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The income level to be eligible for Medicaid will be determined by two factors. First, the state you live in. While the federal Medicaid program sets minimum standards, each state has the authority to increase the income eligibility level in order to provide coverage for more people.
Income eligibility for federal Medicaid standards is based on the Federal Poverty Level (FPL) or a percentage of the FPL. The table below shows income levels based on FPL and family size.
So, for example, if your state sets eligibility at 200% of the FPL, you just look at 200% and find your family size to see what your maximum income can be for eligibility. In order to determine the income eligibility levels for your state, you can visit your states’ Medicaid website. You can also contact the Medicaid office within your county. When you apply for Medicaid, you apply through the county office.
The second factor taken into consideration is the size of your household. The more people there are in your household; the higher your income can be. For Medicaid, a household is determined by those that are claimed as dependents when filing your taxes. It includes you, your spouse, and any dependents, which may include children, elderly parents, or other elderly or disabled relatives.
Although it may vary based on your personal situation and custody arrangements, dependent children may include biological children, stepchildren, adopted children, foster children, grandchildren, underage siblings, or nieces and nephews, if you have custody of them.
The premiums and potential costs associated with Medicaid coverage will also vary based on the state you live in, your household size, and your income. Many states have shared costs built into their Medicaid plans. Shared costs may include co-pays, monthly premiums, and enrollment fees. However, the groups of people states are allowed to charge is limited.
For example, the federal government does not permit states to charge individuals with an income below 150% of the FPL, physically challenged children who qualified under the Family Opportunity Act (FOA), or physically challenged workers that qualified under the Ticket to Work and Work Incentive Improvement Act of 1999. States are also not allowed to charge premiums or enrollment fees to children who are income eligible or people that are institutionalized, which can include nursing homes, hospice, mental, or long-term behavioral institutions.
