What income thresholds and documentation determine eligibility for 2026 Medicaid and CHIP in my state?
Executive summary
Medicaid and CHIP income thresholds vary by state and are usually expressed as percentages of the Federal Poverty Level (FPL); for adult expansion populations most states use MAGI and commonly adopt the 133% (effectively 138%) FPL floor created by the ACA, while CHIP limits for children range widely—roughly 170% to 400% of FPL depending on state and program design [1] [2]. Federal guidance also requires states to use MAGI rules for most groups and to submit compliance plans and documentation for renewal procedures by December 31, 2026 [3] [4].
1. How thresholds are set: FPL percentages and MAGI rules
States set Medicaid and CHIP eligibility using federal frameworks expressed as percentages of the Federal Poverty Level; for MAGI-based groups (most children, adults, pregnant women) states compare household Modified Adjusted Gross Income (MAGI) to their state’s FPL-based thresholds, typically applying a 5% FPL “disregard” in calculations [5] [3]. CMS publishes national tables showing these MAGI-based eligibility levels and states retain flexibility for some CHIP and child coverage options [6] [7].
2. What the common thresholds look like in practice
In expansion states, adults 19–64 are commonly eligible up to roughly 133% of FPL (calculated as 138% because of the MAGI methodology) — the baseline created by the ACA — though a few states set different expansion ceilings [1]. CHIP income limits for children vary far more: program design and state choice produce upper limits from about 170% up to 400% of FPL in some states and counties [2] [7]. National trackers like KFF and CMS maintain state-by-state charts for precise percentages by population [8] [7].
3. Documentation and verification — what states ask for
States generally verify income using MAGI-based documentation and systems that can cross-check tax data and unemployment or wage records; CMS guidance and state pages describe MAGI as the primary income methodology for Medicaid and CHIP eligibility determinations [5] [3]. For non-MAGI groups (some seniors, people with disabilities, long-term care), states use different income and asset tests and may require pay stubs, tax returns, bank statements, and documentation of assets or medical need [9] [3]. Specific lists of acceptable documents are established by state Medicaid agencies and are reflected on state websites [5] [10].
4. Special pathways and exceptions that affect thresholds
States operate multiple eligibility pathways beyond simple income cutoffs: Medically needy pathways, spend‑down rules, Miller (Qualified Income) Trusts for nursing-home applicants, and separate CHIP funding options can make people eligible even when raw income appears too high [9] [11]. These non-MAGI and waiver pathways mean an income table alone can miss real-world eligibility options available in many states [9] [7].
5. The near-term policy context: renewal rules and timing through 2026
CMS has required states to assess compliance with renewal rules and submit plans; states must meet full compliance with federal Medicaid/CHIP renewal and verification requirements by December 31, 2026, and must document their processes and evidence as part of those compliance plans [4] [12]. Recent federal legislation and budget reconciliation measures also propose operational changes — for example, mandating six‑month redeterminations for expansion adults starting Dec. 31, 2026 — which would change how often income is reverified for certain populations [13] [14].
6. Where to find the exact thresholds and paperwork for your state
Available federal sources provide national tables and explain the MAGI methodology, but precise percent‑of‑FPL cutoffs and the exact documents your state will accept are maintained on state Medicaid and CHIP sites and state publications; CMS and KFF maintain state-by-state charts to consult [7] [8]. For concrete, current dollar figures or allowable document lists, check your state’s Medicaid or CHIP web page and the federal trackers referenced above [5] [8].
7. Conflicting claims and reporting caution
Third‑party guides and advocacy sites sometimes project adjusted 2026 thresholds or propose policy changes (for example, claims about large federal laws or state reinstatements of asset tests); these can mix projections and selective interpretation — rely on CMS and your official state agency for binding rules and the compliance timelines outlined by CMS [15] [3] [4]. Where a specific claim is not present in the sources above, available sources do not mention that claim.
Limitations: This analysis uses federal guidance, policy trackers, and sampled state materials cited above; it does not list your state’s exact percentage or required documents because those are maintained by each state and vary by population group — consult your state Medicaid/CHIP website or the KFF/CMS state charts for the specific numeric thresholds and the precise documentation checklist [8] [7].