Income limits for Medicaid eligibility vary significantly between states, influenced by factors such as the applicant’s marital status, household size, type of Medicaid program, and whether the state has expanded Medicaid under the Affordable Care Act.
Variation by State and Program
- Different income limits by Medicaid type: States set separate income thresholds for programs like Regular Medicaid (often for aged, blind, and disabled individuals), Institutional/Nursing Home Medicaid, Medicaid Waivers/Home and Community-Based Services, and others. For example, in Maryland, Regular Medicaid for aged, blind, and disabled applicants has a monthly income limit of about $350–$392, while Medicaid Waivers allow a higher limit of $2,901 per applicant per month.
- Income limits tied to nursing home costs: Some states like Maryland do not set a hard income cap for Institutional Medicaid but require income not to exceed the cost of care in nursing homes. Massachusetts has no hard limit but requires income over a small threshold (e.g., $72.80/month) to be allocated toward care costs.
Impact of Medicaid Expansion
- In states that have expanded Medicaid, eligibility is largely income-based without many categorical restrictions. Adults with incomes up to 133% of the federal poverty level (FPL), effectively 138% due to calculation specifics, qualify based on income alone.
- In non-expansion states, eligibility is more restrictive, often limited to certain groups such as children, pregnant women, elderly, disabled, or parents/caretakers with lower income thresholds.
Examples of Income Limits
- Iowa: Adults 19-64 qualify if income is up to 133% FPL. For a single adult, the monthly income limit is approx. $1,507; for a family of four, $3,067 per month.
- Louisiana (Expanded Medicaid): Household income must be below 138% FPL, e.g., $2,649 per month for a family of three, with higher limits for children and special categories like pregnant women and disabled workers.
- Maine Regular Medicaid: About $1,305/month for individuals; $1,763 for couples.
- Wyoming Regular Medicaid for aged/blind/disabled: $967/month for individuals; $1,450 for couples.
Summary of State Variation
| State | Medicaid Program Type | Approximate Income Limit (Monthly) |
|---|---|---|
| Maryland | Regular Medicaid (Aged/Disabled) | ~$350–$392 per individual |
| Maryland | Waivers/Home-Based Services | ~$2,901 per individual; double for couples |
| Maine | Regular Medicaid | $1,305 individual; $1,763 couples |
| Wyoming | Regular Medicaid (Aged/Disabled) | $967 individual; $1,450 couples |
| Iowa | Adults 19-64 | $1,507 individual; $3,067 family of 4 |
| Louisiana | Expanded Medicaid | $2,649 (family of 3), higher for children/pregnant |
Conclusion
Medicaid income limits vary greatly between states due to differing Medicaid program rules and whether states have adopted Medicaid expansion. Limits depend on household size, applicant status (individual or couple), and type of Medicaid coverage sought. States that have expanded Medicaid typically set income eligibility close to 138% of the federal poverty level for adults, while others maintain lower, more category-restricted income thresholds.
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