How Much Can You Earn With Medicaid: Limits by Household and State

In 2026, a single adult can earn up to $22,025 a year and qualify for Medicaid in states that expanded the program under the Affordable Care Act. That’s the headline figure, but Medicaid income limits in 2026 vary by household size, by state, and by which Medicaid category you’re applying under. Seniors, people with disabilities, and anyone seeking long-term care face a separate set of rules that also look at what you own, not just what you earn.

2026 Income Limits by Household Size

Medicaid income limits track the Federal Poverty Level, which the federal government updates each January. For 2026, the FPL for a single person in the 48 contiguous states is $15,960, and for a family of three it’s $27,320.¹ In expansion states, adults qualify at up to 138% of FPL:

Single individual: $22,025
Household of two: $29,863
Household of three: $37,702
Household of four: $45,540

Each additional household member adds roughly $7,838 to the limit.¹ Alaska and Hawaii have higher FPL thresholds, so their dollar limits run higher.

The 138% figure has an odd origin. The ACA statute sets the eligibility ceiling at 133% of FPL, but it also builds in a 5-percentage-point income disregard as part of how income is calculated. The practical result is that eligibility extends to 138% of FPL.²

Children and Pregnant Women Qualify at Higher Incomes

Kids and pregnant applicants get more generous limits. Many states cover children up to 200% of FPL or higher through Medicaid or the Children’s Health Insurance Program (CHIP), and pregnant women frequently qualify at 185% to 200% of FPL or above, depending on the state. If your household income puts you over the adult limit, your kids may still qualify.

Your State Changes the Answer

Over 40 states plus the District of Columbia have expanded Medicaid under the ACA. In those states, any adult under 65 with household income at or below 138% of FPL can qualify, regardless of whether they have children, a disability, or any other special circumstance.²

In the roughly ten states that have not expanded, the picture is far more restrictive. Adults without children generally cannot qualify at any income level. Parents may qualify, but the income limits are often dramatically lower than in expansion states, sometimes below 50% of FPL. This creates a gap where people earn too much for their state’s Medicaid program but too little to get subsidized Marketplace insurance. If you live in a non-expansion state, check your state Medicaid agency’s website for the actual thresholds.

How Medicaid Counts Your Income

For most applicants — children, pregnant women, parents, and adults covered by the ACA expansion — Medicaid uses a tax-based measure called Modified Adjusted Gross Income. MAGI starts with the adjusted gross income from your tax return and adds back three items: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.³ MAGI-based eligibility does not count assets at all. No one looks at your bank account or home equity.⁴

Some deductions reduce your MAGI, including traditional IRA contributions and student loan interest payments.³ Even a small deduction can bring you under the cutoff.

Medicaid looks at your current monthly income, not last year’s tax return. If you recently lost a job or had a drop in earnings, you can apply based on your projected income for the coverage period.

If You’re Self-Employed

Medicaid counts your net profit, meaning revenue minus business expenses, not your gross receipts. This is the same figure you’d report on Schedule C.⁵ If your expenses exceed revenue, you report a net loss, which reduces your household income for eligibility purposes. You may be asked to submit a self-employment ledger showing income and expenses; there’s no required format, so a spreadsheet or bookkeeping printout works.

Different Rules for Seniors and People With Disabilities

If you’re applying based on age (65 or older), blindness, or disability, or you need long-term care coverage like nursing home care, MAGI doesn’t apply. These programs use their own income-counting rules with different deductions and disregards, and they impose asset limits that MAGI-based Medicaid does not.⁴

In most states, a single applicant can keep no more than $2,000 in countable assets, and a married couple where both spouses apply can keep $3,000.⁶ These limits, based on federal SSI standards, haven’t increased in decades.

Countable assets include bank accounts, stocks, bonds, and second properties. Many of the things people worry about most are actually exempt:

Your primary home, as long as you or your spouse live there, up to a home equity limit that states set somewhere between $752,000 and $1,130,000 for 2026.⁷
One vehicle, generally regardless of value.
Household goods and personal belongings.
Prepaid funeral and burial arrangements, though states may cap the exempt amount.

How Medicaid treats IRAs and 401(k)s depends on whether the account is in “payout status,” meaning you’re taking regular periodic distributions. If you are, the distributions count as income, not as an asset. If not, many states count the full account balance as a countable resource. Rules vary significantly by state, and the distinction between a lump-sum withdrawal (treated as a resource) and regular monthly payments (treated as income) can make or break eligibility for long-term care Medicaid.

Spousal Protections for Long-Term Care

When one spouse enters a nursing home and the other stays in the community, federal law protects the at-home spouse from being impoverished. Assets are the first piece: the community spouse can keep a share of the couple’s combined resources up to a federally set maximum through the Community Spouse Resource Allowance, with the protected amount varying by state between a federal floor and ceiling.⁷ Assets above the protected amount generally must be spent down before the nursing home spouse qualifies.

Income is the second piece. The community spouse is entitled to a Minimum Monthly Maintenance Needs Allowance. If their own income falls below the floor, some of the nursing home spouse’s income can be diverted to them. For 2026, the maximum monthly maintenance needs allowance is $4,066.50.⁷

Options if Your Income Is Over the Limit

Some states run “medically needy” or spend-down programs for people whose income exceeds the standard limit. You subtract medical expenses you’ve already incurred from your countable income, and once your remaining income drops below the state’s medically needy threshold, Medicaid picks up the rest of that coverage period. Not every state offers this option, and thresholds and covered populations vary.

In states without a medically needy program, a Qualified Income Trust (often called a Miller Trust) can solve the problem of excess income for long-term care applicants. You deposit income above the Medicaid limit into this irrevocable trust each month, and the deposited income no longer counts toward eligibility. Trust funds can only pay specific costs, such as medical bills, a personal needs allowance, and the community spouse’s maintenance. Whatever remains after the recipient’s death goes to reimburse the state. Setup runs from a few hundred to a few thousand dollars with an attorney.

Prepaying funeral and burial expenses through an irrevocable funeral trust removes those funds from countable assets. Because the trust is irrevocable, you can’t get the money back, which is exactly why Medicaid doesn’t count it. States often cap the exempt amount.

If You Also Have Medicare

You can qualify for both Medicare and Medicaid, and even if your income is too high for full Medicaid, you may qualify for a Medicare Savings Program that covers some or all of your Medicare costs.⁸ The three main programs:

Qualified Medicare Beneficiary (QMB) covers Medicare Part A and Part B premiums, deductibles, and copayments. For 2026, the monthly income limit is $1,350 for an individual or $1,824 for a married couple, with resource limits of $9,950 and $14,910 respectively. Medicare providers cannot bill you for covered cost-sharing if you have QMB status.⁹
Specified Low-Income Medicare Beneficiary (SLMB) covers your Part B premium only, at slightly higher income limits than QMB.
Qualified Disabled Working Individual (QDWI) covers the Part A premium for people who lost premium-free Part A when they returned to work.

QMB recipients automatically receive Extra Help with prescription drug costs, paying no more than $12.65 per covered medication in 2026.⁹

Keeping Coverage After You Qualify

States redetermine eligibility every 12 months, and you’ll receive a renewal notice before your coverage period ends. Some states auto-renew by checking electronic data sources, in which case the notice simply confirms the new coverage period. Others require you to complete a renewal form with updated income and household information.¹⁰ Missing a renewal deadline is one of the most common reasons people lose Medicaid. If a form arrives, return it quickly.

Between renewals, report changes in income, household size, or residency to your state Medicaid agency. A new job, a marriage, or a move can all affect eligibility, and not reporting a change can mean losing coverage retroactively or owing money back.

1
U.S. Department of Health and Human Services, ASPE. 2026 Poverty Guidelines – 48 Contiguous States
2
HealthCare.gov. Medicaid Expansion and What It Means for You
3
HealthCare.gov. Modified Adjusted Gross Income (MAGI) – Glossary
4
Medicaid.gov. Eligibility Policy
5
HealthCare.gov. Reporting Self-Employment Income to the Marketplace
6
Social Security Administration. 2026 Cost-of-Living Adjustment (COLA) Fact Sheet
7
Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
8
Centers for Medicare and Medicaid Services. Beneficiaries Dually Eligible for Medicare and Medicaid
9
Medicare.gov. Medicare Savings Programs
10
Medicaid.gov. Eligibility Renewals Overview