The 133% federal poverty level is the Medicaid income limit written into the Affordable Care Act’s expansion, and for 2026 it works out to $21,226.80 a year for a single person in the 48 contiguous states. A mandatory 5-percentage-point income disregard sits on top of it, so the number you actually compare your income against is 138% of the poverty line, or $22,024.80 for one person. If your Modified Adjusted Gross Income falls at or below that figure, you qualify on income grounds in a state that expanded Medicaid.
2026 Income Limits by Household Size
The Department of Health and Human Services publishes new poverty guidelines each January, and every program keyed to a percentage of the FPL adjusts with them. These are the 2026 thresholds for the 48 contiguous states and Washington, D.C.:
- 1 person: 133% = $21,226.80 | 138% = $22,024.80
- 2 people: 133% = $28,781.20 | 138% = $29,863.20
- 3 people: 133% = $36,335.60 | 138% = $37,701.60
- 4 people: 133% = $43,890.00 | 138% = $45,540.00
Each additional household member raises the base poverty guideline by $5,680, which pushes the 133% threshold up by about $7,554 and the 138% threshold by about $7,838 per person.1U.S. Department of Health and Human Services. 2026 Poverty Guidelines
Alaska and Hawaii use higher poverty guidelines. For a single person in Alaska, the 2026 base is $19,950, putting 133% at $26,533.50 and 138% at $27,531.00. In Hawaii, the base is $18,360, so 133% is $24,418.80 and 138% is $25,336.80.1U.S. Department of Health and Human Services. 2026 Poverty Guidelines
The math behind these figures is a simple multiplication. Take the base poverty guideline for your household size and multiply by 1.33 for the statutory threshold, or by 1.38 for the effective threshold after the disregard. The 2026 base for one person in the contiguous states is $15,960, and $15,960 × 1.33 = $21,226.80.2Federal Register. Annual Update of the HHS Poverty Guidelines
Why 138% Is the Number That Actually Matters
The 133% figure comes from Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, which sets Medicaid expansion eligibility for adults under 65 who are not pregnant, not eligible for Medicare, and not covered by another mandatory Medicaid category.3Social Security Administration. Social Security Act 1902 – State Plans for Medical Assistance
But 42 U.S.C. § 1396a(e)(14)(I) requires states to subtract a 5-percentage-point income disregard before comparing an applicant’s income to the cap. That disregard equals 5% of the poverty line for the household. For a single person in 2026, it’s $798 ($15,960 × 0.05). The effect is that someone earning up to $22,024.80 still qualifies, even though the statute reads 133%.4Office of the Law Revision Counsel. 42 U.S. Code 1396a – State Plans for Medical Assistance
The disregard is meant to prevent people from losing coverage over small income fluctuations. If your earnings bounce between $21,000 and $22,000 across the year, the buffer keeps you inside the program. Because the disregard applies to essentially everyone in the expansion group, 138% is the working figure.5HealthCare.gov. Federal Poverty Level (FPL)
Counting Your Household
Household size decides which row of the guidelines applies to you, and Medicaid builds the household around tax relationships rather than living arrangements. If you file a return, your household is you, your spouse if you file jointly, and anyone you claim as a tax dependent.6HealthCare.gov. Who to Include in Your Household
A roommate who isn’t on your return is a separate household. A college student living in a dorm still counts in a parent’s household if the parent claims them as a dependent. The tax relationship controls.
If You Don’t File Taxes
People who don’t file and aren’t claimed by anyone else follow age-based rules. An adult 19 or older counts themselves, a spouse, and any children under 19 living with them. A person under 19 counts themselves, any siblings under 19, their own children, and any parents in the home. Married couples living together are always in each other’s household regardless of filing status.
Mid-Year Changes
A birth, marriage, divorce, or change in who you claim as a dependent shifts your household size and your income threshold. Report these to your state Medicaid agency when they happen. A larger household means a higher income limit, so a new baby can make you eligible when you weren’t before. Pregnancy itself counts: a pregnant person is counted as themselves plus the number of expected children.
What Counts as Income
Medicaid expansion uses Modified Adjusted Gross Income, or MAGI. The starting point is the adjusted gross income from your tax return, with three items added back: foreign earned income excluded under Section 911 of the tax code, tax-exempt interest, and any Social Security benefits that weren’t in taxable income.7Office of the Law Revision Counsel. 26 U.S.C. 36B – Refundable Credit for Coverage Under a Qualified Health Plan
Most familiar sources feed the MAGI figure: wages, tips, self-employment profit after business expenses, taxable interest, unemployment, and Social Security. Some income people assume doesn’t count still does, like tax-exempt bond interest, which is added back even though it doesn’t appear as taxable on your 1040.
Certain sources are left out. Supplemental Security Income (SSI) and child support you receive are not counted. Veterans’ disability benefits and workers’ compensation are generally excluded from MAGI because they don’t appear in adjusted gross income. This differs from older Medicaid rules, under which SSI and child support were often counted.
Self-employed applicants report net profit, not gross revenue. Freelance income of $40,000 with $18,000 in legitimate business expenses contributes $22,000 to MAGI. Clean expense records can decide whether you land above or below the 138% line.
Agencies generally look at projected annual income for the current year, though monthly income can matter for immediate decisions. If your earnings are seasonal, the annual projection often works in your favor compared to a single high-earning month.5HealthCare.gov. Federal Poverty Level (FPL)
If Your Income Is Above the Limit
Income above 138% of the FPL doesn’t leave you without options in an expansion state. Marketplace premium tax credits are available for households between 100% and 400% of the poverty line, which for one person in 2026 runs from $15,960 to $63,840. Medicaid covers you up to effectively 138%, and Marketplace subsidies take over above that.5HealthCare.gov. Federal Poverty Level (FPL)
Non-Expansion States
The 133% threshold only functions as an eligibility standard in states that adopted the ACA’s Medicaid expansion. As of 2026, 41 states including Washington, D.C., have expanded, and 10 have not. In non-expansion states, adult Medicaid eligibility follows pre-ACA rules that in many cases limit coverage to parents well below 100% of the poverty line and exclude childless adults.
The hardest position is earning less than 100% of the poverty line in a non-expansion state. Marketplace premium tax credits start at 100% of FPL, so adults who earn too much for traditional Medicaid but less than $15,960 (single person, 2026) qualify for neither. If that’s your situation, your options are unsubsidized Marketplace plans, community health centers, or any state-funded programs outside of Medicaid expansion.