Preferential health insurance: how much income is needed to participate in the Medicaid program

Many Americans still lack health insurance despite the expansion of Medicaid under the Affordable Care Act, which raised the income thresholds for Medicaid eligibility. What is now the lowest and highest income to participate in the Medicaid program, the publication found out AS.

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In 2020, US Census Bureau data showed that 28 million people, or about 8,6% of the US population, were not insured at any time during the year.

There are 12 states that have yet to expand Medicaid, leaving over 2 million people uncovered. They earn and qualify for subsidized health insurance plans under the Affordable Care Act, but do not meet the state's income requirements for Medicaid.

Find out if you qualify for Medicaid in your state, you can link.

Medicaid income thresholds vary by state

Medicaid is a health insurance program funded jointly by the federal and state governments that aims to help low-income people access health care. It was created to provide health insurance for children, parents, pregnant women, the elderly, and people with limited incomes.

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Although the federal government sets some ground rules, each state can decide whether to cover more health care services than is allowed. The Affordable Care Act has given states funding to expand coverage to all adults with incomes up to 133% above the federal poverty line, but because of how it's calculated, it comes out to be 138%.

All states, the District of Columbia, and US territories offer Medicaid, although participation is not required. Similarly, states can take part in expanding Medicaid, which 12 have chosen not to. States can set their own income thresholds higher or lower.

Federal Poverty Thresholds for Medicaid Eligibility

The federal poverty rate is defined by family size for the 48 states and the District of Columbia. For example, in 2022 it is $13 for an adult, $590 for a family of four, and $27 for a family of eight. To calculate for larger families, you need to add $750 for each additional person in families with nine or more members.

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The federal poverty rate, which is determined by the Department of Health and Human Services, is higher in Alaska and Hawaii. The amount is adjusted each year for inflation and is effective from 1 January.

In addition, in states that have expanded Medicaid, low-income people have greater access to mental health care.

Income to qualify for Medicaid, in addition to varying by state, is also higher or lower depending on who it is for. Many states that have expanded Medicaid coverage have set income limits for both parents and single adults at 138% of the federal poverty level.

The District of Columbia has the highest income limits, set at 221% for a family of three and 215% for all other adults. Pregnant women and children tend to have a much higher income threshold to qualify.

The threshold percentage of income may depend on whether the person is working, but it usually does not apply to certain categories, including the elderly, the disabled, pregnant women and children.

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