News & Commentary

Medicaid eligibility standards adjusted to allow higher income


Every state except Idaho and North Dakota now extends Medicaid and CHIP to children from families at 200% of the federal poverty level (FPL) or above, and 19 states provide coverage for children whose families are at or above 300% of the FPL, according to the Kaiser Family Foundation. Not surprisingly, in states that have expanded Medicaid under the ACA, the income eligibility standards for children, parents, and childless adults are easier to meet—people can earn more money and still get Medicaid coverage—than the standards in states that haven’t expanded Medicaid. For pregnant women, there is less of a difference between the expansion and the nonexpansion states (213% of FPL vs. 201%).

Median Medicaid/CHIP eligibility thresholds for a family of 3
  Expanding Medicaid (28 states)* Not expanding Medicaid (23 states)
Children 305% ($60,359)** 215% ($42,548)
Pregnant women 213% ($42,153) 201% ($39,777)
Parents 138% ($27,310) 45% ($8,905)
Childless adults 138% ($16,105) 0% ($0)
*Includes the District of Columbia.
**Percent of the federal poverty level (annual earnings).

Elibility levels are based on the 2014 federal povery level (FPL). In 2014, the FPL for a family of three was 19,790 and for an individual, $11,670.

Source: “Modern Era Medicaid: Findings From a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP as of January, 2015,” Kaiser Commission on Medicaid and the Uninsured

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