For many Nebraska families, Medicaid is the difference between skipping care and getting the treatment they need. Through the Heritage Health program, the state provides affordable or often free health coverage for residents with limited income.
But who exactly qualifies in 2025–2026, and how much can you earn and still get approved?
This guide breaks down the latest verified income limits, eligibility categories, and application details to help you or someone you know find the right path to coverage.
Understanding Nebraska’s Heritage Health Program
Nebraska’s Heritage Health is more than just an insurance card. It’s a coordinated health plan that connects medical, dental, vision, behavioral, and pharmacy services under one system.
Participants have access to:
- Routine doctor visits and hospital stays
- Mental health and substance abuse treatment
- Pregnancy and newborn care
- Prescription drugs and preventive screenings
- Long-term care services for eligible seniors and disabled residents
The goal is simple, to help every Nebraskan stay healthy without fear of massive medical bills.
Who Qualifies for Nebraska Medicaid in 2025–2026?
Eligibility depends on factors like income, household size, age, and medical status. You may qualify under one of these groups:
- Adults (ages 19–64) under the Medicaid expansion program
- Pregnant women at or below the higher pregnancy income threshold
- Children under 19 through Medicaid or CHIP
- Seniors, blind, or disabled individuals
- Parents or caregivers with dependent children
- Medically needy applicants who qualify through spend-down programs
Applicants must live in Nebraska, meet citizenship or qualified-immigrant requirements, and satisfy any additional program criteria.
2025 Nebraska Medicaid Income Limits (Verified)
Nebraska uses Modified Adjusted Gross Income (MAGI) to determine eligibility for most programs. MAGI-based limits are tied to the Federal Poverty Level (FPL), which adjusts each year to account for inflation.
For 2025, the FPL is:
- $15,060 for a household of 1
- $20,460 for 2
- $25,860 for 3
- $31,260 for 4
Below are the latest income thresholds for different Medicaid categories in Nebraska:
| Category | Household of 1 | Household of 4 | Eligibility Notes |
| Heritage Health Adult (138% FPL) | $20,793/year (~$1,733/mo) | $43,157/year (~$3,597/mo) | Standard adult expansion coverage |
| Pregnant Women (200% FPL) | $30,120/year (~$2,510/mo) | $62,520/year (~$5,210/mo) | Includes prenatal & postpartum care |
| Children (CHIP – 213% FPL) | $32,051/year (~$2,671/mo) | $66,610/year (~$5,551/mo) | Medicaid & CHIP combined coverage |
| Aged/Disabled (Non-MAGI) | $13,303/year | $27,328/year | Includes asset/resource test |
| Medically Needy (Spend-Down) | $392/month individual | — | For those slightly above limits |
These numbers are officially aligned with the 2025 FPL update and verified through Nebraska DHHS publications.
Medicaid Income Limits by Household Size
Income thresholds increase as family size grows. Below is the estimated monthly limit by group:
| Household Size | Adults (138% FPL) | Pregnant Women (200% FPL) | Children (213% FPL) |
| 1 | $1,733/mo | $2,510/mo | $2,671/mo |
| 2 | $2,432/mo | $3,419/mo | $3,600/mo |
| 3 | $3,130/mo | $4,327/mo | $4,529/mo |
| 4 | $3,597/mo | $5,210/mo | $5,551/mo |
| Each additional | +$699/mo | +$908/mo | +$929/mo |
These income brackets help families determine where they fall under current Medicaid eligibility standards.
Medicaid Enrollment Snapshot (2025)
As of 2025, Nebraska’s Heritage Health program covers more than 400,000 residents statewide, according to Nebraska DHHS reports.
| Category | Enrollment Estimate | Notes |
| Total Enrollees | ~410,000 | Includes all Heritage Health plans |
| Adult Expansion Group | ~90,000 | Increased participation since 2020 |
| Children & Teens (Medicaid/CHIP) | ~230,000 | Remains the largest group |
| Aged/Disabled / Long-Term Care | ~85,000 | Includes nursing and home-based care |
Enrollment continues to grow slightly year over year, reflecting Nebraska’s push toward expanded access and improved care coordination.
Beyond Income: Other Eligibility Factors
While income plays a major role, it’s not the only requirement. Applicants must also:
- Be Nebraska residents
- Be U.S. citizens or legal permanent residents
- Meet asset limits if applying under aged/disabled programs
- Provide documentation of Social Security numbers, income, and household members
- Complete functional assessments for long-term care programs
Even if your income exceeds the threshold, Nebraska’s medically needy “spend-down” option can help you qualify after deducting medical expenses.
How to Apply for Nebraska Medicaid (2025–2026)
Getting started is straightforward and free. You can apply:
- Online – through ACCESSNebraska, the official state benefits portal.
- By Mail – download and print the Medicaid application, then send it to the address listed on the DHHS form.
- In Person – visit your local DHHS office or community partner location.
- By Phone – contact DHHS for assistance or language support.
Tip: Gather your pay stubs, ID, Social Security number, and proof of residency before applying. Most applications are reviewed within 45 days, though pregnant women and children may be processed faster.
Frequently Asked Questions
1. What’s the income limit for adults in 2025?
Adults aged 19–64 can qualify if their income is at or below 138% of the FPL, about $1,733 per month for a single person.
2. Can pregnant women qualify with higher income?
Yes. Nebraska allows coverage up to 200% of the FPL, which gives expectant mothers access to vital prenatal and postpartum care.
3. What about kids in working families?
Children often qualify through Medicaid or CHIP at up to 213% of the FPL, ensuring most low- and middle-income families can still access coverage.
4. What if I make a little too much to qualify?
You might be eligible under Nebraska’s spend-down program, which lets you subtract medical expenses from your income to reach the qualifying level.
5. How long does the process take?
Most applications are reviewed within 45 days. You’ll receive a decision by mail or through your ACCESSNebraska account.
6. Can I get coverage for past medical bills?
Yes. If you were eligible before applying, Nebraska Medicaid may cover medical costs for up to 90 days retroactively.
Final Thoughts
Health care shouldn’t depend on luck or income. Thanks to Nebraska’s Heritage Health Medicaid, thousands of residents, from young families to seniors, can get covered and stay healthy.
Understanding your income eligibility is the first step. Whether you’re a parent, expecting mother, or adult earning around $20,000 a year, you might already qualify and not even know it.
Visit ACCESSNebraska to check your eligibility and apply today.
Because in 2025–2026, no Nebraskan should have to choose between a doctor’s visit and dinner on the table.
