New York Medicaid Income Limits in 2026

Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Medicaid.gov and NYS Department of Health guidelines | Last Updated: March 2026

In 2026, the Medicaid income limit in New York is $1,836 per month ($22,025 per year) for one person.

Pregnant women and infants qualify with income up to $2,966 per month (223% FPL). Over 7 million New Yorkers are currently enrolled in Medicaid.

You will find income charts, eligibility rules, covered benefits, and step-by-step instructions on how to apply.

Quick Summary

• Income limit for one person: $1,836/month (138% FPL)
• Pregnant women and infants: Up to $2,966/month (223% FPL)
• Children ages 1–18: Up to $2,049/month (154% FPL)
• No asset test for most adults under 65 (MAGI rules)
• Seniors and disabled: Must meet both income AND asset limits
• How to apply: Online at nystateofhealth.ny.gov or call 1-855-355-5777
• 👉 Use our free New York Medicaid eligibility calculator 2026 to check if you qualify

What Is Medicaid in New York?

Medicaid is a health insurance program for people with low income. It is run by the federal government and the state together.

In New York, the Department of Health (DOH) manages the program.

Medicaid pays for doctor visits, hospital stays, prescriptions, and more. New York expanded Medicaid under the Affordable Care Act (ACA) in 2014.

This means adults ages 19–64 can now qualify — even without children.

How Does New York Medicaid Work?

New York uses two main ways to count income. The method depends on your age and health status.

• MAGI (Modified Adjusted Gross Income): Used for most adults under 65, children, and pregnant women. It looks at your tax-return income. There is no asset test under MAGI rules.
• Non-MAGI: Used for seniors (65+), blind, and disabled individuals. This method checks both income and assets.

If you are unsure which method applies to you, your local Department of Social Services (DSS) can help.

What Is the Federal Poverty Level (FPL)?

The FPL is an income guideline set by the federal government each year. Medicaid uses the FPL to decide who qualifies.

In 2026, 100% FPL for one person is $15,960 per year ($1,330 per month). Each extra household member adds $5,680 per year.

The 2026 FPL figures were published on January 15, 2026. New York adopted them on February 13, 2026. They are retroactive to January 1, 2026.

Who Qualifies for Medicaid in New York in 2026?

Several groups of people can get Medicaid in New York. Your eligibility depends on your age, income, household size, and health status.

You can also review the general Medicaid eligibility requirements for 2026 to see how New York compares to federal rules.

Eligible Groups and FPL Thresholds

Important notes:

• Children ages 6–18 qualify at 154% FPL. A lower 110% FPL threshold is used for some determinations.
• Child Health Plus (CHPlus) covers children up to 400% FPL.
• Pregnant women receive 12 months of guaranteed postpartum coverage.
• Under MAGI rules, once approved, your coverage continues for 12 months — even if your income rises temporarily.

Seniors, Blind, and Disabled Individuals

Since January 2023, the Non-MAGI income limit also matches 138% FPL. However, this group must also pass an asset test.

• Single person asset limit: $33,038
• Married couple asset limit: $44,796

Assets include bank accounts, investments, and other countable resources. Your primary home, one car, and personal belongings are usually exempt.

New York Medicaid Income Limits 2026

These are the official MAGI income limits by household size. They apply to most adults under 65, children, and pregnant women. There is no asset test for this group.

This data comes from NYS DOH GIS 26 MA/05. For a side-by-side comparison of all states, see Medicaid income limits by state in 2026.

MAGI Income Limits by Household Size

• 138% FPL is the limit for most adults and parents.
• 223% FPL is the limit for pregnant women and infants under 1.

Non-MAGI Income and Asset Limits (Seniors 65+, Blind, Disabled)

The community spouse may keep 50% of the couple’s joint assets up to $162,660. If 50% is less than $74,820, the spouse keeps 100% up to $74,820.

What Is a Spend-Down?

If your income is slightly above the limit, you may still qualify. New York allows a “spend-down.” This means you pay medical bills until your countable income drops below the threshold. Medicaid then covers the rest for that period.

Long-Term Care Medicaid in New York (2026)

Long-term care Medicaid covers nursing home stays and home-based care. It has extra rules beyond standard income and asset limits. You must also pass a functional assessment to show you need a Nursing Facility Level of Care.

Nursing Home and Home Care Income Limits

Key Long-Term Care Rules for 2026

• 60-month look-back period applies to Nursing Home Medicaid. Any assets transferred below fair market value during this window may trigger a penalty period.
• No look-back currently applies to Community (Home Care) Medicaid. However, New York plans to start a 30-month look-back. The start date is still TBD as of early 2026.
• Home equity limit: $1,130,000. This is automatically exempt if a spouse, child under 21, or blind/disabled child lives in the home.
• Nursing Home personal needs allowance: $50/month.
• Home Care / MLTC personal needs allowance: $653/month.
• Family member allowance: Up to $902/month (based on 150% FPL for a household of 2).

Understanding how providers bill Medicaid can also help you plan costs. Learn more about the Medicaid Fee Schedule 2026 for details.

Essential Plan Income Limits in New York (2026)

The Essential Plan offers low-cost or zero-premium health coverage for adults who earn too much for Medicaid but not enough for marketplace plans. It is available to MAGI-eligible adults.

Current and Upcoming Changes

⚠️ Important change: On July 1, 2026, the upper income limit drops from 250% FPL to 200% FPL. This is due to the expiration of enhanced federal funding under H.R. 1.

About 450,000 people in the 200–250% FPL bracket will need to move to Qualified Health Plans (QHPs). These marketplace plans may have higher out-of-pocket costs. If you are in this group, plan your transition now.

Medicare Savings Programs in New York (2026)

Medicare Savings Programs help people on Medicare pay for premiums, deductibles, and coinsurance. These programs are for people who have both low income and Medicare coverage.

2026 Income Limits by Program

• QMB covers Part B premiums, coinsurance, and deductibles.
• SLMB and QI cover Part B premiums only.
• MBI-WPD asset limit: $33,038 (single) / $44,796 (couple).
• No resource test applies to QMB, SLMB, or QI.
• The standard Medicare Part B premium for 2026 is $202.90/month.

What Does Medicaid Cover in New York?

New York Medicaid covers a wide range of health services. The program is one of the most generous in the country. Here is what is included in your coverage.

Core Benefits

• Doctor visits and specialist care
• Hospital inpatient and outpatient services
• Emergency room care
• Prescription drugs
• Lab tests and X-rays
• Mental health and substance abuse treatment
• Preventive care and screenings

Additional Benefits

• Dental care (including cleanings, fillings, and extractions)
• Vision care (eye exams and glasses)
• Hearing aids
• Transportation to medical appointments
• Home health care and personal care services
• Nursing home care
• Durable medical equipment (wheelchairs, oxygen, etc.)
• Family planning and reproductive health services
• 12 months of postpartum coverage for pregnant women

Most people receive their benefits through a managed care plan. Your plan assigns you a primary care provider. You can choose your plan during enrollment.

How to Apply for Medicaid in New York

Applying for Medicaid in New York is free. You can apply any time of the year. There is no limited enrollment period. Follow these steps to get started.

Step 1: Choose Your Application Method

• Online: Go to nystateofhealth.ny.gov (NY State of Health marketplace).
• Phone: Call 1-855-355-5777 (NY State of Health) or 1-800-541-2831 (general Medicaid help).
• In person: Visit your local Department of Social Services (DSS) office.

Step 2: Gather Your Documents

You will need:

• Proof of identity (state ID, driver’s license, or passport)
• Social Security numbers for everyone applying
• Proof of income (pay stubs, tax returns, or employer letters)
• Proof of New York residency (utility bill, lease, or bank statement)
• Birth certificates for children
• Immigration documents (if applicable)
• Medical records (for long-term care applications)

Step 3: Complete and Submit the Application

Fill out the application online, by phone, or on paper. Answer all questions honestly. Double-check your income and household size before submitting.

Step 4: Wait for a Decision

Processing typically takes 45 days. Disability-related applications may take up to 90 days. You will receive a notice by mail with the decision.

If you live in another state, application steps may differ. For example, here is how it works for New York Medicaid eligibility in 2026.

What Happens After You Apply?

After you submit your application, the state reviews your information. You will get a decision within 45 days in most cases. Here is what to expect during and after the process.

If You Are Approved

• You will receive your Medicaid card by mail.
• You can choose a managed care plan. If you don’t choose one, the state will assign one to you.
• Your coverage start date may be retroactive up to 3 months before your application date — if you were eligible during that time.
• Coverage lasts for 12 months. You must renew each year.

If You Are Denied

• You will receive a denial letter explaining why.
• You have the right to appeal the decision.
• Common reasons for denial include income over the limit or missing documents.
• You can reapply at any time if your situation changes.

Annual Renewal

New York requires you to renew your Medicaid each year. The state will mail you a renewal form before your coverage ends. Fill it out and return it on time to keep your benefits.

Important Changes for New York Medicaid in 2026

Several key changes affect Medicaid in New York this year. Stay informed so you don’t lose coverage.

One Big Beautiful Bill Act (OBBBA) and Federal Impact

The One Big Beautiful Bill Act includes roughly $1 trillion in Medicaid cuts over 10 years. The first cuts took effect January 1, 2026. These only eliminated a temporary financial incentive for states that expanded Medicaid under the ACA.

• Nursing Home Medicaid is largely protected from future cuts.
• Home and Community Based Services (HCBS) may face funding reductions.
• The Essential Plan’s 200–250% FPL tier ends July 1, 2026 due to related federal changes.

Other Key Updates

• The 2026 Social Security COLA was 2.8%. This affects income calculations for many applicants.
• 12-month continuous eligibility under MAGI rules: Once approved, you keep coverage for 12 months even if income rises temporarily.
• The 30-month Community Medicaid look-back has not started yet. The implementation date remains TBD.
• Pending New York Bill A01043 may raise asset limits to $300,000. This still requires federal approval.
• The federal gift tax exemption ($19,000/recipient in 2026) does NOT override Medicaid’s look-back rules. Gifting under this threshold still counts as a transfer for Medicaid purposes.

Frequently Asked Questions

Sources & Disclaimer

Official Sources

• NYS Department of Health – GIS 26 MA/05: 2026 Federal Poverty Levels (February 13, 2026)
• HHS ASPE 2026 Poverty Guidelines (Federal Register, January 15, 2026)
• NY State of Health
• Medicaid.gov – Official Federal Medicaid Information
• Healthcare.gov – Medicaid & CHIP Overview
• Centers for Medicare & Medicaid Services (CMS)

Disclaimer

CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. Eligibility rules are complex and individual circumstances vary. For official eligibility, contact the NYS Department of Health at health.ny.gov or visit Medicaid.gov.