New York Medicaid is one of the most comprehensive programs in the country, offering health coverage to millions of residents. In 2025, eligibility is determined by the updated Federal Poverty Level (FPL), with expanded access for adults, children, pregnant women, and seniors.
Unlike states with stricter rules, New York has embraced expansion and continues to lead in providing affordable care.
Key Takeaways
- Adults 19–64 qualify up to 138% FPL.
- Pregnant women and children are covered at higher thresholds, often above 200% FPL.
- Seniors and disabled residents qualify under income and asset-based rules.
- Applications are processed through the NY State of Health marketplace.
New York Medicaid in Context
New York has consistently maintained one of the largest Medicaid programs in the nation, covering more than 7 million residents as of 2024.
Its broad eligibility rules, combined with expansion under the Affordable Care Act, make it easier for low-income adults to gain coverage compared to states like Texas or Florida.
The state also invests heavily in children and maternal health. Pregnant women are covered up to 223% FPL, one of the highest thresholds in the country.
Children are supported through Medicaid and Child Health Plus, ensuring nearly universal pediatric coverage.
Seniors and people with disabilities qualify through the Aged, Blind, and Disabled Medicaid program. These applicants face income and asset tests, but New York offers unique long-term care waivers, allowing individuals to receive care at home instead of entering nursing facilities. This makes the program especially supportive for families managing elderly care.
Income Limits by Household Size (2025)
| Household Size | 100% FPL (Annual) | 138% FPL (Adults) | 200%+ FPL (Pregnancy/Children) |
| 1 person | $15,650 | $21,597 | ~$31,300+ |
| 2 person | $21,150 | $29,187 | ~$42,300+ |
| 3 person | $26,650 | $36,777 | ~$53,300+ |
| 4 person | $32,150 | $44,367 | ~$64,300+ |
Source: HHS Poverty Guidelines 2025
This table shows how eligibility expands with household size. For example, a single adult earning less than $21,600 annually qualifies, while a pregnant woman in a family of three may qualify at income levels up to $53,000 or more.
Who Qualifies for New York Medicaid?
Adults 19–64
Covered under expansion up to 138% of FPL, ensuring broader access compared to non-expansion states.
Children
Children qualify at higher income levels, often up to 200% FPL or beyond, through Medicaid and Child Health Plus.
Pregnant Women
Pregnant women qualify up to 223% FPL, with extended postpartum coverage for 12 months.
Seniors and People with Disabilities
The Aged, Blind, and Disabled program applies strict income and asset tests. However, New York offers long-term care waivers that allow services at home rather than only in nursing facilities.
How to Apply for Medicaid in New York (2025)
- Start at the NY State of Health marketplace.
- Use the eligibility tool to estimate your coverage options.
- Gather documents:
- Proof of income (pay stubs or tax forms)
- Proof of residency (lease, bill, ID)
- Social Security numbers for household members
- Immigration documents, if applicable
- Submit your application online, by mail, or with an enrollment assister.
- Renew coverage annually by updating household and income information.
Alternatives if You Don’t Qualify
If your income is slightly above Medicaid limits, other programs are available:
- Child Health Plus: Affordable coverage for children whose family income exceeds Medicaid limits.
- Essential Plan: For adults up to 200% FPL, offering lower-cost coverage with state funding support.
- Marketplace Plans: Subsidies on HealthCare.gov help higher-income residents buy insurance.
- Community Health Centers: Provide low-cost care for uninsured adults across New York.
FAQs
Q1: What is the income limit for adults in New York Medicaid?
Adults qualify up to 138% FPL, about $21,600 per year for a single adult.
Q2: What about pregnant women?
Pregnant women are covered up to 223% FPL, among the highest limits nationwide.
Q3: Can children qualify if parents don’t?
Yes, children qualify up to higher income levels through Medicaid or Child Health Plus.
Q4: Do seniors face asset tests?
Yes, seniors and disabled applicants must meet both income and asset rules.
Q5: What is the Essential Plan?
It’s a low-cost coverage option for adults earning up to 200% FPL, unique to New York.
Q6: How do I apply?
Applications are submitted through the NY State of Health marketplace.
Conclusion
New York Medicaid in 2025 continues to stand out as one of the broadest systems in the country. Adults are covered up to 138% FPL, while pregnant women and children benefit from higher thresholds. Seniors and disabled individuals receive additional support through long-term care waivers.
If you think you qualify, start your application through the NY State of Health marketplace. For those above Medicaid limits, programs like Child Health Plus and the Essential Plan provide affordable alternatives.
