Medicaid Income Limits in NY: Eligibility, Assets, and Spend-Down

A single adult in New York qualifies for Medicaid in 2026 with annual income at or below roughly $22,025, or about $1,836 per month. That figure is 138% of the federal poverty level, the standard cutoff for most adults. Children, pregnant individuals, and applicants who are 65 or older, blind, or disabled follow different thresholds or different counting rules, and several programs help people who land just over the line. The Medicaid income limits in New York for 2026 are pegged to federal poverty guidelines that the U.S. Department of Health and Human Services updates each January.¹

2026 Income Limits by Eligibility Group

The 2026 federal poverty guideline is $15,960 per year for a single person and $21,640 for a household of two, with $5,680 added for each additional person. New York applies different FPL percentages depending on who is applying.

Adults ages 19 through 64 (not on Medicare): Income up to 138% of the FPL. For one person, roughly $22,025 per year or $1,836 per month. For a household of two, about $29,863 per year or $2,489 per month.
Age 65 and older, blind, or disabled: The same 138% FPL threshold, but income is counted using different rules.
Children ages 1 through 18: Up to 154% of the FPL. About $33,326 a year for a family of two, or $42,073 for a family of three.
Pregnant individuals and infants under age one: Up to 223% of the FPL, the most generous cap. About $35,591 a year for one pregnant individual, or $48,257 for a family of two.

The New York State Department of Health publishes exact monthly and annual charts by family size at the start of each year.² The figures here are calculated from the 2026 poverty guidelines and may differ by a dollar or two from the state’s rounded amounts. Limits climb with household size, so a family of four at 138% FPL has a substantially higher dollar cutoff than a single adult.

How New York Counts Your Income

Two people with identical paychecks can get different answers on Medicaid depending on which set of counting rules applies. That distinction matters as much as the dollar limit itself.

MAGI Rules for Most Adults, Children, and Pregnant Individuals

If you are under 65, not on Medicare, or applying as a child or pregnant individual, New York uses Modified Adjusted Gross Income (MAGI).³ MAGI is essentially the adjusted gross income from your tax return plus any tax-exempt interest and foreign income. It includes wages, self-employment earnings, Social Security benefits, pensions, and investment income.⁴ There is no separate asset test under MAGI, so savings accounts, retirement balances, and property values do not affect eligibility for this group.

Non-MAGI Rules for Aged, Blind, or Disabled Applicants

If you are 65 or older, blind, or disabled, New York uses non-MAGI budgeting. The income threshold is still 138% of the FPL, but the state applies specific deductions and disregards, and certain income types that count under MAGI may be partially excluded. Asset limits also apply, which they don’t under MAGI.

Retirement accounts get their own treatment. An IRA, 401(k), or 403(b) in payout status, meaning you are taking your Required Minimum Distribution each year, has its principal treated as exempt. Only the distribution itself counts as monthly income, spread across twelve months. Withdraw more than the required amount in a year and the account loses its exempt status entirely, with the full balance counted as a resource.

Asset Limits for ABD Applicants

Only applicants in the aged, blind, or disabled category face an asset test. In 2025 the limits were $32,396 for a single individual and $43,781 for a married couple with both spouses applying.⁵ The figures are adjusted each January in the state’s annual Medicaid levels update.⁶

Several categories of property do not count toward those limits:

Your primary residence, as long as its equity does not exceed $1,130,000 in 2026 for nursing facility and community-based long-term care coverage. The equity cap does not apply if a spouse, a child under 21, or a blind or disabled child of any age lives in the home.⁶
One vehicle, regardless of value.
Personal belongings and household goods.
Prepaid burial arrangements.
Retirement accounts in payout status, as described above.

All applicants must also be New York residents, U.S. citizens or noncitizens with satisfactory immigration status, and must provide a Social Security number or proof of having applied for one.⁷

When Your Income Is Over the Limit

Being a bit above the threshold does not automatically end the conversation. New York offers two main paths.

The Excess Income (Spend-Down) Program

The Excess Income program works like a deductible. Your “excess income” is the amount your monthly income exceeds the Medicaid limit. If you can show medical expenses equal to or greater than that excess in a given month, Medicaid covers your remaining medical costs for the rest of that month.⁸ Paid or unpaid medical bills, prescription costs, and health insurance premiums all qualify.

Some counties offer a Pay-In Program as an alternative. Instead of accumulating medical bills, you pay your excess income amount directly to your local Department of Social Services at the start of any month when you want coverage.⁸ The pay-in option fits months when you know you need care but don’t yet have enough bills to reach the spend-down.

Pooled Income Trusts

For people who need consistent coverage rather than a monthly patchwork, a pooled income trust is often the better tool. A nonprofit organization administers the trust. Each month you deposit your excess income into the trust, and that deposit is excluded from countable income for Medicaid budgeting. The nonprofit then uses the deposited funds to pay your living expenses like rent and utilities.

Pooled trusts are authorized under federal law for individuals who are disabled.⁹ Deposits must happen every month to keep eligibility active; miss a month and you lose coverage for it. Several New York nonprofits, including NYSARC Trust Services, administer these trusts.

Protections When One Spouse Needs Long-Term Care

When one spouse enters a nursing facility or applies for home-based long-term care, the other spouse is not expected to spend down to nothing. Federal spousal impoverishment rules let the community spouse keep a share of the couple’s combined assets, called the Community Spouse Resource Allowance. In 2026 New York’s CSRA ranges from a state minimum of $74,820 to a federal maximum of $162,660.⁶¹⁰

The community spouse is also entitled to a Minimum Monthly Maintenance Needs Allowance of $4,066.50 per month in 2026.⁶ If the community spouse’s own income falls below that floor, part of the institutionalized spouse’s income can be redirected to close the gap. Couples who don’t know about these rules sometimes exhaust savings before applying that they were entitled to keep.

How to Apply

The application route depends on your eligibility category:

MAGI applicants (adults under 65, children, pregnant individuals) apply through NY State of Health, the state’s health insurance marketplace, at nystateofhealth.ny.gov.³
Non-MAGI applicants (age 65 and older, blind, or disabled) apply through their local Department of Social Services or a Facilitated Enroller, online, by mail, or in person.³

Have proof of identity, New York residency, income, citizenship or immigration status, and, for non-MAGI applicants, documentation of resources such as bank statements, life insurance policies, and vehicle valuations.¹¹ The state verifies your information against IRS records, Social Security data, and wage-reporting databases; mismatches trigger a request for additional documents.⁴ If you had medical expenses in the three months before applying and would have qualified then, Medicaid can cover those bills retroactively once your eligibility is confirmed.¹²

1
ASPE – HHS.gov. 2026 Poverty Guidelines: 48 Contiguous States
2
New York State Department of Health. GIS 26 MA/05 – 2026 Federal Poverty Levels
3
Department of Health. How to Apply for NY Medicaid
4
Medicaid.gov. New York MAGI-Based Verification Plan
5
NYC.gov. Resource Levels Medicaid Income Eligibility Levels
6
New York State Department of Health. GIS 26 MA/03 – 2026 Medicaid Levels and Other Updates
7
Health.ny.gov. Citizenship and Alien Status Requirements for the Medicaid Program
8
Department of Health. Medicaid Excess Income (“Spenddown” or “Surplus Income”) Program
9
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
10
Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
11
New York State Department of Health. Documentation Checklist for Health Insurance
12
Office of the Law Revision Counsel. 42 USC 1396a – State Plans for Medical Assistance