This calculator provides an ESTIMATE. Actual eligibility depends on specific state rules and individual circumstances. Consult official state Medicaid resources for definitive information.
Children
Pregnant Women
Parents and Caretakers
Elderly (65+)
Disabled
Adults (19-64) Without Dependents
Medically Needy (Spenddown)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Understanding Medicaid Eligibility
Medicaid is a crucial government program in the United States that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Eligibility for Medicaid is complex and varies significantly by state, often based on income, household size, disability status, pregnancy, and other factors.
How Medicaid Eligibility is Determined
Medicaid eligibility is primarily determined by a Modified Adjusted Gross Income (MAGI) calculation, which is a percentage of the Federal Poverty Level (FPL). However, some groups, like the elderly and disabled individuals applying for long-term care, may use different eligibility rules that don't rely on MAGI.
Key Factors Include:
Household Size: The number of people in your household directly impacts the income limits. Larger households generally have higher income thresholds.
Household Income: Your total income (before taxes) is compared against the FPL for your household size.
Medicaid Category: Eligibility criteria are often different for specific groups such as children, pregnant women, parents, the elderly, and disabled individuals.
State Expansion: Many states have expanded Medicaid under the Affordable Care Act (ACA), which has broadened eligibility for low-income adults. States that have not expanded Medicaid have stricter criteria for adults without dependent children or disabilities.
Medically Needy Programs (Spenddown): Some states offer "medically needy" programs. If your income is too high for regular Medicaid, you might still qualify if you have significant medical expenses that reduce your "countable" income to the state's eligibility limit. You essentially "spend down" your income on medical care to become eligible.
The Role of Federal Poverty Level (FPL)
The Federal Poverty Level (FPL) is a measure of income issued annually by the Department of Health and Human Services. States set their Medicaid income eligibility limits as a percentage of the FPL. For example, a state might cover children up to 200% of the FPL, pregnant women up to 133% of the FPL, and non-disabled adults in a non-expansion state might have very low limits (e.g., below 50% of the FPL).
Using This Calculator
This calculator uses general guidelines and common MAGI-based FPL percentages. It is designed to give you an *estimate* based on the information you provide. The exact percentages and rules can differ by state and may change annually.
Household Size: Enter the total number of individuals in your household.
Monthly Income: Provide your household's total gross monthly income (before taxes).
Medicaid Category: Select the category that best fits your situation. Note that 'Adults (19-64) Without Dependents' eligibility varies drastically based on whether your state expanded Medicaid.
Medically Needy: If you select "Medically Needy," you will be prompted to enter your monthly medical expenses. This is used to calculate if you could potentially "spend down" to meet eligibility requirements.
State: Select your state of residence, as rules vary significantly.
Disclaimer: This tool is for informational purposes only. It is not a substitute for professional advice or official determination by your state's Medicaid agency. For accurate and up-to-date information, please visit your state's official Medicaid website or contact them directly.
Find Your State's Medicaid Office: You can typically find your state's Medicaid information by searching online for "[Your State Name] Medicaid" or visiting Medicaid.gov's State Profile Pages.
// FPL percentages – these are generalized and can vary slightly by year and state
// These are rough estimates based on common MAGI thresholds.
var fplPercentages = {
children: 200, // Typically higher for children
pregnantWomen: 133, // Often around this threshold
parentsAndCaretakers: 133, // Varies greatly, expansion states are higher
elderly: 100, // Often based on SSI limits, but MAGI can apply
disabled: 100, // Often based on SSI limits, but MAGI can apply
adultsNoDependents: 133, // For expansion states. Non-expansion states are much lower or zero.
medicallyNeedy: 133 // The threshold *after* medical expenses are considered.
};
// Approximate 2023 Federal Poverty Guidelines (for a household of 1)
// These are annual values. We'll need to convert monthly income to annual for comparison.
// Source: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references/2023-poverty-guidelines
var hhsPovertyGuidelines = {
1: 14580,
2: 19720,
3: 24860,
4: 30000,
5: 35140,
6: 40280,
7: 45420,
8: 50560
// Add more for larger households if needed, or calculate dynamically
};
function getFPLForHousehold(householdSize) {
if (hhsPovertyGuidelines[householdSize]) {
return hhsPovertyGuidelines[householdSize];
}
// Estimate for larger households: Base for 8 + $5140 for each additional person
var base = hhsPovertyGuidelines[8];
var additional = (householdSize – 8) * 5140;
return base + additional;
}
function calculateMedicaidEligibility() {
var householdSize = parseInt(document.getElementById("householdSize").value);
var incomePerMonth = parseFloat(document.getElementById("incomePerMonth").value);
var medicaidCategory = document.getElementById("medicaidCategory").value;
var state = document.getElementById("state").value;
var medicallyNeedyIncome = 0;
if (medicaidCategory === "medicallyNeedy") {
medicallyNeedyIncome = parseFloat(document.getElementById("medicallyNeedyIncome").value);
}
var resultDiv = document.getElementById("result");
resultDiv.className = ""; // Reset classes
// — Input Validation —
if (isNaN(householdSize) || householdSize < 1) {
resultDiv.textContent = "Please enter a valid household size (at least 1).";
resultDiv.className = "ineligible";
return;
}
if (isNaN(incomePerMonth) || incomePerMonth < 0) {
resultDiv.textContent = "Please enter a valid monthly income.";
resultDiv.className = "ineligible";
return;
}
if (medicaidCategory === "medicallyNeedy" && (isNaN(medicallyNeedyIncome) || medicallyNeedyIncome < 0)) {
resultDiv.textContent = "Please enter valid expected medical expenses for the medically needy category.";
resultDiv.className = "ineligible";
return;
}
// — Eligibility Calculation —
var annualIncome = incomePerMonth * 12;
var federalPovertyLevel = getFPLForHousehold(householdSize);
var incomeLimitPercent = fplPercentages[medicaidCategory] || 133; // Default to 133% if category not found
var eligibleIncomeLimit = (federalPovertyLevel * incomeLimitPercent) / 100;
var isEligible = false;
var eligibilityMessage = "";
var isConditional = false;
// Simplified logic for demonstration. Real state rules are far more complex.
// This handles basic MAGI cases and acknowledges state differences.
if (medicaidCategory === "medicallyNeedy") {
// For medically needy, we check if expenses *reduce* income below the threshold
var countableIncome = annualIncome – medicallyNeedyIncome;
if (countableIncome <= eligibleIncomeLimit) {
isEligible = true;
eligibilityMessage = "Potentially Eligible (Medically Needy)";
isConditional = true; // Indicate it requires meeting spenddown
} else {
eligibilityMessage = "Likely Ineligible";
}
} else if (medicaidCategory === "adultsNoDependents" && state !== "CA" && state !== "CO" && state !== "DC" && state !== "HI" && state !== "MA" && state !== "MD" && state !== "NJ" && state !== "NM" && state !== "NY" && state !== "OR" && state !== "VT" && state !== "WA") {
// Simplified check for non-expansion states for adults without dependents
// These states generally have much lower limits, often tied to specific programs or are non-existent for childless adults.
// For simplicity, we'll use a very low threshold (e.g., 50% FPL) or indicate strong likelihood of ineligibility without specific program checks.
var nonExpansionLimit = (federalPovertyLevel * 50) / 100;
if (annualIncome <= nonExpansionLimit) {
isEligible = true;
eligibilityMessage = "Potentially Eligible (Low Income Adult – Non-Expansion State)";
} else {
eligibilityMessage = "Likely Ineligible (Adult – Non-Expansion State)";
}
}
else {
// General MAGI-based eligibility for other categories
if (annualIncome <= eligibleIncomeLimit) {
isEligible = true;
eligibilityMessage = "Potentially Eligible";
} else {
eligibilityMessage = "Likely Ineligible";
}
}
// Display result
if (isEligible) {
resultDiv.textContent = "Estimated Eligibility: " + eligibilityMessage + " (Income: " + annualIncome.toFixed(2) + " / year)";
if(isConditional) {
resultDiv.className = "conditional";
} else {
resultDiv.className = "eligible"; // Use a green class for eligible
}
} else {
resultDiv.textContent = "Estimated Eligibility: " + eligibilityMessage + " (Income: " + annualIncome.toFixed(2) + " / year)";
resultDiv.className = "ineligible"; // Use a red class for ineligible
}
}
// Show/hide medically needy income field based on category selection
document.getElementById("medicaidCategory").addEventListener("change", function() {
var medicallyNeedyGroup = document.getElementById("medicallyNeedyIncomeGroup");
if (this.value === "medicallyNeedy") {
medicallyNeedyGroup.style.display = "block";
} else {
medicallyNeedyGroup.style.display = "none";
}
});