The federal poverty level is the yardstick Medicaid uses to decide whether your income is low enough to qualify, and in states that adopted the Affordable Care Act’s Medicaid expansion, the cutoff is 138 percent of FPL. For 2026, that works out to about $22,025 a year for an individual and $45,540 for a family of four in the 48 contiguous states. Your exact limit depends on your household size, how your income is counted, and which eligibility category you fall into.
The 2026 Poverty Guidelines
Every year the Department of Health and Human Services publishes updated poverty guidelines, and Medicaid’s income tests are built on top of them. For 2026, 100 percent of FPL in the 48 contiguous states and D.C. is:
- 1 person: $15,960
- 2 people: $21,640
- 3 people: $27,320
- 4 people: $33,000
- 5 people: $38,680
- 6 people: $44,360
- 7 people: $50,040
- 8 people: $55,720
Add $5,680 for each additional person past eight. Alaska and Hawaii have higher figures to reflect their cost of living.1U.S. Department of Health and Human Services. 2026 Poverty Guidelines: 48 Contiguous States
These are the base numbers. Medicaid eligibility isn’t set at 100 percent of these figures; it’s set at a percentage of them that varies by group. The one most adults will run into is 138 percent, the Medicaid expansion threshold.
Who Counts in Your Household
The FPL number that applies to you depends entirely on how many people are in your household, and Medicaid defines household using federal tax filing rules rather than who sleeps at your address. Your household generally includes you, your spouse if you file jointly, and anyone you claim as a tax dependent. Roommates who split rent but not finances don’t count.
Dependency follows IRS rules for qualifying children and qualifying relatives. A qualifying child is generally under 19, or under 24 if a full-time student, lives with you more than half the year, and doesn’t provide more than half of their own support. A qualifying relative doesn’t have to live with you if they fall into certain family relationships, but you must provide more than half of their financial support.2Internal Revenue Service. Publication 501 – Dependents, Standard Deduction, and Filing Information
Get the count right. Someone earning $20,000 is over 100 percent of FPL as a household of one, but well under the poverty line as a household of three. Undercounting can make you appear ineligible when you actually qualify; overcounting can lead to benefits you weren’t entitled to and repayment later.
How Medicaid Measures Your Income
Medicaid doesn’t look at take-home pay or bank balances. It uses Modified Adjusted Gross Income, or MAGI, which starts with your adjusted gross income from your federal tax return and adds back three things: tax-exempt interest, untaxed foreign income, and the non-taxable portion of Social Security benefits.3HealthCare.gov. Modified Adjusted Gross Income (MAGI)
AGI already captures wages, self-employment earnings, investment income, taxable interest, retirement distributions, unemployment benefits, and most other income streams. The adjustments that reduce AGI, like the student loan interest deduction and traditional IRA contributions, carry through and reduce MAGI too.
Some money you receive doesn’t count at all. Child support, Supplemental Security Income, and most public assistance benefits are excluded. Gifts and inheritances are also generally excluded for MAGI-based eligibility groups, though one-time payments like lottery winnings or insurance settlements count as income in the month you receive them.
MAGI is calculated for the whole household, not just the applicant. A working spouse’s paycheck and a teenager’s part-time earnings all fold into the total that gets compared against the FPL threshold.
The 138 Percent Expansion Threshold
The Affordable Care Act wrote the Medicaid expansion income limit as 133 percent of FPL, but a built-in “five percent income disregard” ignores five percentage points when comparing your income to the ceiling. The practical result is that anyone earning up to 138 percent of FPL qualifies.4Medicaid and CHIP Payment and Access Commission. Overview of the Affordable Care Act and Medicaid
In 2026 dollars, 138 percent of FPL in the contiguous states is:
- Individual: $22,025
- Couple: $29,863
- Family of 3: $37,702
- Family of 4: $45,540
If your household MAGI is at or below the figure for your household size, you’re financially eligible in states that adopted expansion.1U.S. Department of Health and Human Services. 2026 Poverty Guidelines: 48 Contiguous States There’s no asset test for the expansion group. When you apply through your state marketplace or HealthCare.gov, the system compares your reported income against these thresholds automatically.5CMS Information Security and Privacy Program. Federal Data Services Hub
Whether the 138 Percent Limit Actually Applies to You
The Supreme Court ruled in 2012 that states can’t be forced to expand Medicaid, so adoption is voluntary. As of 2025, 41 states plus D.C. have expanded and 10 have not.6HealthCare.gov. Medicaid Expansion and You
In expansion states, the 138 percent threshold applies to nearly all adults ages 18 through 64, including adults without children, a group that historically had no path to Medicaid at any income level.7Medicaid.gov. Eligibility Policy
Non-expansion states still operate under pre-ACA rules, which are far tighter. Income limits for parents in some of these states are as low as 20 or 30 percent of FPL, and adults without dependent children are often shut out entirely no matter how little they earn.6HealthCare.gov. Medicaid Expansion and You This produces the coverage gap: people who earn too much for their state’s Medicaid but less than 100 percent of FPL, which is the floor for marketplace premium tax credits. An estimated 1.4 million people across the 10 non-expansion states sit in that gap.
If you live in a non-expansion state, don’t assume the 138 percent number applies to you. Check your state Medicaid agency’s specific income limits for your eligibility category.
Different Rules for Seniors and People with Disabilities
If you’re 65 or older, or applying on the basis of a disability or blindness, MAGI-based rules don’t govern your case. Eligibility in these categories runs through a separate framework tied to the Supplemental Security Income program, and it includes an asset test on top of the income test.7Medicaid.gov. Eligibility Policy
The federal resource limits for SSI-based Medicaid are $2,000 for an individual and $3,000 for a couple in 2026.8Social Security Administration. 2026 Cost-of-Living Adjustment (COLA) Fact Sheet States can set higher thresholds. Countable assets typically include bank accounts, investments, and additional real estate; your primary home, one vehicle, and personal belongings are usually excluded.
States also have the option to cover people with disabilities at incomes up to 100 percent of FPL, and institutionalized individuals can qualify under a special income rule at up to roughly 222 percent of FPL, which equals 300 percent of the SSI federal benefit rate.9MACPAC. People with Disabilities
About 36 states plus D.C. also offer a medically needy, or “spend-down,” pathway for people whose income exceeds the standard limits but who face heavy medical bills. Unreimbursed medical expenses are subtracted from income, and once they bring your effective income below the state’s medically needy threshold, Medicaid pays the rest.7Medicaid.gov. Eligibility Policy The thresholds for these programs vary widely by state.
Children and Immigrants: Where the Standard Rules Don’t Apply
Children have broader eligibility than adults. Most states cover kids well above the 138 percent adult threshold, and the Children’s Health Insurance Program often extends coverage to families earning 200 percent of FPL or more. Since January 2024, federal law also requires every state to give enrolled children 12 months of continuous coverage regardless of income fluctuations during that period, with narrow exceptions.10eCFR. 42 CFR 435.926 – Continuous Eligibility for Children
Immigration status changes the analysis too. Most “qualified” immigrants, including lawful permanent residents, must wait five years after entering the United States before receiving Medicaid, even if their income is well under the threshold.11Office of the Law Revision Counsel. 8 USC 1613 – Five-Year Limited Eligibility of Qualified Aliens for Federal Means-Tested Public Benefit Refugees, asylees, Cuban and Haitian entrants, trafficking victims, and veterans with their spouses and children are exempt from the wait. States can also cover lawfully residing children and pregnant women with no waiting period, and many do.12Medicaid.gov. Overview of Eligibility for Non-Citizens in Medicaid and CHIP Undocumented immigrants are not eligible for full-scope Medicaid, though emergency Medicaid covers conditions that would endanger life or limb if left untreated.
Once you know which group you fall into and which state you’re in, the FPL comparison is straightforward: household size sets the baseline number, MAGI is what gets compared against it, and the applicable percentage of FPL determines the cutoff.