Non-MAGI Medicaid is the group of Medicaid pathways that decide eligibility based on age, blindness, disability, or the need for long-term care rather than on a simple income calculation. These rules borrow from the Supplemental Security Income program, which means the state looks at both your income and your countable assets, and they exist because the tax-based formula used for most Medicaid applicants cannot capture the financial reality of seniors, people with serious disabilities, and people who need nursing home or in-home care.
How Non-MAGI Differs From MAGI Medicaid
MAGI Medicaid, which expanded under the Affordable Care Act, uses federal income tax rules to count household income. There is no asset test. If your income falls below the threshold, you qualify, and most people under 65 who apply through the health insurance marketplace are evaluated this way.
Non-MAGI works differently in almost every respect. Federal regulations require states applying Non-MAGI financial methodologies to follow the SSI program’s approach for people who are 65 or older, blind, or disabled.1Medicaid.gov. Implementation Guide: Medicaid State Plan Eligibility Non-MAGI Methodologies MAGI rules explicitly prohibit any asset test; Non-MAGI programs almost always impose one.2eCFR. 42 CFR Part 435 Subpart G – General Financial Eligibility Requirements and Options Non-MAGI also allows deductions and disregards that MAGI does not, such as subtracting medical expenses or work-related costs for people with disabilities.
Who Qualifies
Non-MAGI Medicaid serves several distinct groups, sometimes collectively called the ABD (Aged, Blind, and Disabled) populations.3HHS.gov. Implementation Guide: Financial Eligibility Requirements for Non-MAGI Groups
- People 65 and older with limited income and assets.
- Blind or disabled people of any age who meet the Social Security Administration’s definition and have limited resources.
- Recipients of federal Supplemental Security Income, who qualify automatically in most states.
- People who need nursing home care or home and community-based services and meet both financial and functional requirements.
- Low-income Medicare beneficiaries who qualify through Medicare Savings Programs.
SSI Recipients
The only Non-MAGI pathway every state must cover is SSI recipients. In 2026, the maximum federal SSI payment is $994 per month for an individual and $1,491 for a couple, with resource limits of $2,000 and $3,000.4Social Security Administration. SSI Federal Payment Amounts for 20265Social Security Administration. 2026 Cost-of-Living Adjustment (COLA) Fact Sheet If you receive SSI, your finances have already been verified against those limits, so Medicaid follows automatically in most states.
A handful of states, known as 209(b) states, apply stricter criteria than SSI. In those states, SSI eligibility does not automatically produce Medicaid coverage, and you may need to meet the state’s own tighter financial or medical requirements.6Medicaid.gov. Medicaid State Plan Eligibility More Restrictive Requirements – 209(b) States Just over half of states also extend coverage above the SSI limit through optional eligibility groups, so an income slightly above $994 per month is not automatically disqualifying.
Disability-Based Coverage
For applicants under 65 whose eligibility rests on disability, Medicaid follows Social Security Administration criteria.7eCFR. 42 CFR 435.541 – Determinations of Disability You need a medical condition severe enough to prevent substantial work activity, expected to last at least 12 months or result in death. Applications on this basis take longer because of the medical review.
Long-Term Care and Home-Based Services
People who need nursing home care or equivalent services at home can qualify through long-term care pathways. Along with financial eligibility, you have to show a medical need for the level of care a nursing facility provides. Federal rules require that an evaluation confirm you would need institutional care without home and community-based services, and the evaluation must be repeated at least annually.8eCFR. 42 CFR Part 441 Subpart G – Home and Community-Based Services: Waiver Requirements
When the state finds you meet the institutional level of care, it must tell you about home and community-based services (HCBS) waivers and let you choose between institutional care and remaining at home with services like personal attendants, meal delivery, or skilled nursing visits.
Medicare Savings Programs
Medicare Savings Programs (MSPs) are Non-MAGI Medicaid pathways that help low-income Medicare beneficiaries cover what Medicare does not. All three main programs use the same 2026 resource limits: $9,950 for an individual and $14,910 for a couple.
- Qualified Medicare Beneficiary (QMB) covers Part A and Part B premiums, deductibles, and coinsurance. Monthly income must be at or below $1,350 for an individual or $1,824 for a couple.9Social Security Administration. Medicare Savings Programs Income and Resource Limits
- Specified Low-Income Medicare Beneficiary (SLMB) covers only the Part B premium. Monthly income must be at or below $1,616 for an individual or $2,184 for a couple.
- Qualifying Individual (QI) also covers only the Part B premium, at a slightly higher ceiling of $1,816 for an individual or $2,455 for a couple.10Medicare.gov. Medicare Savings Programs
Limits are slightly higher in Alaska and Hawaii. If you have Medicare and are struggling with premiums or cost-sharing, MSPs are worth checking even if your income seems a little too high, because some states set their limits above the federal floor.
Income and Asset Limits
Non-MAGI financial eligibility rests on two pieces: income and countable resources. Income ceilings are usually tied to a percentage of the federal poverty level, which for a single person in 2026 is $15,960 per year, or $1,330 per month, in the 48 contiguous states.11Federal Register. Annual Update of the HHS Poverty Guidelines The specific percentage varies by program and state. For SSI-linked coverage the effective ceiling is $994 per month, but many states set higher thresholds for optional groups.
The asset test is what really separates Non-MAGI from MAGI. Countable resources include bank accounts, stocks, bonds, and additional real estate beyond your home. Several important assets are typically excluded:
- Your primary home, as long as you or your spouse lives there, though states impose an equity limit.
- One vehicle, either entirely exempt or capped in value depending on the state.
- Personal belongings and household goods.
- Burial funds, usually up to a set amount, often $1,500.
- Life insurance policies with a face value under $1,500.
The SSI-based resource limit of $2,000 for an individual and $3,000 for a couple is the floor in most states, though some have raised their asset limits substantially or eliminated them for certain Non-MAGI groups. This is where state variation is most dramatic, so check your state Medicaid agency’s current numbers before assuming the federal floor applies.
If Your Income Is Too High: Spend-Down
If your income exceeds your state’s limit but your medical bills are heavy, you may still qualify through a “medically needy” or spend-down pathway. Roughly 36 states and the District of Columbia offer one.12Medicaid.gov. Eligibility Policy
You subtract your medical expenses from your income. Once the remainder drops to or below the state’s Medically Needy Income Level, Medicaid picks up the rest of your expenses for the eligibility period. The Medically Needy Income Level varies widely by state, from under $200 per month to over $1,800 per month for an individual.
Expenses that count toward spend-down include doctor visits, hospital stays, prescriptions, medical equipment, insurance premiums (including Medicare premiums), copayments, and dental care. The catch is that Medicaid will not pay the bills you used to meet the spend-down. Only expenses accruing after you hit the threshold get covered. For community Medicaid, the spend-down period is typically one month; for long-term care, it can stretch to six months. Bring all unpaid medical bills, including those from the past three months, when you apply.
Spousal Impoverishment Protections
When one spouse enters a nursing home and applies for Medicaid, federal law prevents the other spouse from being wiped out.13Office of the Law Revision Counsel. 42 USC 1396r-5 – Treatment of Income and Resources for Certain Institutionalized Spouses Two protections apply in 2026:
- The Community Spouse Resource Allowance lets the at-home spouse keep between $32,532 and $162,660 in countable assets, depending on the couple’s combined resources and state rules. Assets above the maximum go toward the institutionalized spouse’s eligibility calculation.14Medicaid.gov. Spousal Impoverishment
- The Minimum Monthly Maintenance Needs Allowance guarantees the community spouse income of at least $2,643.75 per month, up to $4,066.50. If the community spouse’s own income is below the floor, a portion of the institutionalized spouse’s income can be redirected to close the gap.
These figures adjust annually. The allowance includes a shelter component that can raise the amount for high housing costs, and states can set a higher floor through a fair hearing or court order. Many families do not learn these protections exist until after they have spent down assets they could have kept.
How to Apply
Non-MAGI applications typically go through your local Department of Social Services or state Medicaid agency directly, not through the marketplace. Some states have facilitated enrollers or Medicaid specialists who can walk you through it.
You will need identity and residency documents, proof of citizenship or immigration status, financial records (bank statements, investment accounts, pay stubs, tax returns, and documentation of any property beyond your home), and, for disability claims, medical records from treating physicians, discharge summaries, and evidence of functional limitations.
Federal rules give the state 45 days to decide most applications and 90 days for disability-based applications because of the medical review.15eCFR. 42 CFR 435.912 – Timely Determination and Redetermination of Eligibility Follow up if your case exceeds those windows.
Retroactive Coverage
If you are approved, coverage can reach back up to three months before your application month, provided you would have qualified during those months.16Office of the Law Revision Counsel. 42 USC 1396a – State Plans for Medical Assistance Unpaid bills from that window may be covered. Request retroactive coverage when you apply and bring the bills with you. Not every state emphasizes this option, and applicants who do not ask sometimes miss coverage they were entitled to.
The Five-Year Look-Back for Long-Term Care
If you apply for long-term care Medicaid, the state reviews your financial transactions going back 60 months.17Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets Anything you gave away, sold below fair market value, or moved into certain trusts during that window can trigger a penalty period when Medicaid will not pay for your long-term care.
The penalty is calculated by dividing the transferred value by the average daily cost of nursing home care in your state. A $60,000 gift in a state where nursing home care averages $300 per day produces a 200-day penalty. The penalty does not begin until you would otherwise be eligible and are receiving institutional care, which can create a gap where you have neither the transferred assets nor Medicaid coverage.
One common and expensive mistake: the IRS allows tax-free gifts of up to $19,000 per recipient per year, and families often assume Medicaid honors the same exemption. It does not. A $15,000 gift to a grandchild is fine for tax purposes but counts as a penalizable transfer for Medicaid.
The look-back does not apply to regular aged, blind, and disabled Medicaid covering only community-based care. Some transfers are exempt from penalty, including transfers to a spouse, to a blind or disabled child, or of a home to a child who lived there and provided care that delayed institutionalization. The exemptions have specific requirements, and misapplying them creates the same penalty as an ordinary gift.
Estate Recovery After Death
Every state must recover Medicaid spending from the estates of beneficiaries who were 55 or older when they received benefits. At a minimum, states must seek recovery for nursing home services, home and community-based services, and related hospital and prescription drug costs.17Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets Many states go further and pursue recovery for all Medicaid services provided after age 55.
The family home that was protected during the beneficiary’s lifetime can become subject to a Medicaid claim after death. The state cannot recover if the beneficiary is survived by a spouse, a child under 21, or a blind or disabled child of any age.18Medicaid.gov. Estate Recovery States must also offer hardship waivers when recovery would cause undue hardship to surviving family members.
For someone permanently institutionalized and not expected to return home, the state can place a lien on real property during the beneficiary’s lifetime. The lien can only be placed after the state determines the person is permanently institutionalized and provides an opportunity for a hearing on that finding. The state must remove the lien if the person is discharged and returns home. No lien can be placed if a spouse, a child under 21, a blind or disabled child, or a sibling who has lived in the home for at least a year before admission still lives there.19ASPE. Medicaid Liens
Estate recovery is the piece of Non-MAGI Medicaid that surprises families most often. Learning how it works before applying, rather than after a relative dies, is what separates keeping a home from losing it.