Median Medicaid/CHIP eligibility threshold January 2023

Medicaid and the Children’s Health Insurance Program (CHIP) provide medical coverage to millions of Americans, and one of the main criteria to determine eligibility is income. In states with expanded coverage, the minimum eligibility threshold for adults is 138 percent of the federal poverty level (FPL).

The impact of the Affordable Care Act

The Affordable Care Act (ACA) created the opportunity for states to expand Medicaid to cover nearly all low-income adults. Most states chose to extend coverage, meaning adults are eligible if their household income is at or below 138 percent of the FPL. Before the ACA, applicants had to fit into one of several categories in order to be eligible. Each group had its own income rules, and they all differed from state to state. Most low-income adults without children were not eligible.

Medicaid income rules simplified

The ACA established a new methodology to determine income eligibility that helped to align rules that previously varied nationwide. In general, an individual’s eligibility is now determined by their Modified Adjusted Gross Income (MAGI) and where it falls in relation to the FPL. In 2021, the FPL for a one-person household was set at 12,880 U.S. dollars, which was the minimum income a person had to earn to qualify for Medicaid. In expansion states, an individual would still be eligible if they earned up to 138 percent of that figure.