New York Medicaid Income Limits
Updated August 2026
New York expanded Medicaid under the ACA. Adults 19–64 qualify at 138% of the Federal Poverty Level (FPL). The table below uses the 2026 federal poverty guidelines as published in the NY DOH income standards document (GIS 26 MA/03, effective January 1, 2026).
138%
FPL — adults 19–64
223%
FPL — pregnant / infants
250%
FPL — Essential Plan
No
Asset test (MAGI)
No asset test for most New York Medicaid — long-term care is different
MAGI-based New York Medicaid has no asset test. A savings account, home, or car does not count against eligibility for standard coverage. Long-term care Medicaid — nursing home or MLTC-level programs — uses a different (Non-MAGI) eligibility track with resource limits. For institutionalized individuals, the resource limit for a single person is $32,396 (per GIS 26 MA/03). Spousal impoverishment rules allow the community spouse to retain up to $162,660 in countable resources. Consult a Medicaid planning professional before spending down assets — the rules for non-MAGI Medicaid are complex.
Income limits for adults (ages 19–64) under ACA expansion
| Household size | Annual limit (138% FPL) | Monthly limit |
|---|---|---|
| 1 person | $21,597 | $1,800/mo |
| 2 people | $29,187 | $2,433/mo |
| 3 people | $36,777 | $3,065/mo |
| 4 people | $44,367 | $3,698/mo |
| 5 people | $51,957 | $4,330/mo |
| 6 people | $59,547 | $4,963/mo |
| 7 people | $67,137 | $5,595/mo |
| 8 people | $74,727 | $6,228/mo |
1 person
- Annual limit (138% FPL)
- $21,597
- Monthly limit
- $1,800/mo
2 people
- Annual limit (138% FPL)
- $29,187
- Monthly limit
- $2,433/mo
3 people
- Annual limit (138% FPL)
- $36,777
- Monthly limit
- $3,065/mo
4 people
- Annual limit (138% FPL)
- $44,367
- Monthly limit
- $3,698/mo
5 people
- Annual limit (138% FPL)
- $51,957
- Monthly limit
- $4,330/mo
6 people
- Annual limit (138% FPL)
- $59,547
- Monthly limit
- $4,963/mo
7 people
- Annual limit (138% FPL)
- $67,137
- Monthly limit
- $5,595/mo
8 people
- Annual limit (138% FPL)
- $74,727
- Monthly limit
- $6,228/mo
Income limits by coverage group (2026)
| Coverage group | FPL threshold | Monthly limit (1 person) |
|---|---|---|
| Adults 19–64 (ACA expansion) | 138% FPL | $1,800/mo |
| Parents/caretaker relatives | 138% FPL | $1,800/mo |
| Pregnant individuals | 223% FPL | $2,909/mo |
| Children under 1 year | 223% FPL | $2,909/mo |
| Children ages 1–5 | 154% FPL | $2,009/mo |
| Children ages 6–18 (Medicaid) | 154% FPL | $2,009/mo |
| Children under 19 (Child Health Plus/CHIP) | Up to 400% FPL | See CHIP page |
| SSI recipients | SSI limit | Automatic eligibility |
| Medicaid Buy-In for Working People with Disabilities (MBI-WPD) | 250% FPL | $3,261/mo |
| Essential Plan (not Medicaid — see note) | 139%–250% FPL | ~$1,801–$3,261/mo |
Adults 19–64 (ACA expansion)
- FPL threshold
- 138% FPL
- Monthly limit (1 person)
- $1,800/mo
Parents/caretaker relatives
- FPL threshold
- 138% FPL
- Monthly limit (1 person)
- $1,800/mo
Pregnant individuals
- FPL threshold
- 223% FPL
- Monthly limit (1 person)
- $2,909/mo
Children under 1 year
- FPL threshold
- 223% FPL
- Monthly limit (1 person)
- $2,909/mo
Children ages 1–5
- FPL threshold
- 154% FPL
- Monthly limit (1 person)
- $2,009/mo
Children ages 6–18 (Medicaid)
- FPL threshold
- 154% FPL
- Monthly limit (1 person)
- $2,009/mo
Children under 19 (Child Health Plus/CHIP)
- FPL threshold
- Up to 400% FPL
- Monthly limit (1 person)
- See CHIP page
SSI recipients
- FPL threshold
- SSI limit
- Monthly limit (1 person)
- Automatic eligibility
Medicaid Buy-In for Working People with Disabilities (MBI-WPD)
- FPL threshold
- 250% FPL
- Monthly limit (1 person)
- $3,261/mo
Essential Plan (not Medicaid — see note)
- FPL threshold
- 139%–250% FPL
- Monthly limit (1 person)
- ~$1,801–$3,261/mo
What happens if your income is over 138% FPL?
Adults with income between 139% and 250% FPL do not qualify for Medicaid but can enroll in New York's Essential Plan through NY State of Health. Premiums are $0 or $20/month depending on income level. The Essential Plan covers most medical, behavioral health, and pharmacy needs — it is not Medicaid, but it substantially reduces out-of-pocket costs for this income band.
Adults above 250% FPL can purchase qualified health plans through NY State of Health with premium tax credits, depending on income. No state-level coverage bridge exists above 250% FPL.
Pregnancy coverage extends to 223% FPL — higher than the adult standard
Pregnant individuals in New York qualify for Medicaid up to 223% FPL, a significantly higher threshold than the standard adult rate of 138% FPL. A single pregnant person earning up to $2,909/month (as of January 2026) qualifies. Coverage continues through the end of the month in which the 60th day post-delivery falls, regardless of income changes after delivery.
The newborn receives guaranteed Medicaid eligibility for one full year if the mother was enrolled at delivery. Hospitals can make presumptive eligibility determinations for pregnant individuals on-site, enabling coverage to begin before the formal application is processed.
What counts as income under MAGI rules
New York uses Modified Adjusted Gross Income (MAGI) for most Medicaid programs — the same methodology as ACA marketplace coverage. Because there is no asset test, savings accounts, a home, and vehicles are not counted.
- Wages, salaries, tips
- Self-employment net income
- Unemployment compensation
- Social Security (taxable portion)
- Capital gains and dividends
- Alimony received (pre-2019 divorces)
What does not count as income under MAGI rules
Long-term care Medicaid (nursing home, MLTC) uses a different Non-MAGI track with a resource limit of $32,396 for a single person. The MAGI no-asset-test rule does not apply to LTC applications.
- Child support received
- SSI payments
- Veterans' disability compensation
- Gifts and inheritances
- SNAP/food stamps benefits
- Workers' compensation
New York's full coverage ladder: Medicaid to marketplace
New York is unusual in having a near-seamless coverage ladder from $0 to well above the ACA marketplace subsidy range. The Essential Plan eliminates most of the gap other states have at the 138% FPL cliff.
| Income range (single adult) | Program | Monthly cost |
|---|---|---|
| $0 – $1,800/mo (138% FPL) | New York Medicaid | $0 |
| $1,801 – $2,282/mo (139–175% FPL) | Essential Plan | $0 |
| $2,283 – $3,261/mo (175–250% FPL) | Essential Plan | $20/mo |
| $3,262+/mo (above 250% FPL) | Marketplace plans (ACA subsidies may apply) | Varies |
$0 – $1,800/mo (138% FPL)
- Program
- New York Medicaid
- Monthly cost
- $0
$1,801 – $2,282/mo (139–175% FPL)
- Program
- Essential Plan
- Monthly cost
- $0
$2,283 – $3,261/mo (175–250% FPL)
- Program
- Essential Plan
- Monthly cost
- $20/mo
$3,262+/mo (above 250% FPL)
- Program
- Marketplace plans (ACA subsidies may apply)
- Monthly cost
- Varies
Medicare Savings Programs (QMB) in New York
New Yorkers who are enrolled in both Medicare and Medicaid, or who are approaching Medicare eligibility on a fixed income, often search "New York QMB income limits" without realizing QMB is one of three tiers under New York's Medicare Savings Programs — QMB, SLMB, and QI. Each tier is administered by the New York State Department of Health and applied for through your Local Department of Social Services (LDSS), or HRA if you live in New York City — not through Medicare or the Social Security Administration.
| Program | Situation | Monthly income limit |
|---|---|---|
| QMB | Individual | $1,350/mo |
| QMB | Married couple | $1,824/mo |
| SLMB | Individual | $1,616/mo |
| SLMB | Married couple | $2,184/mo |
| QI | Individual | $1,816/mo |
| QI | Married couple | $2,455/mo |
QMB
- Situation
- Individual
- Monthly income limit
- $1,350/mo
QMB
- Situation
- Married couple
- Monthly income limit
- $1,824/mo
SLMB
- Situation
- Individual
- Monthly income limit
- $1,616/mo
SLMB
- Situation
- Married couple
- Monthly income limit
- $2,184/mo
QI
- Situation
- Individual
- Monthly income limit
- $1,816/mo
QI
- Situation
- Married couple
- Monthly income limit
- $2,455/mo
Qualified Medicare Beneficiary (QMB) is the broadest tier: in 2026, an individual qualifies with income up to $1,350/mo and resources up to $9,950; a couple qualifies up to $1,824/mo in income and $14,910 in resources. QMB pays your Part A premium if one is owed, your full Part B premium ($202.90/mo in 2026), and every Medicare deductible, coinsurance charge, and copayment. Federal law bars any provider from billing a QMB enrollee for those costs — a protection that applies whether or not the provider realizes you're enrolled.
Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) sit above QMB on the income scale — SLMB up to $1,616/mo individual ($2,184/mo couple), QI up to $1,816/mo individual ($2,455/mo couple) — and cover only the Part B premium. QI has capped annual funding awarded first-come, first-served, so enrollees must reapply every year rather than renewing automatically.
All three tiers carry automatic enrollment in Extra Help, which limits what you pay for covered Part D prescriptions to $12.65 per drug in 2026. To apply, contact your county DSS (or HRA in NYC), or call the New York State of Health line at 1-855-355-5777 to be routed to the right office — Medicare Savings Program applications are processed outside the standard MAGI application used for the coverage groups described earlier on this page.
New York Medicaid
Visit the official New York Medicaid websiteIncome Limits in Nearby States
Related guides
Income Limits
Current income cutoffs by state and household size, tied to the Federal Poverty Level.
Read more →Spend-Down
How to qualify by deducting medical bills from income that's above the limit.
Read more →QMB Program
What the QMB program covers, what a QMB card proves, and how to apply.
Read more →