As the cost of healthcare continues to be a concern for millions of Americans, understanding the income limits for Medicaid eligibility is more important than ever. For 2025, states have updated their thresholds based on the Federal Poverty Level (FPL), which determines how much income you can earn and still qualify for free or low-cost health coverage.
Medicaid eligibility limits vary depending on the state, family size, and individual circumstances, including pregnancy, disability, and whether you’re a parent or childless adult. Here’s a breakdown of what you need to know.
How Medicaid Eligibility Is Determined
Medicaid is a state-run program funded by both state and federal governments, which means each state has the authority to set its income limits within federal guidelines. These limits are expressed as a percentage of the Federal Poverty Level. For example:
- 100% of the FPL for a single individual in 2025 is $14,580 per year.
- 100% of the FPL for a family of four is $30,000 per year.
Each state decides how much of the FPL is needed to qualify for Medicaid. In some states, the income limit for adults is up to 138% of the FPL, thanks to Medicaid expansion under the Affordable Care Act. Other states may have lower limits or stricter qualifications.
State-by-State Medicaid Income Limits
For adults without children in states that expanded Medicaid, the general income threshold is 138% of the FPL:
- Single individual: $20,120 annual income limit
- Family of four: $41,400 annual income limit
However, non-expansion states have much stricter limits, often restricting coverage to parents and those with disabilities. Here are some examples:
- California (Expansion State): Up to 138% of FPL for most adults
- Texas (Non-Expansion State): Only parents with income under 18% of FPL qualify (around $5,400 annually for a family of four)
- Florida: Limited Medicaid coverage for adults without children unless they qualify due to disability or pregnancy
For pregnant women and children, the limits are typically higher, with many states covering children in households earning up to 200%-300% of the FPL.
Why These Limits Matter
For millions of low-income Americans, Medicaid provides essential access to healthcare services, including doctor visits, hospital stays, and prescription drugs. Without Medicaid, many families face significant barriers to obtaining affordable healthcare. Understanding whether you qualify could save you thousands of dollars in medical expenses.
How to Check Your Eligibility
To find out if you qualify for Medicaid in your state, you can:
- Visit your state’s Medicaid website
- Use the federal Healthcare.gov eligibility checker
- Contact a local Medicaid office for assistance
You’ll need to provide details about your household size, income, and any specific medical conditions. Even if you don’t qualify based on income alone, you may still be eligible if you’re pregnant, disabled, or a parent of young children.
What’s Next?
As healthcare policies evolve, Medicaid expansion continues to be a topic of political debate. Some states may increase income limits or expand eligibility in the future, so staying informed is crucial. If you think you might qualify, don’t wait—apply now to ensure you get the coverage you need.
