Medicaid Eligibility Calculator | Check If You Qualify

Medicaid income limits for 2025 vary by state, marital status, program type (Nursing Home, Home and Community Based Services, or Regular Medicaid), and eligibility category, such as seniors, disabled individuals, adults, children, or pregnant women. Limits are often tied to the Federal Poverty Level (FPL) or Federal Benefit Rate (FBR). Below is a detailed guide to help you understand eligibility requirements.

Income Limits for Seniors and Disabled

Income limits for seniors (65+) and disabled individuals depend on the Medicaid program and marital status. Most states use the FBR ($967/month single, $1,450/month couple in 2025) or a percentage of it. Some states have no hard limit for Nursing Home Medicaid, requiring excess income to go toward care costs.

• Institutional / Nursing Home Medicaid: Typically $2,901/month for singles and $5,802/month for couples (both applying) in most states. States like California, Hawaii, and Missouri have no hard limit, but income above $35–$72.80/month goes toward care costs, except for a Personal Needs Allowance ($30–$200/month).
• Home and Community Based Services (HCBS) Waivers: Often $2,901/month for singles and $5,802/month for couples, but some states have lower limits (e.g., Illinois: $1,304/month single). Beneficiaries keep income for living expenses like rent and utilities.
• Regular Medicaid (Aged, Blind, Disabled): Varies widely, from $235/month (Kentucky, single) to $1,801/month (California, single). Couples typically face limits from $291/month (Kentucky) to $2,433/month (California).

Income Limits for Other Groups

Other eligibility categories use Modified Adjusted Gross Income (MAGI), based on FPL, for income calculations:

• Medicaid Expansion (Adults, 19–64): In 40 states and D.C., adults qualify up to 138% FPL ($21,597/year for one, $29,187 for two). Non-expansion states (e.g., Alabama, Florida) have stricter limits, often below 100% FPL ($15,650/year for one).
• Children/CHIP: Limits often reach 200% FPL ($31,300/year for one, $42,300 for two) or higher, varying by state.
• Pregnant Women: Typically 185–200% FPL ($28,972–$31,300/year for one), with some states offering higher thresholds.

State-Specific Income Limits (All Eligibility Categories)

The following table lists 2025 Medicaid income limits for all eligibility categories across all U.S. states and Washington, D.C. Limits are monthly unless noted, with Federal Poverty Level (FPL) percentages provided where applicable.

Note: Income limits are estimates based on 2025 FPL guidelines and typical state policies. Seniors/Disabled limits reflect the highest of Nursing Home, HCBS Waivers, or Regular Medicaid (ABD). Non-expansion states (e.g., Alabama, Florida) have no ACA Adult coverage. Children and Pregnant Women limits may vary (e.g., CHIP up to 300% FPL in some states). Parents/Caretakers limits are lower in non-expansion states. Confirm with your state’s Medicaid office or use the Medicaid.gov eligibility tool for precise criteria.

Options if Over the Income Limit

If your income exceeds the limit, you may still qualify through:

• Medically Needy Pathway: Available in some states, allowing you to “spend down” excess income on medical expenses to meet eligibility.
• Miller Trusts/Qualified Income Trusts: Redirect excess income to meet limits, often used for Nursing Home or HCBS Waivers.
• Certified Medicaid Planners: Professionals can help navigate complex financial strategies to achieve eligibility.

2025 Federal Poverty Level (FPL) Guidelines

2025 FPL Guidelines (Annual Income, Effective January 15, 2025)

Household Size	48 States & D.C. (100% FPL)	48 States & D.C. (138% FPL)	Alaska (100% FPL)	Hawaii (100% FPL)
1	$15,650	$21,597	$19,550	$17,990
2	$21,150	$29,187	$26,430	$24,320
3	$26,650	$36,777	$33,310	$30,650
4	$32,150	$44,367	$40,190	$36,980

Stay Prepared: Check your eligibility using the Medicaid Eligibility Calculator above based on your income, household size, and category.