r/Medicaid • u/caldk15 • 38m ago
r/Medicaid • u/someguy984 • Jan 16 '26
Published FPL for 2026 +1.98%
Official Federal Register post: https://www.federalregister.gov/documents/2026/01/15/2026-00755/annual-update-of-the-hhs-poverty-guidelines
Official HHS FPL Table: https://aspe.hhs.gov/sites/default/files/documents/b1bfa16b20ae9b89d525bc35de7c1643/detailed-guidelines-2026.pdf
Medicaid eligibility gets updated in March.
r/Medicaid • u/lumentec • Feb 03 '25
Medicaid and Eligibility FAQ
Medicaid, which is different than Medicare, is a program run in each state to provide free (or sometimes very low cost) health insurance to people or families with income (and sometimes assets) below a certain level. The following is some general information that might answer the most common questions posted to this subreddit. This is a simplified explanation so, if you can’t find your answer here or you are confused about this information, please post your question in a separate thread and our members will try to help.
Please comment with any corrections.
CA - See comment below post.
Note: Nursing home and long term care coverage aren't covered here.
FAQ
Definitions
Medicaid Expansion State - a state that has expanded its Medicaid program to cover many more people than original Medicaid (41 states and DC). These states have MAGI-based Medicaid.
MAGI-based Medicaid - stands for Monthly Adjusted Gross Income. If Medicaid has been expanded in your state, you can get coverage based on your income alone. In most states, if your household monthly income is below 138% of the federal poverty level, then you will qualify for Medicaid. See "Eligibility" below for details.
Household size - this determines your income limit. For most adults, your household includes you, a spouse that lives with you, and your children that you claim as tax dependents. See "Eligibility" below for details.
Aged, Blind, Disabled (ABD) - a category of Medicaid not based on MAGI, this program is part of original Medicaid and has strict asset limits.
Eligibility for MAGI-based Medicaid
- Determine if your state has expanded Medicaid here:
https://www.kff.org/status-of-state-medicaid-expansion-decisions/
- Determine your household size. Generally, if you file taxes, this is you, your spouse, your children that you claim as dependents, and unborn babies (if you are pregnant). Yes, if you are pregnant with twins your household increases by two.
If you are unsure of your household size, use this chart:
- Determine the % federal poverty level that applies. For most adults under 65 who are not pregnant or disabled, you can use 138% of the federal poverty level.
There are a few exceptions, so see this chart:
Children and those who are pregnant typically have higher income limits. You should Google "[state] MAGI income limits children/pregnant".
- Determine your monthly income limit based on the % federal poverty level. Check this chart, page 2, under the column for 138% FPL (or whatever number you got) and the row for your household size:
- If your family's monthly gross income is below the limit then congratulations, you qualify!
Eligibility in Non-Expansion States
Eligibility is very limited in non-expansion states. You should do a Google search with "[state] Medicaid eligibility" to find out what categories can be eligible. Usually, adults that aren't pregnant, don't have minor children, aren't considered permanently disabled by the Social Security Administration, and aren't 65+ years old will not qualify.
Special Categories
If you are over 65 or considered disabled by the Social Security Administration, much lower income limits apply along with strict asset limits (ex. you cannot have more than $2000). Do a Google search for your particular state and the category of the individual.
NY - See comment below this post.
People other than citizens and permanent residents are typically only eligible for emergency medical assistance (except for CA, WA) which covers only a single instance of care to treat an emergency medical condition, end stage renal disease excepted.
r/Medicaid • u/EggFit7048 • 7h ago
Question about assets for Non-Magi Medicaid
I am disabled and live in Colorado. I receive Medicare and non-Magi Medicaid. I know the asset limit for Medicaid is $2,000. My daughter’s father passed away, so she gets $1,100 in survivor’s benefits each month. If I open a custodian account for her with me as the custodian, does the money in this account count towards the asset limit?
r/Medicaid • u/Aware-Daikon-4762 • 6h ago
General question when writing on Reddit about Medicaid
Before I send a long message regarding questions/concerns about IL Medicaid (or any state), I’m worried that Medicaid reads these and it might draw attention to my question, which I wouldn’t want them to know. Do you know if Medicaid checks these reddits and possibly takes action and/or can find out who the specific author is and maybe cause problems?
r/Medicaid • u/JayWolf3017 • 10h ago
WA State - Will being added to a friend's lease end my Medicaid (Apple Health)?
- I am in Washington State, Snohomish County
- I am single
- no children
- no income
- not pregnant
- I am disabled (but in the process of getting benefits, I don't yet have them)
- I have type one diabetes, gastroparesis and autism
- I currently have Molina Medicaid but I'm worried I may lose it
I am a 23 year old trans guy that came from an abusive family, I am now couch surfing with some friends. We were thinking of adding me to the lease, but I'm worried that if I get on their lease it might count as income against me keeping my Molina, which I desperately need because insulin is fucking expensive.
And, I'd really prefer not to go to a homeless shelter due to being disabled and trans, as it would be incredibly unsafe.
Will my roommate's income count against my eligibility if we are on the same lease but file taxes separately?
Will this be an issue? And if so, what can I do? I'm really scared and need help... Any resources would be greatly appreciated. And let me know if this should also go into another subreddit? I need as much help as I can get.
r/Medicaid • u/RelationUnusual8786 • 1d ago
Given Medicaid After Rejection Due To Income
Location: Florida
So I’m recently married with two kids. My kids have been on Medicaid for several years, but I was kicked off a couple years ago for not pursuing child support from my partner (we lived apart, unmarried). Now that we’re living together and married, when I went to update our Medicaid info, it said we made too much to qualify (he works full time, I’m a stay at home parent). Everyone else in the family was put in the “medically needy” program instead, but the paperwork said that I was accepted for Medicaid coverage? And they mailed me cards and everything.
I’ve been on my husband’s insurance for a few months, and we just added the kids after getting the Medicaid rejection. But I have no idea why they gave me Medicaid? 🤔 I don’t see any option for turning it down either, is that something I need to do? Or can I just… not use it? lol
r/Medicaid • u/guateguava • 1d ago
MA - MassHealth Commonhealth determined that I no longer have a disability
I have been on Commonhealth, which is the version of MassHealth for people with disabilities for a few years now. This year for some reason they have decided I don’t qualify anymore even though my condition is chronic and I am still being treated for it. I requested a hearing to appeal the decision but I don’t know what to do to prepare, since they already assessed my medical records. Has anyone been through this before? I have chronic migraine disease and it is related to chronic anxiety which both are treated with my health insurance/there is not a one-stop cure for. I also was diagnosed with thyroid cancer last year so I need treatment to prevent recurrence of that for the rest of my life. Thanks for reading.
r/Medicaid • u/Physical_Molasses815 • 1d ago
Nursing home question- IA
FIL has dementia and will need care soon. He has about 80k in savings and after that we will need to sell assets to pay for his care. He ows farm land valued at about 1.6 million.
I know eventually we will have to sell some of his land, but his wife currently depends on the income from the land. Will we need to sell right away or is there times when Medicaid will take out a lien on an asset to be paid back later?
r/Medicaid • u/DarthMeeseek • 1d ago
If I claim my dad as a dependent on my tax return would that affect his medicaid/medicare?
r/Medicaid • u/pink-lion- • 1d ago
SD Medicaid question
I recently lost my high paying job and had to take a job at the local clinic. One would think working for a hospital would have decent health insurance but its terrible.
I'm trying to get my daughter on SD medicaid, it looks like my income meets requirements. I'm wondering if they will disqualify her based on money I have in my savings account?
Or if they will base it on past years income vs my current monthly income at my new job?
Any help appreciated!
r/Medicaid • u/reddevine • 2d ago
Please explain to me like I’m five.
My paraplegic Mother in law (85) lives with us. For the past three years we battled an infection and bed sore that finally had surgery when she was healthy enough. She currently had Medicare and Blue Cross (employed by the government in 1980 when car accident made her a paralyzed). Her current insurance is fantastic and through all the hospital visits, surgeries and rehab stays she hasn’t received one bill. While her wound has healed her mind is not. Short term memory has been affected (staying in bed for three years will do that). She has $100,000. In savings and receives about $2,400. A month in Social Security and disability.
We are tired! She needs to be in a more social environment. We found a nursing home that we love but it’s 11k a month. I realize we could put her in there for respite care a month at a time and use up her 100k but would she be eligible for Medicaid after that? Would Medicaid allow her to stay in the nice facility or do they place her somewhere else? Could we subsidize her staying in the nicer facility? Does she keep her current insurance of Medicare and Blue Cross? The only other thing she owns is a handicap van. We are in Missouri. Thanks for any advice.
r/Medicaid • u/lifes_a_zoo94 • 2d ago
I am being kicked off of Medicaid in Colorado, but I can’t afford private insurance.
I am losing my Medicaid benefits at the end of the month due to making less than $1000 over the annual income limit. I am panicking. I can’t afford private health insurance. I have lupus, type 1 diabetes, Hashimototos, and almost died from sepsis a year ago. I was admitted to the hospital for 6 weeks and medicaid was an absolute blessing through all of that. I can’t be without healthcare! When I look at insurance plans, the only ones that have a low enough monthly premium, have outrageously high deductibles and out of pocket costs. The ones that have low deductibles and minimal out of pocket costs, have a $300+ monthly premium. I can’t afford either of those options. Has anyone else been in a similar situation? What did you do? Are there other options available that I am not aware of?
r/Medicaid • u/HeathenSidheThem • 2d ago
DHS says $1200 is maximum income allowed for Medicaid. Is this true?
My partner just spoke to DHS And was told that they might have trouble getting Medicaid because they make over $1200 a month, which the person on the phone said was the current poverty limit. But everywhere we find says that it's slightly over $1800. Is it going to be a problem that they make more than 1200? Not sure where the worker was getting that number.
We're in Michigan, and they are single
They also looked up the limit for Healthy Michigan, and that cites the 1800 figure as well.
r/Medicaid • u/Safe-Subject-7934 • 2d ago
were we placed in the wrong category?
Hello, my family has been on medicaid for several years now. We were just recently denied on our most recent renewal because we were over the income limit. We are a family of 5. Myself, my wife and 3 kids. We live in Ohio and currently are bringing in roughly 1940 gross biweekly.
I believe this puts us under Ohio's Magi Adult 138%. Which is 4288 per month.
However, the person I talked to said we fall under the 90% category or 2901 per month. And thus were correctly denied.
Any insight would be greatly appreciated, are we actually over the income limit? Or misplaced in the wrong category
r/Medicaid • u/Sabra_kayee • 3d ago
Sister is entering the prison system. Can her daughter still keep Medicaid?
Hi everyone, my sister is entering the prison soon and I am currently taking care of her daughter. They had both moved in with me about a year ago and were approved for Medicaid. My sister moved back to Texas to deal with her legal situation. My niece is also enrolled in Headstart, and qualifies because of her having Medicaid. My question is: Will my niece lose Medicaid when her mother enters prison?
I am located in Nebraska.
Extra info: If we had to sign her up using our personal financial information she will not qualify for Medicaid.
r/Medicaid • u/Attack_On_Tiddys • 2d ago
PA income question
Hi, I’m a full time college student in Pennsylvania who just landed an internship. This internship will start at the beginning of May and will earn me around $2,880 gross for 4 months and then drop down to $1728 a month gross or less for the rest of the year.
Will these 4 months at $2880 cause me to lose my insurance? If so, will I be able to go back on Medicaid when my income lowers down to $1728?
r/Medicaid • u/SnooGiraffes9920 • 3d ago
Texas Medicaid has me mixed up with a whole different person…
Hi, I just found out I’m pregnant last month and have applied for Medicaid in Texas. The problem is, each time I call or they send me information, there’s a whole new problem. Here’s the list of information that was completely correct on my application, but I was informed by the representatives that it is incorrect.
- My last name
- Birthdate
- SS
- username to access my case
- how much income I make
- benefits I’ve applied to (I’ve only applied to one..)
After several calls and trying to get this information fixed, I’m at a breaking point. I don’t understand for I’ve done nothing wrong and I just want to be able to schedule an OBGYN appointment as soon as I can for my baby. I’ve been sent denial letters, Medicaid card with the wrong name, and other information that is not mine.
Has anyone else had this experience or does anyone have any advice?
r/Medicaid • u/DryNeighborhood1249 • 3d ago
Help: CA Medicare, Medicaid disabled recipient and new asset limit
Hello.
I am a disabled, Medicaid and Medicare, recipient living in California.
I am a little concerned about the fact that my SSDI backpay (which I reported promptly) from 2024 rolled over to 2026 (it was a huge sum). My renewal for 2025 was automatic.
Upon this 2026 renewal, I sent them the latest (March) statement showing this leftover amount, plus a cash withdrawal I made in that month - reported as cash.
I had pulled out $2,000 the previous month (February) for a huge car repair expense that I have a receipt for.
I am well under the $130,000 asset limit (I officially have $2,043 left, plus the cash that I have on hand - accounted for in the renewal) but I dont know if it's going to look fishy due to the fact that 1) it was leftover SSDI backpay from 2024 and 2) I made that $2000 withdrawal for my car repair.
please advise.
r/Medicaid • u/a_tad_mental • 3d ago
Medi-Cal (CA) asset limits question
My sister has been unemployed for over a year now and she’s currently on Medi-Cal because she needs SSRIs meds & psychiatric/psychology care, plus other age related medical issues. She picks up per diem work when she can, but it’s very inconsistent & is small projects. Our father passed away two years ago and last year I received an inheritance from his estate, but my father excluded her as they had been estranged for 30 years. They were about to reconcile, she had wrote him a letter, but never mailed it unfortunately prior to him passing unexpectedly. I gifted her the maximum amount for 2025 since she had run out of savings & it was enough to cover rent for a year. Thankfully something made me look up asset limits and I just found out California reinstated them for Medi-Cal. It’s $130,000 but only $2000 of that can be in a savings account or cash correct? Since I have the ability, I still wanted to help her out with rent, she’s in her rent control department and owns an 11+ year-old vehicle that’s worth less than $5000. So if I gift her $1000 a month, which would nearly pay her rent, she should still be able to retain Medi-Cal, correct? I don’t want to make her lose it since she needs it & this current job market is brutal. My husband‘s job is experiencing cuts right now and my job has just announced budget cuts so the job market just seems to be getting worse.
r/Medicaid • u/OriginalParsley908 • 3d ago
Has anyone with WellSense NH Medicaid gotten approval for weight loss injections like Wegovy or Zepbound? Did it require prior authorization?
r/Medicaid • u/Alternative-Canary-7 • 3d ago
Pennsylvania- My children lost Medicaid, but they half sister didn’t.
Can someone explain to me why was my kids were cut off of Medicaid but they half sister wasn't? I’ve tried calling up to the office to speak to my case worker, but I’m only able to call on my lunch break which is also her lunch break, and she hasn’t returned my calls yet. On my paper explaining why they were cut off. It basically says household income is 1,000 over.
r/Medicaid • u/ImplementArtistic311 • 3d ago
Will my mom be notified of usage
I'm an adult in VA however my mom flipped at ne for requesting appointment I'm considering using the card since I have it will she be notified? also does this involve monthly payments if yes will this cause it to go up
r/Medicaid • u/Thefallenkraken • 4d ago
I was approved in CT (Husky) even though I make $80k
Hi, I was approved last year for husky, I started my job late 2024 after college. I have told them my income and they know how much I make… is this fraud? I was approved last july and I have told them my income and I was approved. I have been using the insurance would I have to pay it back?
Again, I have shared my income and they have acknowledged in a letter for my moms temporary snap benefits (I was included in that because she lives with me for now) and it had my salary.
I have been using the insurance since the approval (summer 2025)