchase private health insurance through the Health Insurance Marketplace (like Healthcare.gov).

States that have expanded Medicaid generally cover adults up to 138% FPL, effectively closing this gap and providing a continuous pathway to coverage. The existence of the coverage gap is a direct result of a state choosing not to adopt the ACA expansion, which was designed specifically to provide coverage for individuals in this income bracket (below 100% FPL) who were previously left out of both Medicaid and affordable private insurance options. This difference in state policy choices creates vastly different realities for healthcare access for low-income adults depending on where they live.

Table: State Medicaid Expansion Status (as of early 2025)

Knowing whether your state has expanded Medicaid is crucial context for understanding adult eligibility.

State	ACA Medicaid Expansion Status
Alabama	Not Adopted
Alaska	Adopted
Arizona	Adopted
Arkansas	Adopted
California	Adopted
Colorado	Adopted
Connecticut	Adopted
Delaware	Adopted
District of Columbia	Adopted
Florida	Not Adopted
Georgia	Not Adopted (Partial Waiver)
Hawaii	Adopted
Idaho	Adopted
Illinois	Adopted
Indiana	Adopted (Waiver)
Iowa	Adopted (Waiver)
Kansas	Not Adopted
Kentucky	Adopted
Louisiana	Adopted
Maine	Adopted
Maryland	Adopted
Massachusetts	Adopted
Michigan	Adopted
Minnesota	Adopted
Mississippi	Not Adopted
Missouri	Adopted
Montana	Adopted
Nebraska	Adopted
Nevada	Adopted
New Hampshire	Adopted
New Jersey	Adopted
New Mexico	Adopted
New York	Adopted
North Carolina	Adopted
North Dakota	Adopted
Ohio	Adopted
Oklahoma	Adopted
Oregon	Adopted
Pennsylvania	Adopted
Rhode Island	Adopted
South Carolina	Not Adopted
South Dakota	Adopted
Tennessee	Not Adopted
Texas	Not Adopted
Utah	Adopted
Vermont	Adopted
Virginia	Adopted
Washington	Adopted
West Virginia	Adopted
Wisconsin	Not Adopted
Wyoming	Not Adopted

Source: Based on data from KFF, CMS, CBPP

State-by-State Guide to Medicaid Income Limits (MAGI Rules for 2025)

The following section provides a state-by-state breakdown of Medicaid income eligibility limits for key groups based on MAGI rules, reflecting the 2025 Federal Poverty Levels (FPL) where available and generally including the standard 5% FPL income disregard. Remember that 100% FPL in 2025 for the 48 contiguous states and DC is $15,650 for a household of one, $21,150 for two, $26,650 for three, and $32,150 for four. Alaska and Hawaii have higher FPLs.

These limits apply primarily to children, pregnant women, parents/caretaker relatives, and ACA expansion adults. Eligibility based on age (65+), blindness, or disability follows different (non-MAGI) rules, often including asset limits (see Section VI).

Always verify current eligibility details directly with the official state Medicaid agency using the links provided.

Alabama

• Expansion Status: Not Adopted
• Infants (<1): ≤ 146% FPL (~$31,090/year for household of 2)
• Children (1-18): ≤ 146% FPL (~$38,909/year for household of 3) (CHIP/ALL Kids covers higher incomes up to 317% FPL)
• Pregnant Women: ≤ 146% FPL (~$38,909/year for household of 3)
• Parents/Caretaker Relatives: ≤ 18% FPL (~$4,797/year for household of 3)
• ACA Adults (19-64): Not Applicable (Non-Expansion State)
• Official Source: Alabama Medicaid Agency

Note: Alabama’s 18% FPL limit for parents is among the lowest in the nation, creating a significant coverage gap. A parent in a family of three earning just $400 per month could be ineligible for both Medicaid and Marketplace subsidies.

Alaska

• Expansion Status: Adopted
• Infants (<1): ≤ 208% FPL (~$55,000/year for household of 2 using AK FPL)
• Children (1-18): ≤ 208% FPL (~$69,285/year for household of 3 using AK FPL)
• Pregnant Women: ≤ 230% FPL (~$76,613/year for household of 3 using AK FPL)
• Parents/Caretaker Relatives: ≤ 138% FPL (approx. based on state $ threshold) (~$46,000/year for household of 3 using AK FPL)
• ACA Adults (19-64): ≤ 138% FPL (~$26,980/year for household of 1 using AK FPL)
• Official Source: Alaska Dept. of Health – Division of Public Assistance & DB101 Alaska

Note: Alaska uses higher FPL guidelines than the contiguous states.

Arizona

• Expansion Status: Adopted
• Infants (<1): ≤ 152% FPL (~$32,148/year for household of 2)
• Children (1-5): ≤ 146% FPL (~$38,909/year for household of 3)
• Children (6-18): ≤ 138% FPL (~$36,777/year for household of 3) (KidsCare/CHIP up to 205% FPL)
• Pregnant Women: ≤ 161% FPL (~$42,907/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Arizona Health Care Cost Containment System (AHCCCS)

Arkansas

• Expansion Status: Adopted
• Infants (<1): ≤ 147% FPL (ARKids A) (~$31,090/year for household of 2)
• Children (1-18): ≤ 147% FPL (ARKids A) (~$39,175/year for household of 3) (CHIP/ARKids B up to 216% FPL)
• Pregnant Women: ≤ 214% FPL (~$57,031/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Arkansas Dept. of Human Services (DHS)

California

• Expansion Status: Adopted
• Infants (<1): ≤ 266% FPL (Medi-Cal) (~$56,259/year for household of 2)
• Children (1-18): ≤ 266% FPL (Medi-Cal) (~$70,889/year for household of 3)
• Pregnant Women: ≤ 213% FPL (MAGI Medi-Cal) (~$56,770/year for household of 3) (MCAP covers 213%-322% FPL)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: California Dept. of Health Care Services (DHCS)

Note: California provides broad coverage, with high limits for children directly under Medi-Cal. It also uniquely eliminated asset limits for most non-MAGI Medi-Cal programs effective January 1, 2024.

Colorado

• Expansion Status: Adopted
• Infants (<1): ≤ 147% FPL (Health First Colorado) (~$31,090/year for household of 2)
• Children (1-18): ≤ 147% FPL (Health First Colorado) (~$39,175/year for household of 3) (CHP+/CHIP up to 260% FPL)
• Pregnant Women: ≤ 195% FPL (Medicaid) or ≤ 260% FPL (CHP+) (~$51,968/year or ~$69,290/year for household of 3)
• Parents/Caretaker Relatives: ≤ 68% FPL (~$18,122/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Colorado Dept. of Health Care Policy & Financing (HCPF) / Health First Colorado, Programs for Adults

Note: The dual limits for pregnant women reflect coverage options through both Medicaid (Health First Colorado) and CHIP (CHP+), demonstrating how states may layer programs.

Connecticut

• Expansion Status: Adopted
• Infants (<1): ≤ 201% FPL (HUSKY A) (~$42,512/year for household of 2)
• Children (1-18): ≤ 201% FPL (HUSKY A) (~$53,567/year for household of 3) (HUSKY B/CHIP up to 323% FPL)
• Pregnant Women: ≤ 263% FPL (HUSKY A) (~$70,080/year for household of 3)
• Parents/Caretaker Relatives: ≤ 160% FPL (HUSKY A) (~$42,640/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (HUSKY D) (~$21,597/year for household of 1)
• Official Source: HUSKY Health Connecticut / Access Health CT, Income Chart

Delaware

• Expansion Status: Adopted
• Infants (<1): ≤ 217% FPL (~$45,866/year for household of 2)
• Children (1-5): ≤ 147% FPL (~$39,175/year for household of 3)
• Children (6-18): ≤ 138% FPL (~$36,777/year for household of 3) (DHCP/CHIP up to 217% FPL)
• Pregnant Women: ≤ 217% FPL (~$57,831/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Delaware Division of Medicaid & Medical Assistance (DMMA), Eligibility Info

District of Columbia

• Expansion Status: Adopted
• Infants (<1): ≤ 324% FPL (~$68,526/year for household of 2)
• Children (1-18): ≤ 324% FPL (~$86,346/year for household of 3)
• Pregnant Women: ≤ 324% FPL (~$86,346/year for household of 3)
• Parents/Caretaker Relatives: ≤ 221% FPL (~$58,897/year for household of 3)
• ACA Adults (19-64): ≤ 215% FPL (~$33,640/year for household of 1)
• Official Source: DC Dept. of Health Care Finance (DHCF) / DC Health Link, DC Health Link Medicaid

Note: DC’s income limits are notably higher across the board compared to most states, reflecting a local policy choice for broader Medicaid access.

Florida

• Expansion Status: Not Adopted
• Infants (<1): ≤ 211% FPL (~$44,627/year for household of 2)
• Children (1-5): ≤ 145% FPL (~$38,643/year for household of 3)
• Children (6-18): ≤ 138% FPL (~$36,777/year for household of 3) (Florida KidCare/CHIP covers higher incomes)
• Pregnant Women: ≤ 196% FPL (~$52,234/year for household of 3)
• Parents/Caretaker Relatives: ≤ 30% FPL (~$7,995/year for household of 3)
• ACA Adults (19-64): Not Applicable (Non-Expansion State)
• Official Source: Florida Dept. of Children and Families (DCF) / Agency for Health Care Administration (AHCA), Florida Medicaid

Georgia

• Expansion Status: Not Adopted (Partial waiver ‘Pathways’ covers adults up to 100% FPL with work requirements)
• Infants (<1): ≤ 210% FPL (~$44,415/year for household of 2)
• Children (1-5): ≤ 154% FPL (~$41,041/year for household of 3)
• Children (6-18): ≤ 138% FPL (~$36,777/year for household of 3) (PeachCare for Kids®/CHIP up to 247% FPL)
• Pregnant Women: ≤ 225% FPL (~$59,963/year for household of 3)
• Parents/Caretaker Relatives: ≤ 36% FPL (~$9,594/year for household of 3)
• ACA Adults (19-64): ≤ 100% FPL (~$15,650/year for household of 1) only if meeting work requirements via Georgia Pathways waiver
• Official Source: Georgia Dept. of Community Health (DCH) / Georgia Gateway, PeachCare for Kids

Note: Georgia’s Pathways program is a limited, conditional expansion covering fewer adults and imposing work rules compared to standard ACA expansion, leaving a coverage gap.

Hawaii

• Expansion Status: Adopted
• Infants (<1): ≤ 196% FPL (~$47,667/year for household of 2 using HI FPL)
• Children (1-5): ≤ 196% FPL (~$60,074/year for household of 3 using HI FPL)
• Children (6-18): ≤ 144% FPL (~$44,136/year for household of 3 using HI FPL) (CHIP up to 313% FPL)
• Pregnant Women: ≤ 196% FPL (~$60,074/year for household of 3 using HI FPL)
• Parents/Caretaker Relatives: ≤ 105% FPL (~$32,183/year for household of 3 using HI FPL)
• ACA Adults (19-64): ≤ 138% FPL (~$24,826/year for household of 1 using HI FPL)
• Official Source: Hawaii Dept. of Human Services – Med-QUEST Division, Income Standards

Note: Hawaii uses higher FPL guidelines than the contiguous states.

Idaho

• Expansion Status: Adopted
• Infants (<1): ≤ 147% FPL (~$31,090/year for household of 2)
• Children (1-5): ≤ 147% FPL (~$39,175/year for household of 3)
• Children (6-18): ≤ 138% FPL (~$36,777/year for household of 3) (CHIP up to 190% FPL)
• Pregnant Women: ≤ 138% FPL (~$36,777/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Idaho Dept. of Health and Welfare (DHW)

Illinois

• Expansion Status: Adopted
• Infants (<1): ≤ 147% FPL (All Kids Assist) (~$31,090/year for household of 2)
• Children (1-18): ≤ 147% FPL (All Kids Assist) (~$39,175/year for household of 3) (All Kids Share/Premium/CHIP up to 318% FPL)
• Pregnant Women: ≤ 213% FPL (Moms & Babies) (~$56,770/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (FamilyCare/ACA Adults) (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Illinois Dept. of Healthcare and Family Services (HFS) / Application for Benefits Eligibility (ABE), ABE Portal

Indiana

• Expansion Status: Adopted (via HIP 2.0 Waiver)
• Infants (<1): ≤ 213% FPL (Hoosier Healthwise) (~$45,040/year for household of 2)
• Children (1-18): ≤ 163% FPL (Hoosier Healthwise) (~$43,430/year for household of 3) (CHIP up to 255% FPL)
• Pregnant Women: ≤ 213% FPL (Hoosier Healthwise/HIP Maternity) (~$56,770/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (Healthy Indiana Plan – HIP) (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (Healthy Indiana Plan – HIP) (~$21,597/year for household of 1)
• Official Source: Indiana Family and Social Services Administration (FSSA), Eligibility Guide

Note: Indiana uses the Healthy Indiana Plan (HIP), a waiver-based expansion model featuring POWER accounts and potential cost-sharing, differing from standard Medicaid expansion.

Iowa

• Expansion Status: Adopted (via Iowa Health and Wellness Plan waiver)
• Infants (<1): ≤ 380% FPL (~$80,370/year for household of 2)
• Children (1-18): ≤ 172% FPL (Medicaid) (~$45,838/year for household of 3) (Hawki/CHIP up to 307% FPL)
• Pregnant Women: ≤ 380% FPL (~$101,270/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (Iowa Health & Wellness Plan) (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (Iowa Health & Wellness Plan) (~$21,597/year for household of 1)
• Official Source: Iowa Dept. of Health and Human Services (HHS), Iowa Health Link/Hawki

Note: Iowa’s current high limits for infants and pregnant women are slated for significant reduction in 2025 due to state legislation, highlighting the potential for state policy changes to impact eligibility.

Kansas

• Expansion Status: Not Adopted
• Infants (<1): ≤ 171% FPL (~$36,167/year for household of 2)
• Children (1-5): ≤ 154% FPL (~$41,041/year for household of 3)
• Children (6-18): ≤ 138% FPL (~$36,777/year for household of 3) (CHIP up to 255% FPL)
• Pregnant Women: ≤ 171% FPL (~$45,570/year for household of 3)
• Parents/Caretaker Relatives: ≤ 38% FPL (~$10,127/year for household of 3)
• ACA Adults (19-64): Not Applicable (Non-Expansion State)
• Official Source: Kansas Dept. of Health and Environment – KanCare

Kentucky

• Expansion Status: Adopted
• Infants (<1): ≤ 218% FPL (~$46,107/year for household of 2)
• Children (1-18): ≤ 218% FPL (~$58,100/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 218% FPL (~$58,100/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Kentucky Cabinet for Health and Family Services – kynect

Louisiana

• Expansion Status: Adopted
• Infants (<1): ≤ 217% FPL (~$45,866/year for household of 2)
• Children (1-18): ≤ 217% FPL (~$57,831/year for household of 3) (LaCHIP up to 255% FPL)
• Pregnant Women: ≤ 138% FPL (~$36,777/year for household of 3)
• Parents/Caretaker Relatives: ≤ 19% FPL (~$5,064/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Louisiana Dept. of Health

Note: Despite expanding Medicaid for adults up to 138% FPL, Louisiana maintains a very low 19% FPL limit for the traditional Parent/Caretaker group. Parents between 19% and 138% FPL might qualify under the ACA adult category.

Maine

• Expansion Status: Adopted
• Infants (<1): ≤ 305% FPL (MaineCare) (~$64,508/year for household of 2)
• Children (1-18): ≤ 305% FPL (MaineCare) (~$81,283/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 214% FPL (~$57,031/year for household of 3)
• Parents/Caretaker Relatives: ≤ 105% FPL (~$27,983/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Maine Dept. of Health and Human Services – Office for Family Independence / MyMaineConnection

Maryland

• Expansion Status: Adopted
• Infants (<1): ≤ 322% FPL (~$68,093/year for household of 2)
• Children (1-18): ≤ 322% FPL (~$85,753/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 264% FPL (~$70,356/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Maryland Dept. of Health – Maryland Health Connection

Massachusetts

• Expansion Status: Adopted
• Infants (<1): ≤ 205% FPL (MassHealth) (~$43,358/year for household of 2)
• Children (1-18): ≤ 155% FPL (MassHealth Standard/CommonHealth) (~$41,308/year for household of 3) (CHIP up to 305% FPL)
• Pregnant Women: ≤ 205% FPL (~$54,633/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: MassHealth (Massachusetts Medicaid) / MA Health Connector

Michigan

• Expansion Status: Adopted
• Infants (<1): ≤ 217% FPL (Healthy Kids) (~$45,866/year for household of 2)
• Children (1-18): ≤ 217% FPL (Healthy Kids/MIChild) (~$57,831/year for household of 3) (No separate CHIP over this limit)
• Pregnant Women: ≤ 200% FPL (MOMS program) (~$53,300/year for household of 3)
• Parents/Caretaker Relatives: ≤ 54% FPL (~$14,391/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (Healthy Michigan Plan) (~$21,597/year for household of 1)
• Official Source: Michigan Dept. of Health & Human Services (MDHHS) / MI Bridges

Minnesota

• Expansion Status: Adopted
• Infants (<1): ≤ 288% FPL (Medical Assistance) (~$60,912/year for household of 2)
• Children (1-18): ≤ 280% FPL (Medical Assistance) (~$74,620/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 283% FPL (~$75,410/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (Medical Assistance) or 138%-200% FPL (MinnesotaCare BHP) (~$21,597/year or up to $31,300/year for household of 1)
• Official Source: Minnesota Dept. of Human Services / MNsure

Note: Minnesota uses a Basic Health Program (MinnesotaCare) to cover adults between 138%-200% FPL, bridging the gap between Medicaid and higher-subsidy Marketplace plans.

Mississippi

• Expansion Status: Not Adopted
• Infants (<1): ≤ 199% FPL (~$42,089/year for household of 2)
• Children (1-5): ≤ 148% FPL (~$39,442/year for household of 3)
• Children (6-18): ≤ 138% FPL (~$36,777/year for household of 3) (CHIP up to 214% FPL)
• Pregnant Women: ≤ 199% FPL (~$53,034/year for household of 3)
• Parents/Caretaker Relatives: ≤ 24% FPL (~$6,396/year for household of 3)
• ACA Adults (19-64): Not Applicable (Non-Expansion State)
• Official Source: Mississippi Division of Medicaid

Missouri

• Expansion Status: Adopted
• Infants (<1): ≤ 201% FPL (MO HealthNet) (~$42,512/year for household of 2)
• Children (1-18): ≤ 155% FPL (MO HealthNet) (~$41,308/year for household of 3) (CHIP up to 305% FPL)
• Pregnant Women: ≤ 201% FPL (MO HealthNet) or ≤ 305% FPL (CHIP) (~$53,567/year or ~$81,283/year for household of 3)
• Parents/Caretaker Relatives: ≤ 21% FPL (~$5,597/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Missouri Dept. of Social Services – Family Support Division / MO HealthNet

Montana

• Expansion Status: Adopted
• Infants (<1): ≤ 148% FPL (Healthy Montana Kids – HMK) (~$31,282/year for household of 2)
• Children (1-18): ≤ 148% FPL (HMK) (~$39,442/year for household of 3) (HMK Plus/CHIP up to 266% FPL)
• Pregnant Women: ≤ 162% FPL (~$43,173/year for household of 3)
• Parents/Caretaker Relatives: ≤ 30% FPL (~$7,995/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Montana Dept. of Public Health and Human Services (DPHHS)

Nebraska

• Expansion Status: Adopted
• Infants (<1): ≤ 218% FPL (~$46,107/year for household of 2)
• Children (1-18): ≤ 218% FPL (~$58,100/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 199% FPL (~$53,034/year for household of 3)
• Parents/Caretaker Relatives: ≤ 63% FPL (~$16,790/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Nebraska Dept. of Health and Human Services (DHHS) / ACCESSNebraska

Nevada

• Expansion Status: Adopted
• Infants (<1): ≤ 165% FPL (Nevada Medicaid) (~$34,898/year for household of 2)
• Children (1-5): ≤ 165% FPL (Nevada Medicaid) (~$43,973/year for household of 3)
• Children (6-18): ≤ 138% FPL (Nevada Medicaid) (~$36,777/year for household of 3) (Nevada Check Up/CHIP up to 205% FPL)
• Pregnant Women: ≤ 165% FPL (~$43,973/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Nevada Division of Welfare and Supportive Services (DWSS) / Access Nevada

New Hampshire

• Expansion Status: Adopted
• Infants (<1): ≤ 323% FPL (NH Medicaid) (~$68,305/year for household of 2)
• Children (1-18): ≤ 323% FPL (NH Medicaid/CHIP) (~$86,080/year for household of 3) (No separate CHIP over this limit)
• Pregnant Women: ≤ 201% FPL (~$53,567/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (NH Granite Advantage Health Care Program) (~$21,597/year for household of 1)
• Official Source: New Hampshire Dept. of Health & Human Services (DHHS) / NH Easy Gateway

New Jersey

• Expansion Status: Adopted
• Infants (<1): ≤ 199% FPL (NJ FamilyCare) (~$42,089/year for household of 2)
• Children (1-5): ≤ 147% FPL (NJ FamilyCare) (~$39,175/year for household of 3)
• Children (6-18): ≤ 138% FPL (NJ FamilyCare) (~$36,777/year for household of 3) (NJ FamilyCare/CHIP up to 355% FPL)
• Pregnant Women: ≤ 205% FPL (~$54,633/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: NJ Dept. of Human Services – Division of Medical Assistance and Health Services / NJHelps / NJ FamilyCare, NJ FamilyCare Eligibility

New Mexico

• Expansion Status: Adopted
• Infants (<1): ≤ 305% FPL (Centennial Care) (~$64,508/year for household of 2)
• Children (1-5): ≤ 305% FPL (Centennial Care) (~$81,283/year for household of 3)
• Children (6-18): ≤ 245% FPL (Centennial Care) (~$65,293/year for household of 3) (CHIP up to 305% FPL)
• Pregnant Women: ≤ 255% FPL (~$67,958/year for household of 3)
• Parents/Caretaker Relatives: ≤ 42% FPL (~$11,193/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: New Mexico Human Services Dept. / YesNM portal

New York

• Expansion Status: Adopted
• Infants (<1): ≤ 223% FPL (NY Medicaid) (~$47,165/year for household of 2)
• Children (1-18): ≤ 154% FPL (NY Medicaid) (~$41,041/year for household of 3) (Child Health Plus/CHIP up to 405% FPL)
• Pregnant Women: ≤ 223% FPL (~$59,420/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (NY Medicaid) or 138%-250% FPL (Essential Plan BHP) (~$21,597/year or up to $39,125/year for household of 1)
• Official Source: New York State Dept. of Health / NY State of Health Marketplace, Essential Plan

Note: New York’s Essential Plan (a Basic Health Program) covers adults between 138%-250% FPL, offering affordable coverage above the standard Medicaid limit.

North Carolina

• Expansion Status: Adopted (Effective Dec 1, 2023)
• Infants (<1): ≤ 216% FPL (NC Medicaid) (~$45,684/year for household of 2)
• Children (1-5): ≤ 216% FPL (NC Medicaid) (~$57,564/year for household of 3)
• Children (6-18): ≤ 138% FPL (NC Medicaid) (~$36,777/year for household of 3) (NC Health Choice/CHIP up to 216% FPL)
• Pregnant Women: ≤ 201% FPL (~$53,567/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: North Carolina Dept. of Health and Human Services (NCDHHS) / ePASS portal

North Dakota

• Expansion Status: Adopted
• Infants (<1): ≤ 175% FPL (ND Medicaid) (~$37,013/year for household of 2)
• Children (1-18): ≤ 175% FPL (ND Medicaid/Healthy Steps CHIP) (~$46,638/year for household of 3) (No separate CHIP over this limit)
• Pregnant Women: ≤ 175% FPL (~$46,638/year for household of 3)
• Parents/Caretaker Relatives: ≤ 48% FPL (~$12,792/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: North Dakota Health and Human Services (HHS)

Ohio

• Expansion Status: Adopted
• Infants (<1): ≤ 211% FPL (Healthy Start) (~$44,627/year for household of 2)
• Children (1-18): ≤ 211% FPL (Healthy Start/Healthy Families) (~$56,232/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 205% FPL (~$54,633/year for household of 3)
• Parents/Caretaker Relatives: ≤ 95% FPL (~$25,318/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Ohio Dept. of Medicaid / Ohio Benefits portal

Oklahoma

• Expansion Status: Adopted
• Infants (<1): ≤ 210% FPL (SoonerCare) (~$44,415/year for household of 2)
• Children (1-18): ≤ 210% FPL (SoonerCare) (~$55,965/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 210% FPL (SoonerCare) (~$55,965/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Oklahoma Health Care Authority – SoonerCare

Oregon

• Expansion Status: Adopted
• Infants (<1): ≤ 190% FPL (Oregon Health Plan – OHP) (~$40,185/year for household of 2)
• Children (1-5): ≤ 138% FPL (OHP) (~$36,777/year for household of 3)
• Children (6-18): ≤ 138% FPL (OHP) (~$36,777/year for household of 3) (OHP Plus/CHIP up to 305% FPL)
• Pregnant Women: ≤ 190% FPL (~$50,635/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (OHP) or 138%-200% FPL (OHP Bridge BHP) (~$21,597/year or up to $31,300/year for household of 1)
• Official Source: Oregon Health Authority – Oregon Health Plan (OHP) / ONE Applicant Portal

Note: Oregon’s OHP Bridge is a Basic Health Program covering adults between 138%-200% FPL, similar to programs in MN and NY.

Pennsylvania

• Expansion Status: Adopted
• Infants (<1): ≤ 220% FPL (Medical Assistance) (~$46,530/year for household of 2)
• Children (1-5): ≤ 162% FPL (Medical Assistance) (~$43,173/year for household of 3)
• Children (6-18): ≤ 138% FPL (Medical Assistance) (~$36,777/year for household of 3) (CHIP up to 319% FPL)
• Pregnant Women: ≤ 220% FPL (~$58,630/year for household of 3)
• Parents/Caretaker Relatives: ≤ 38% FPL (~$10,127/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Pennsylvania Dept. of Human Services / COMPASS portal

Rhode Island

• Expansion Status: Adopted
• Infants (<1): ≤ 266% FPL (~$56,259/year for household of 2)
• Children (1-18): ≤ 266% FPL (~$70,889/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 258% FPL (~$68,757/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Rhode Island Executive Office of Health & Human Services (EOHHS) / HealthSource RI

South Carolina

• Expansion Status: Not Adopted
• Infants (<1): ≤ 213% FPL (Healthy Connections) (~$45,040/year for household of 2)
• Children (1-18): ≤ 213% FPL (Healthy Connections Kids) (~$56,770/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 199% FPL (~$53,034/year for household of 3)
• Parents/Caretaker Relatives: ≤ 67% FPL (~$17,856/year for household of 3)
• ACA Adults (19-64): Not Applicable (Non-Expansion State)
• Official Source: South Carolina Dept. of Health and Human Services (SCDHHS) – Healthy Connections

South Dakota

• Expansion Status: Adopted (Effective July 1, 2023)
• Infants (<1): ≤ 187% FPL (~$39,551/year for household of 2)
• Children (1-18): ≤ 187% FPL (~$49,836/year for household of 3) (CHIP up to 209% FPL)
• Pregnant Women: ≤ 138% FPL (~$36,777/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: South Dakota Dept. of Social Services (DSS)

Tennessee

• Expansion Status: Not Adopted
• Infants (<1): ≤ 200% FPL (TennCare) (~$42,300/year for household of 2)
• Children (1-5): ≤ 147% FPL (TennCare) (~$39,175/year for household of 3)
• Children (6-18): ≤ 138% FPL (TennCare) (~$36,777/year for household of 3) (CoverKids/CHIP up to 255% FPL)
• Pregnant Women: ≤ 200% FPL (~$53,300/year for household of 3)
• Parents/Caretaker Relatives: ≤ 105% FPL (~$27,983/year for household of 3)
• ACA Adults (19-64): Not Applicable (Non-Expansion State)
• Official Source: TennCare (Tennessee Medicaid) / TennCare Connect portal

Texas

• Expansion Status: Not Adopted
• Infants (<1): ≤ 203% FPL (~$42,935/year for household of 2)
• Children (1-5): ≤ 149% FPL (~$39,709/year for household of 3)
• Children (6-18): ≤ 138% FPL (~$36,777/year for household of 3) (CHIP up to 206% FPL)
• Pregnant Women: ≤ 203% FPL (~$54,100/year for household of 3)
• Parents/Caretaker Relatives: ≤ 17% FPL (~$4,531/year for household of 3)
• ACA Adults (19-64): Not Applicable (Non-Expansion State)
• Official Source: Texas Health and Human Services (HHS) / YourTexasBenefits.com

Utah

• Expansion Status: Adopted
• Infants (<1): ≤ 144% FPL (~$30,456/year for household of 2)
• Children (1-18): ≤ 144% FPL (~$38,376/year for household of 3)
• Children (6-18): ≤ 138% FPL (~$36,777/year for household of 3) (CHIP up to 205% FPL)
• Pregnant Women: ≤ 144% FPL (~$38,376/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Utah Dept. of Health & Human Services – Division of Integrated Healthcare (Medicaid) / UtahID portal

Vermont

• Expansion Status: Adopted
• Infants (<1): ≤ 317% FPL (Green Mountain Care) (~$67,046/year for household of 2)
• Children (1-18): ≤ 317% FPL (Green Mountain Care) (~$84,481/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 213% FPL (~$56,770/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: State of Vermont – Agency of Human Services – Dept. for Children and Families / Vermont Health Connect, Vermont Health Connect Portal

Virginia

• Expansion Status: Adopted
• Infants (<1): ≤ 148% FPL (FAMIS MOMS/Medicaid) (~$31,282/year for household of 2)
• Children (1-18): ≤ 148% FPL (FAMIS/Medicaid) (~$39,442/year for household of 3) (FAMIS/CHIP up to 205% FPL)
• Pregnant Women: ≤ 205% FPL (FAMIS MOMS/CHIP) (~$54,633/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Virginia Dept. of Medical Assistance Services (DMAS) / Cover Virginia / CommonHelp portal

Washington

• Expansion Status: Adopted
• Infants (<1): ≤ 215% FPL (Apple Health) (~$45,473/year for household of 2)
• Children (1-18): ≤ 215% FPL (Apple Health) (~$57,298/year for household of 3) (Apple Health for Kids/CHIP up to 317% FPL)
• Pregnant Women: ≤ 198% FPL (~$52,767/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: Washington State Health Care Authority – Apple Health (Medicaid) / Washington Healthplanfinder

West Virginia

• Expansion Status: Adopted
• Infants (<1): ≤ 163% FPL (WV Medicaid) (~$34,475/year for household of 2)
• Children (1-5): ≤ 146% FPL (WV Medicaid) (~$38,909/year for household of 3)
• Children (6-18): ≤ 138% FPL (WV Medicaid) (~$36,777/year for household of 3) (WV CHIP up to 305% FPL)
• Pregnant Women: ≤ 190% FPL (WV Medicaid) or ≤ 305% FPL (WV CHIP) (~$50,635/year or ~$81,283/year for household of 3)
• Parents/Caretaker Relatives: ≤ 138% FPL (~$36,777/year for household of 3)
• ACA Adults (19-64): ≤ 138% FPL (~$21,597/year for household of 1)
• Official Source: West Virginia Dept. of Human Services – Bureau for Medical Services / WV PATH portal, WV PATH

Wisconsin

• Expansion Status: Not Adopted (Covers adults up to 100% FPL via waiver, but not considered ACA expansion)
• Infants (<1): ≤ 306% FPL (BadgerCare Plus) (~$64,719/year for household of 2)
• Children (1-18): ≤ 306% FPL (BadgerCare Plus) (~$81,549/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 306% FPL (~$81,549/year for household of 3)
• Parents/Caretaker Relatives: ≤ 100% FPL (~$26,650/year for household of 3)
• ACA Adults (19-64): ≤ 100% FPL (~$15,650/year for household of 1)
• Official Source: Wisconsin Dept. of Health Services – BadgerCare Plus / ACCESS Wisconsin portal, ACCESS Wisconsin

Note: Wisconsin covers adults up to 100% FPL through BadgerCare Plus, which predates the ACA and uses a federal waiver. While this prevents a coverage gap below 100% FPL, it is not considered ACA expansion, and adults between 100%-138% FPL are not covered by Medicaid.

Wyoming

• Expansion Status: Not Adopted
• Infants (<1): ≤ 205% FPL (~$43,358/year for household of 2)
• Children (1-18): ≤ 205% FPL (~$54,633/year for household of 3) (No separate CHIP)
• Pregnant Women: ≤ 159% FPL (~$42,374/year for household of 3)
• Parents/Caretaker Relatives: ≤ 56% FPL (~$14,924/year for household of 3)
• ACA Adults (19-64): Not Applicable (Non-Expansion State)
• Official Source: Wyoming Dept. of Health

Non-MAGI Eligibility: Aged, Blind, and Disabled

While the MAGI rules cover most Medicaid applicants, a separate and more complex set of rules applies to individuals seeking eligibility based on being age 65 or older, blind, or having a qualifying disability. These are often referred to as “non-MAGI” pathways.

Key Differences from MAGI

• Income Counting: Non-MAGI income rules are generally based on SSI methodologies, which differ from the tax-based MAGI rules. This can involve different definitions of countable income and specific income disregards.
• Asset Tests: Unlike MAGI pathways, nearly all non-MAGI pathways include strict limits on countable assets (resources like savings, stocks, bonds, and sometimes property beyond a primary home). Asset limits are often low (e.g., $2,000 for an individual), though they can vary by state and program. California is a notable exception, having eliminated asset limits for most non-MAGI programs as of 2024.
• Disability Determination: Applicants seeking eligibility based on disability generally need to undergo a formal disability determination process, often aligned with Social Security criteria, unless they are already receiving SSI or Social Security Disability Insurance (SSDI).
• Functional Needs Tests: For pathways related to Long-Term Services and Supports (LTSS), individuals usually must meet functional eligibility criteria, demonstrating a need for help with Activities of Daily Living (ADLs) like bathing, dressing, or eating, often requiring a level of care typically provided in a nursing home.
• Complexity and State Variation: Because many non-MAGI pathways are optional for states, eligibility criteria, income limits, asset limits, and covered services vary significantly across the country.

Common Non-MAGI Pathways

States offer various pathways for this population, including:

• SSI Recipients: Individuals receiving Supplemental Security Income are typically automatically eligible for Medicaid.
• Aged, Blind, and Disabled (ABD) Medicaid: Covers individuals meeting age/disability criteria with income and assets below state-set limits, which may be aligned with SSI or set slightly higher (e.g., up to 100% FPL).
• Medicare Savings Programs (MSPs): Help low-income Medicare beneficiaries pay for Medicare premiums and sometimes cost-sharing. Income and asset limits apply, and benefits are limited to Medicare cost assistance, not full Medicaid.
• Medically Needy Programs: Allow individuals with high medical expenses to “spend down” their income to meet eligibility levels. Income and asset limits are typically very low before spend-down.
• Home and Community-Based Services (HCBS) Waivers: Provide LTSS in community settings for individuals who meet nursing home level of care criteria but wish to remain at home. Often use higher income limits (e.g., up to 300% of the SSI benefit rate) but still have asset limits.
• Medicaid Buy-In for Workers with Disabilities: Allows working individuals with disabilities whose earnings exceed standard limits to pay a premium to access Medicaid. Income and asset limits are generally higher than other pathways.

Importance of State-Specific Information

Given the complexity and variability of non-MAGI rules, it is essential to consult official resources from your specific state’s Medicaid agency. National summaries provide an overview, but only the state agency can provide definitive information on income limits, exact asset rules (including which assets are counted or exempt, like a primary home or one vehicle), functional assessments, and application procedures for these pathways.

You can find links to state Medicaid agencies via Medicaid.gov or reputable policy organizations like KFF.

Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.