How do state Medicaid income eligibility thresholds compare to 2026 FPL percentages?
Executive summary
States set Medicaid income limits as percentages of the Federal Poverty Level (FPL); most expansion states use roughly 133–138% FPL for adults while non‑expansion states rely on much lower, varied thresholds or categorical rules [1] [2]. KFF maintains a state‑by‑state dataset of adult Medicaid income limits as percent of FPL for 2025/2026 that captures this variation [3].
1. How Medicaid ties to the FPL — the baseline rule
Federal guidance and consumer resources show Medicaid eligibility for many groups is calibrated to the FPL: if your income is below about 133% of FPL (effectively 138% after the five‑percent income disregard), you qualify in states that adopted the ACA expansion; below 100% or other program‑specific percentages in non‑expansion states, children, pregnant people and other categories have their own higher percentages [1] [4] [5].
2. Two different regimes: expansion vs. non‑expansion states
The clearest divide is whether a state implemented the ACA Medicaid expansion. In expansion states adults up to roughly 133% FPL (commonly referenced as 138% FPL in public materials) are eligible based on income alone [1] [2]. In non‑expansion states, adults without qualifying categories may be excluded even if they are under 100% FPL; children, pregnant people and other groups still have state‑specific FPL percentages that can be higher [5] [6].
3. State variation above and below the headline numbers
Beyond the expansion cutpoint, states overlay many different limits: some use higher percentages for children or pregnant women (for example, Florida lists children and pregnant women thresholds at 133–206% of FPL for various ages and pregnancy) and special state programs (Basic Health Programs, waivers) can set higher caps — New York, Massachusetts and others operate programs that reach well above the standard 138% line [6] [7]. Alaska applies higher nominal limits because of cost‑of‑living adjustments [8].
4. Where to find the precise state percentages for 2026
Non‑partisan trackers compile state‑level percentages: KFF’s state indicator lists “Medicaid income eligibility limits for adults as a percent of the FPL” and is the go‑to source for comparing exact state cutoffs [3]. Where states run special programs (BHPs, waivers) or temporarily higher limits, state pages and policy briefs such as HealthInsurance.org and state Medicaid sites document those exceptions [9] [7].
5. Why the exact FPL numbers matter in 2026
Administrative practice uses FPL percentages together with the annual FPL dollar figures. For coverage year determinations, marketplaces and Medicaid often rely on the prior year’s HHS poverty guidelines during transitions; for example, eligibility in early 2026 may still be assessed against 2025 FPL numbers until states begin using 2026 figures in March–April [9]. That timing means a percent cutoff (e.g., 138% FPL) maps to concrete monthly and annual dollar thresholds that shift with the HHS update [9] [10].
6. Policy changes and program quirks that shift the picture
Several providers note jurisdictional policy choices that alter access: D.C. reduced a previously higher parental/adult limit back toward 138% in 2026 while planning a BHP for others; states like New York and Massachusetts maintain separate programs with much higher income ceilings [8] [7]. Some states also use the Federal Benefit Rate (FBR) for long‑term care eligibility instead of FPL, complicating straight FPL comparisons [11] [10].
7. What the available sources do not mention
Available sources do not mention a single, final national chart of 2026 dollar thresholds mapped to every state’s percentage — that mapping requires the 2026 HHS poverty guidelines and state policy tables (not available in the provided excerpts) [9] [3]. They also do not provide full month‑by‑month operational rules for renewal reporting or how specific state outreach will change enrollment numbers in 2026 beyond cited examples [8] [7].
8. Practical takeaway for readers comparing thresholds
Use two pieces of information to compare: the state’s Medicaid percentage limit (KFF’s state indicator is authoritative for percent cutoffs) and the 2026 HHS poverty guidelines to convert percent to dollars — remembering some programs (kids, pregnant people, BHPs, long‑term care) use different percentages or the FBR [3] [9] [11]. For most adults, the practical divide is simple: expansion states generally cover to roughly 133–138% FPL; non‑expansion states do not and rely on narrower, more variable rules [1] [2].