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Medicaid income: What is the lowest and highest income to qualify for Medicaid?


Medicaid income: Medicaid is a program designed to help the poor pay for medical treatment, but each state sets its income requirements.

Despite the Medicaid expansion under the Affordable Care Act, which raised the income criteria to qualify for Medicaid, many Americans still do not have health insurance. Census statistics from 2020 showed that 8.6% of the US population, or 28 million people, were uninsured at some point in the year.

Over 2 million people are in the “coverage gap” since 12 states have not yet extended Medicaid. They don’t make enough money to get financial help paying for health insurance through the federal or state marketplaces established by the Affordable Care Act, but they also don’t get enough money to qualify for Medicaid in their home state.

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Medicaid income thresholds vary by state

To ensure that those with low incomes have access to medical treatment, the federal government and the states have created a health insurance program called Medicaid. It was set up to help low-income families pay for medical care for their kids, expectant mothers, seniors, and people with disabilities.

While there are minimum requirements established at the federal level, states have the option of mandating coverage for additional medical services. Funding was made available to states under the Affordable Care Act to increase health insurance coverage for all adults making up to 138 percent of the federal poverty level.

Medicaid is available in every state and the District of Columbia, along with all territories. In a similar vein, states have the option of joining the Medicaid expansion, which 12 have chosen to decline. There is no universal income threshold to qualify for Medicaid because states can choose their own, which, combined with the lower standards in the non-expansion states, implies that states can set their own.

Federal Poverty Level thresholds to qualify for Medicaid

To calculate the Federal Poverty Level for the lower 48 states and DC, we need to know how many people are living in the household. A single adult in 2022 will need to come up with $13,590, while a family of four would need to spend $27,750, and a family of eight will need to spend $46,630. If your family has nine members or more, you need to add $4,720 per person to your total budget.

Alaska and Hawaii have a higher Federal Poverty Level than the rest of the United States. The annual inflation adjustment becomes effective on January 1st.

The income threshold at which a household becomes eligible for Medicaid varies not only from state to state but also according to the type of person seeking coverage. Many of the states that have adopted Medicaid expansion have established eligibility requirements for families and individuals with incomes at or below 138 percent of the federal poverty level.

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When considering family size, the District of Columbia has the highest income limitations at 221 percent and 215 percent, respectively. There is a lower eligibility requirement of 16 percent for a family of three in Texas, which has not extended Medicaid coverage. Many programs have substantially higher income requirements for pregnant women and children.

Certain groups, such as the elderly, the disabled, pregnant women, and children, are typically exempt from the requirement that their income fall below a certain percentage threshold, which can vary depending on whether or not the individual is employed.

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