Social Security

What is the income limit for Medicaid?

Over 82.5 million Americans are covered by Medicaid, making it the largest source of health coverage in the US. But there are limits on who can claim it.

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What is the income limit for Medicaid?
Juan Mabromata AFP

The Affordable Care Act in 2010 allowed states to expand Medicaid to cover more lower income Americans than previously. It also established a new series of eligibility criteria based upon Modified Adjusted Gross Income (MAGI), which was intended to make it easier to consolidate who was eligible by utilizing the same criteria for all support.

The Affordable Care Act allocated funding for states to expand coverage to “nonelderly adults with income up to 133 percent of the federal poverty level.”

The pandemic has also caused a rapid increase in enrollment, as millions lost employer-funded health insurance when they lost their job. The federal government reported a 10.2 percent increase between February and September 2020, taking the number of people claiming the support to its highest level in history.

So what is the limit?

To be eligible you must have an income of less than $1,481 a month. There are many other myriad factors that are also taken into consideration, such as disabilities, but this is 133 percent baseline Federal Poverty Level for 2021. Over a year this would equate to $17,130 and the rate increases depending on number of people in a household.

To be eligible for Medicaid, individuals must also meet certain non-financial eligibility criteria. Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.

If partners are applying together then it is acted as if the limit is doubled. That means a combined total of $4,764 a month.

The Medicaid website provides a PDF which list all the eligible groups and which laws and statutes their rights to Medicaid fall under.

What other factors can give people access to Medicaid?

Home care can be received from Medicaid under “Aged, Blind and Disabled” (ABD) Medicaid. This type of Medicaid usually has a much lower, more restrictive income limit. For example, fo nursing home Medicaid and HCBS Medicaid Waivers, the income limits are usually based on the Supplementary Security Income (SSI) Federal Benefit Rate, while the income limits for ABD Medicaid are generally based on the Federal Poverty Levels.

ABD Medicaid is commonly called Regular Medicaid or State Plan Medicaid. In approximately half of the states, in 2021, ABD Medicaid’s income limit is $794 / month for a single applicant or $1,191 for a married couple. In the remaining states, the income limit for ABD Medicaid is generally $1,073 / month for a single applicant and $1,452 / month for a married couple. The list of which states this applies to can be found here.