How have Medicaid income eligibility limits changed from 2024 to 2026 and why?
Executive summary
From 2024 to 2026 Medicaid income thresholds shifted in two overlapping ways: many states updated long‑term‑care (“institutional” and HCBS waiver) income limits to align with 300% of the Federal Benefit Rate (FBR), producing a common individual cap near $2,982/month in 2026 in most states; and some states and programs adjusted MAGI‑based or state‑specific eligibility bands (for example, New York’s Essential Plan moved to 250% FPL in April 2024 and some District of Columbia adults above 138% FPL face program changes starting 2026) [1] [2] [3] [4]. These changes reflect federal formula updates (FBR/FPL), state policy choices about which federal standard to use, and program redesigns tied to federal funding shifts planned for 2026 [1] [5] [4].
1. Federal formulas set the headline ceilings: FBR, 300% cap, and MAGI rules
Federal guidance limits institutional/HCBS income eligibility to a percent of the Federal Benefit Rate (FBR); most states use 300% of the FBR and so end up with individual monthly caps near $2,982 in 2026 after the FBR for 2026 was released [1]. Separate MAGI‑based rules — the methodology from the Affordable Care Act used for many parents, children and adults — remain the basis for income tests on many Medicaid eligibility categories [5]. States therefore change numeric cutoffs when the underlying federal FBR or FPL figures are updated or when they choose a different federal benchmark [1] [5].
2. State variation is the defining reality — not a single national cut
States exercise choice on which federal measure to use and when to apply new figures; some implement changes immediately, others later in the year, and a few use different percentages of the FBR (for instance, Delaware uses 250% FBR with specific 2026 numeric limits cited) [1]. That patchwork produces widely different monthly limits across states for the same eligibility category despite a single federal cap principle [1].
3. Practical numbers: what many long‑term‑care applicants see in 2026
Multiple planning and state‑by‑state summaries state that in most states the income limit for Nursing Home Medicaid and HCBS waivers is $2,982/month in 2026; married‑spouse protections (MMMNA/CSMIA) and other allowances also change year to year (examples: CSMIA $4,066.50 and community spouse resource allowance max $162,660 cited for 2026 in New York guidance) [2] [6]. States also publish distinct caps for ABD (Aged, Blind, Disabled) MAGI‑exempt groups that vary widely — e.g., projected ranges of $994–$1,795/month for individual ABD limits in 2026 depending on state [2] [1].
4. Program redesigns and federal funding changes are driving policy shifts
Some program changes reflect deliberate policy redesigns tied to federal funding or state initiatives. New York expanded its Essential Plan eligibility from 200% to 250% FPL in April 2024, a state choice to shift people between Medicaid and lower‑cost state programs [3]. The District of Columbia plans to move some adults above 138% FPL off Medicaid starting January 1, 2026, into a Basic Health Program — again a programmatic redesign rather than a uniform nationwide eligibility rollback [4]. Legal and administrative changes tied to federal funding for expansion states are also cited as underpinning changes scheduled to begin in 2026 [6].
5. How states treat excess income and protect spouses
Even when a state sets a higher nominal income cap, Medicaid rules commonly funnel almost all an institutionalized person’s income above a small personal needs allowance toward care and create special rules to protect a community spouse (CSRA, MMMNA). Trusts (Miller/Qualified Income Trusts) and the Medically Needy pathway are recurring tools for people who would otherwise exceed income caps [7] [8].
6. What reporters and families must watch this year
The key things to monitor are state rule updates (timing varies), the annual FBR and FPL publications (which drive many numerical changes), and state policy decisions about program design (for example, whether to move people into a Basic Health Program or expand Essential Plan eligibility) [1] [3] [4]. Available sources do not mention a single nationwide numeric “cut” from 2024 to 2026; instead they document a mixture of federal formula updates and state policy choices that produce different outcomes in different places [1] [5].
Limitations and caveats: the reporting above draws only on the provided state‑planning and legal summaries; exact monthly thresholds and effective dates are state specific and the cited publications emphasize projections and state timing differences [1] [2]. For precise eligibility in any state, consult the state Medicaid office or the detailed state tables referenced in the planning guides [1] [8].