138% of the Federal Poverty Level: Medicaid MAGI and Household Size

If your household’s Modified Adjusted Gross Income falls at or below 138% of the federal poverty level, you qualify for Medicaid in any state that adopted the Affordable Care Act’s expansion. For 2026, that ceiling is $22,025 a year for a single person in the 48 contiguous states and Washington, D.C., and $45,540 for a family of four.¹ The number sounds precise, but what actually counts as income, who counts as your household, and whether the limit applies at all depend on details worth understanding before you apply.

2026 Income Limits by Household Size

The Department of Health and Human Services updates the federal poverty guidelines each January, and the 138% Medicaid figure is those base numbers multiplied by 1.38. For 2026 in the 48 contiguous states and D.C.:

1 person: $22,025
2 people: $29,863
3 people: $37,702
4 people: $45,540
5 people: $53,378
6 people: $61,217
7 people: $69,055
8 people: $76,894

For households larger than eight, add roughly $7,838 per additional person. Alaska and Hawaii use higher poverty guidelines, so their thresholds are higher too. A single person in Alaska qualifies up to about $27,531, and in Hawaii up to about $25,337.²

Eligibility is measured against your expected annual income for the year, not a single month’s paycheck. That matters if your earnings fluctuate.

Why the Number Is 138% and Not 133%

The Affordable Care Act statute sets the expansion eligibility line at 133% of the federal poverty level. A separate provision then tells states to subtract a flat 5 percentage points from each applicant’s income before comparing it to that cap.³ Someone earning 138% gets reduced to 133% on paper. The practical ceiling is 138%, even though no statute uses that exact number.

What Counts as Income

Medicaid uses Modified Adjusted Gross Income to decide whether you fall under the 138% line. MAGI starts with the adjusted gross income from your federal tax return, which captures wages, self-employment earnings, unemployment benefits, taxable interest, dividends, retirement withdrawals, and other ordinary income.⁴

Three things that don’t normally appear on your return get added back: tax-exempt interest such as municipal bond income, foreign earned income you excluded, and the non-taxable portion of Social Security benefits.⁵

Deductions That Lower Your MAGI

Any above-the-line deduction that reduces your adjusted gross income also reduces your MAGI. Student loan interest, traditional IRA contributions, and educator expenses all count.⁵ Itemized deductions like mortgage interest and charitable giving do not, because they sit below the AGI line.

Income That Doesn’t Count

MAGI-based Medicaid ignores several income types that older Medicaid rules used to count. Child support received, Supplemental Security Income, workers’ compensation, gifts, inheritances, and veterans’ disability benefits generally don’t factor in, because they don’t appear in adjusted gross income and aren’t among the three add-back items.

No Asset Test for the Expansion Group

One detail that surprises applicants: the expansion group faces no asset or resource limit. You can have savings, own a car, or hold investments without any of it affecting eligibility, as long as your MAGI stays under the threshold. The switch to MAGI-based rules removed the old bank-balance and property-value reporting. States cannot layer their own asset tests onto the expansion adult group.

How Household Size Is Counted

Household size drives which dollar limit applies to you, and Medicaid defines household based on tax filing rather than who sleeps under your roof. Federal regulations set out three main scenarios.⁶

If you file a return and no one claims you as a dependent, your household is you plus everyone you expect to claim as a dependent. If someone else expects to claim you, you usually count as part of that person’s household. Married couples living together are always in each other’s household, whether they file jointly or separately.⁶

If You Don’t File Taxes

When you don’t file and aren’t claimed as anyone’s dependent, the rules shift to a living-arrangement test. For adults 19 and older, the household is you, your spouse if you live together, and your children under 19 living with you. For someone under 19, the household includes parents, siblings under 19, and the person’s own children, all living together.⁶

Medicaid uses your expected tax status for the current year, not last year’s return. If you got married, had a child, or changed dependents, use this year’s plan.

The Limit Only Matters in Expansion States

The 138% ceiling applies in the 40 states plus Washington, D.C. that adopted the ACA’s Medicaid expansion. Ten states have not. In non-expansion states, adults without children typically can’t qualify for Medicaid at any income level, and parents often face income limits well below the poverty line.

That creates the coverage gap. In a non-expansion state, adults who earn more than the state’s traditional Medicaid limits but less than 100% of the federal poverty level ($15,960 for a single person in 2026) also can’t get premium tax credits on the marketplace, because those credits start at 100% FPL.⁷ The ACA assumed every state would expand, so no federal fallback exists for people in that income range.

What Happens If You Earn More Than 138%

Going over the line doesn’t leave you without help. It changes which program helps. Households with incomes between 100% and 400% of the poverty level qualify for premium tax credits that reduce marketplace premiums,⁷ and those credits are substantial at the lower end of that range.

If your income rises mid-year and you lose Medicaid, you get a special enrollment period of 60 days to sign up for a marketplace plan. If you lost Medicaid or CHIP coverage specifically, that window is 90 days.⁸ The switch isn’t automatic. You have to apply on HealthCare.gov or your state marketplace within that window, or you risk a coverage gap.

Applying and Keeping Coverage

Most people apply through HealthCare.gov, and some states run their own marketplaces. You’ll need Social Security numbers for everyone in the household, including people not applying, plus income documents like pay stubs and tax returns.⁴ If federal records don’t match what you reported, expect a request for documentation and a deadline of at least 90 days to resolve it.⁹

Once you’re enrolled, you have to report significant changes in income or household size to your state Medicaid agency. Timelines vary by state; many require notification within 10 days. Reporting a raise or new job promptly does two things: it stops an overpayment balance from building, and it starts the process of moving you to marketplace subsidies if that’s where you now belong.

Estate Recovery for Enrollees 55 and Older

Federal law requires every state to try to recover Medicaid costs from the estates of recipients who were 55 or older when they received benefits.¹⁰ States must pursue recovery for nursing facility services and related costs. Some go further and recover for all Medicaid-paid services during the expansion period, including routine care.

Recovery cannot occur while a surviving spouse is alive, or while a child under 21 or a disabled child of any age survives. States must also waive recovery in cases of undue hardship.¹⁰

If you’re in your late 50s or 60s, qualify for expansion Medicaid, and own a home or other assets you plan to leave to heirs, the scope of your state’s recovery policy is worth checking before you enroll. Some states recover only the federal minimum; others recover broadly. Your state Medicaid agency can tell you which applies.

1
U.S. Department of Health and Human Services. 2026 Poverty Guidelines – Detailed Tables
2
GovInfo. Annual Update of the HHS Poverty Guidelines, 2026
3
Office of the Law Revision Counsel. 42 USC 1396a – State Plans for Medical Assistance
4
HealthCare.gov. Get Ready to Apply for or Re-Enroll in Your Health Insurance Marketplace Coverage
5
Medicaid.gov. Changes to Modified Adjusted Gross Income (MAGI)-based Income Methodologies
6
eCFR. 42 CFR 435.603 – Application of Modified Adjusted Gross Income (MAGI)
7
HealthCare.gov. Federal Poverty Level (FPL)
8
HealthCare.gov. Getting Health Coverage Outside Open Enrollment
9
HealthCare.gov. When the Marketplace Needs Documents to Confirm Information From Your Application
10
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets