FPL stands for Federal Poverty Level, and it’s the income benchmark the government uses to decide whether you qualify for Medicaid. Your eligibility isn’t based on a single dollar amount that applies to everyone. Instead, each state sets its Medicaid income limit as a percentage of the FPL, and that percentage varies depending on where you live, how large your household is, and which category you fall into (adult, child, pregnant person, or someone with a disability).
How the Federal Poverty Level Works
The FPL is a set of income figures published every year by the U.S. Department of Health and Human Services. It’s updated based on the Consumer Price Index, which tracks how much everyday goods and services cost. For 2025, 100% of the FPL in the lower 48 states and Washington, D.C., breaks down like this:
- 1 person: $15,650 per year ($1,304 per month)
- 2 people: $21,150 per year ($1,763 per month)
- 3 people: $26,650 per year ($2,221 per month)
- 4 people: $32,150 per year ($2,679 per month)
Each additional household member adds $5,500 per year. Alaska and Hawaii have higher FPL thresholds because the cost of living is steeper in both states.
When you see a Medicaid income limit described as “138% FPL,” that means you multiply the dollar figures above by 1.38 to find the actual cutoff. For a single person in 2025, 138% FPL comes out to roughly $21,597 per year.
FPL Percentages for Medicaid Eligibility
Medicaid doesn’t use a single FPL percentage for everyone. The threshold depends on which group you belong to and whether your state has expanded Medicaid under the Affordable Care Act.
In the 40 states (plus D.C.) that have adopted Medicaid expansion, most adults ages 18 to 65 qualify if their household income falls below 138% of the FPL. The law technically sets the limit at 133%, but a built-in 5% income disregard effectively raises it to 138%. In states that haven’t expanded Medicaid, adult eligibility limits are often far lower, sometimes below 50% FPL, and many childless adults don’t qualify at all regardless of income.
Children and pregnant women generally qualify at higher income thresholds. Many states cover children through Medicaid or the Children’s Health Insurance Program (CHIP) up to 200% FPL or above, and pregnant women often qualify at 185% to 300% FPL depending on the state. These wider thresholds exist because federal law requires states to cover these groups more broadly than other adults.
How Your Income Is Measured Against FPL
For most people applying for Medicaid, the system uses a calculation called Modified Adjusted Gross Income, or MAGI. This is essentially your adjusted gross income from your tax return, plus a few items like tax-exempt interest and certain foreign income. The MAGI method doesn’t count assets like savings accounts, cars, or your home. It looks only at income, and it doesn’t allow states to create their own deductions or disregards beyond what federal rules permit.
Your household size matters because the FPL threshold scales with it. A larger household gets a higher income cutoff. For Medicaid purposes, your household generally mirrors your tax filing unit: you, your spouse if legally married, and anyone you claim as a tax dependent. Children in shared custody count toward your household only in years you claim them on your taxes. Roommates, ex-spouses, and unmarried partners typically don’t count unless you claim them as dependents or share a child. If someone else claims you as a dependent, you’re counted as part of their household rather than your own.
When Asset Tests Still Apply
The income-only approach covers most Medicaid applicants, but certain groups face additional scrutiny. If you’re 65 or older, blind, or have a disability, your eligibility is typically determined using the methodology from the Supplemental Security Income (SSI) program rather than MAGI. That means the state can look at your bank accounts, investments, and other assets in addition to your income.
Long-term care adds another layer. If you need nursing home services or home-based care through Medicaid, the program reviews whether you’ve transferred assets for less than fair market value during the five years before your application. Selling your house to a family member for a dollar, for instance, could result in a penalty period where Medicaid won’t cover long-term care costs. This “look-back” rule exists to prevent people from giving away wealth specifically to qualify for benefits.
Finding Your State’s Specific Limit
Because Medicaid is jointly run by federal and state governments, the FPL percentage that applies to you depends on where you live. Two people with identical incomes and household sizes can have different outcomes if one lives in an expansion state and the other doesn’t. Your state Medicaid agency’s website will list the current income limits by category, or you can use the eligibility screener at HealthCare.gov to get a quick estimate. The application itself will compare your reported income against the FPL thresholds for your household size and state, so you don’t need to do the math yourself.