Since Jan. 1, 2023, the income limit for the Aged, Blind and Disabled is 138% of the Federal Poverty Level (FPL -also known as "Federal Poverty Guidelines"). This is the same income limit used since 2014 for the younger "MAGI" Medicaid group under the Affordable Care Act (ACA).. (Read about how the 2023 increases were rolled out here.) Before 2023, the limit was not based on the Federal Poverty Level - it was a state-only formula. Now that it based on the FPL, NYS cannot announce the annual increases until the federal Dept. of Health & Human Services (HHS) announces the FPL at the beginning of each year.
- Jan. 16, 2026 UPDATE - The federal HHS agency posted the 2026 Federal Poverty guidelines in the Federal Register on Jan. 15, 2026. See also this HHS announcement.
- The 2026 increases will not be in effect in NYS until the NY State Dept. of Health issues a "GIS" directive implementing them. Check here to see when a "GIS" is issued, which will be posted here soon after it is available. Until then, Medicaid continues to use the 2025 income limits.
HRA CHART on 2026 Medicaid Income & Asset Levels posted here - BUT IT MOSTLY STILL SHOWS 2025 levels because the State has not yet released the 2026 levels in accordance with the FPLs. The figures highlighted in yellow will all be updated for 2026. Check back here for the updated chart.
The chart below shows both the 2025 limits and the projected 2026 income limits, which again, are not in effect yet in NYS until the State issues a directive implementing them.
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2025 and projected 2026
FEDERAL MEDICAID MONTHLY INCOME LIMITS
MAGI (<65, Not on Medicare) & Non-MAGI (65+, Disabled, Blind)
138% Federal Poverty Level
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| 1 |
2 |
3 (MAGI only)** |
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$1,800 2025
will be $1,835 - 2026
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$2,433 2025
will be $2,488 2026
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$3,065 2025
will be $3,141 2026
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2026 RESOURCE LIMITS - NON-MAGI MEDICAID ONLY
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$32,396 2025
$33,037 2026
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$43,781 2025
$44,794 2026
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NA - ** |
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2025 ESSENTIAL PLAN MONTHLY INCOME LIMITS
(increased from 200% to 250% FPL on April 1, 2024, BUT
WARNING: In July, 2026 the income limit for the Essential Plan will decrease from 250% FPL to 200% FPL because of cuts enacted in H.R.1. See here.)
(Only for those in MAGI category with income above MAGI Medicaid limits)
See Essential Plan info here
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| Until June 20, 2026- 250% FPL |
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$3,261 2025
$3,325 2026
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$4,407 2025
$4,508 2026
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$5,552 2025
$5,691 2026
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| After July 1, 2026 - 200% FPL - limit decreases = see here |
| $2,6660 |
$3,606 |
$4,553 |
** Non-MAGI budgeting for Aged, Blind and Disabled only allows a Household size of 1 or 2. See more here. Also, for MAGI budgeting, children < 5 and pregnant women have HIGHER INCOME LIMITS than those shown. See NYS 2023 Chart here for larger size MAGI households.
MORE BELOW:
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Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels.
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Box 11 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers. People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down." They have NO resource limit.
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Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care & Nursing Homes and Box 9 on page 5 has the Transfer Penalty rates for nursing home eligibility
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Box 5 has Medicaid Buy-In for Working People with Disabilities Under Age 65
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Box 6 - Family Planning Benefit Program
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Box 7-8 are Medicare Savings Program levels along with annual Medicare figures and COBRA, AIDS Health insurance programs.
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Box 9 are monthly regional Nursing Home rates, used to calculate the transfer penalty for nursing home care. If and when the lookback begins for home care and Assisted Living Program, the same rates will be used for the transfer penalty. See this article
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Box 10 - Fair Market Regional Rates for Special Standard for Housing Expenses - an extra income disregard for people enrolled in MLTC when they return home after 30+ days in a nursing home or adult home. See this article.
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Box 11 are the MAGI income levels -- for those under 65 NOT on Medicare (with some exceptions) -- have expanded eligibility up to 138% of the Federal Poverty Line. They have NO resource limit.
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Box 12 - MAGI limits for children under 18 and pregnant women (CHIP)
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Box 13 - Child Health Plus limits for children under age 19 who are not Medicaid-eligible
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Box 14 - Disabled Adult Child (DAC) income limits
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Box 15 - Congregate Care Levels I, II, and III - these are the income limits used in the Assisted Living Program and in Adult Homes (adult care facilities) and other congregate facilities. These levels are published by the NYS Office of Temporary & Disability Assistance (OTDA) each year - see SSI/SSP 2026 Maximum Monthly Benefit Amounts posted at https://otda.ny.gov/programs/ssp/ or look at OTDA Policy Directives for recent INF directives. Prior years in ARCHIVES link.
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Since 2024, the Medicaid non-MAGI limit has been higher than the Congregate Care Level III limit (combining the federal SSI and state SSP) so the higher Medicaid limit is used as the Medicaid limit for ALP residents. See GIS 24 MA/01. Income exceeding that limit is "excess income" or a spenddown. They keep a Personal Needs Allowance ($262 in 2026.
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Box 16 - SSI levels. The "Allocation Amount" is the difference between the non-MAGI income limit of 1 and limit of 2. This is the amount that the spouse in an MLTC plan or waiver may keep if they and their spouse have Spousal Impoverishment budgeting.
MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND MAGI can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R. § 435.4.
Certain populations have an even higher income limit -
- 224% FPL for pregnant women and babies < age 1,
- 154% FPL for children age 1 - 19.
For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this fact sheet.. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under federal income tax concepts - called "Modified Adjusted Gross Income" (MAGI). There are good changes and bad changes for MAGI.
GOOD MAGI rules: Veteran's benefits, Workers compensation, lawsuit settlements that are not taxable, and gifts from family or others do not count as income.
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Also, there is 12-month guaranteed eligiblity - if you were eligible at the application or renewal, you continue to be eligible for 12 months even if your income goes up in the meantime. Eligibility will be re-evaluated at the renewal based on your then current income - not on changes that may have temporarily occurred during the last 12 months.
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No asset test! But income and dividends earned on savings counts as income.
BAD MAGI rules: There is no "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules. For more about the rules see:
ALSO SEE 2025 Manual on Lump Sums and Impact on Public Benefits - with resource rules
The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even logical. There are different rules depending on the "category" of the person seeking Medicaid. Here are the 2 basic categories and the rules for calculating their household size.
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People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article.
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Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population. Their household size will be determined using federal income tax rules, which are very complicated.
New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49. Also see Legal Aid Society and Empire Justice Center materials
OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category. Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility. See 18 NYCRR 360-4.2, MRG p. 573, NYS GIS 2000 MA-007
- CAUTION: Different people in the same household may be in different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI.
The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid:
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Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no asset limits. It did not allow "spend down" of excess income. This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL.
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Family Health Plus - this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL. This has now been folded into the new MAGI adult group whose limit is 138% FPL. For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange.
This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.
