Medicaid Eligibility in Missouri: Income Limits & How to Apply
Medicaid Eligibility in Missouri
Missouri has expanded Medicaid under the Affordable Care Act. This means adults aged 19-64 with household income at or below 138% of the federal poverty level (FPL) qualify for MO HealthNet. This is approximately $21,597 per year for an individual or $44,367 per year for a family of four in 2026.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for MO HealthNet with free or very low-cost coverage. No premiums, no deductibles.
The following residents are eligible for MO HealthNet:
- Adults aged 19-64 with income up to 138% FPL
- Children in families with income up to 200-300% FPL (varies by age)
- Pregnant women with income up to 185-200% FPL
- Seniors and people with disabilities who meet income and asset requirements
About MO HealthNet
If you're a Missouri resident trying to understand your health coverage options, you've come to the right place. Missouri's Medicaid program, known as MO HealthNet, offers crucial assistance. Adults with household incomes up to 138% of the Federal Poverty Level (FPL) can qualify. For example, in 2024, this means an individual earning up to $20,782 annually, or a household of three earning up to $35,631, could be eligible. Children, pregnant women, seniors, and individuals with disabilities also have pathways to MO HealthNet, often with higher income thresholds. As of October 2025, over 1.2 million Missourians were enrolled in MO HealthNet, demonstrating it's a vital program supporting many across the state.
If your income is slightly above the MO HealthNet cutoff, you'll likely transition to the federal HealthCare.gov marketplace, where you may qualify for significant subsidies. These subsidies can substantially lower your monthly premium for a health plan. For instance, with a benchmark Silver plan costing around $542 per month in Missouri, subsidies can make coverage much more affordable. It's important to remember that your eligibility for either MO HealthNet or marketplace subsidies can shift with changes in your income or household size. If you recently lost MO HealthNet coverage during the "unwinding" period, which saw many Missourians disenrolled, you can reapply at any time if your circumstances change and you believe you now qualify.
MO HealthNet provides comprehensive benefits with little to no cost-sharing for most enrollees, meaning you won't typically pay premiums, deductibles, or co-pays for covered services. This includes essential health benefits like doctor visits, hospital stays, prescription medications, and dental and vision care for children. Missouri also offers several Home and Community-Based Services (HCBS) waivers, like the Aged and Disabled Waiver, which can provide in-home care to help individuals avoid nursing home placement. Additionally, MO HealthNet has expanded its telehealth services, allowing licensed providers to offer care remotely with the same standard as in-person visits.
Be aware that applying for or renewing MO HealthNet can sometimes involve administrative hurdles. During the recent unwinding from the public health emergency, many individuals lost coverage due to procedural reasons like missing paperwork, not necessarily because they were ineligible. Missouri has also experienced application processing delays, with some applicants waiting an average of 50 days for a determination, exceeding the federal 45-day limit. To ensure continuous coverage, keep your contact information updated with MO HealthNet and respond promptly to any requests for information. You can update your information and apply online through myDSS.mo.gov, or by phone.
Missouri Medicaid Income Limits 2026
The following table shows the key income thresholds for Missouri in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
If your household income falls below the 138% FPL column, you qualify for MO HealthNet. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
The benchmark Silver plan in Missouri costs about $542/month before subsidies, which is in line with the national average. Subsidies can significantly reduce this cost for qualifying households.
Marketplace Insurance in Missouri
Missouri residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in Missouri costs approximately $542/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Missouri might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Missouri uses the federal marketplace at HealthCare.gov for ACA enrollment. When you apply, the system automatically checks your Medicaid eligibility — if you qualify, your application is forwarded to the state Medicaid agency.
Missouri adopted Medicaid expansion, bringing MO HealthNet coverage to low-income adults who previously had no affordable option. The transition between Medicaid and marketplace coverage is handled through HealthCare.gov.
How to Apply for MO HealthNet
- Start online at HealthCare.gov — the application automatically screens for MO HealthNet eligibility based on your household income.
- Go through the state directly — Missouri's Medicaid office accepts applications year-round with no enrollment window.
- Get phone support — Missouri's Medicaid hotline can walk you through the process and verify eligibility.
- In-person options — Local social services offices and community health navigators can assist with your application.
To complete your application, you'll need income documentation (pay stubs, tax returns), a Missouri address for residency verification, Social Security numbers for household members, and information about existing coverage.
Calculate Your Subsidy in Missouri
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Missouri.
Check Your Eligibility →Frequently Asked Questions
What is the Missouri Medicaid income cutoff for 2026?
In 2026, the Medicaid income limit in Missouri is 138% of the federal poverty level: $21,597 per year for an individual, $29,187 for a household of 2, $36,777 for 3, and $44,367 for a family of 4.
Has Missouri expanded Medicaid under the ACA?
Yes, Missouri has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for MO HealthNet.
Can I get ACA subsidies in Missouri?
Yes. Missouri residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the Missouri Medicaid program called?
Missouri's Medicaid program is known as MO HealthNet. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
How do I keep my health insurance if I lose Medicaid in Missouri?
If your MO HealthNet coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Can I get Medicaid in Missouri if I have a job?
Yes. Medicaid eligibility in Missouri is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($21,597 for an individual), you qualify for MO HealthNet even if you work full-time. Many MO HealthNet enrollees are working adults.
What's the difference between Medicaid and marketplace insurance in Missouri?
Medicaid (MO HealthNet) is free or near-free with no premiums or deductibles. Marketplace plans in Missouri average $542/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.
Medicaid Eligibility in Nearby States
- Arkansas Medicaid Eligibility — Expansion state
- Illinois Medicaid Eligibility — Expansion state
- Iowa Medicaid Eligibility — Expansion state
- Kansas Medicaid Eligibility — Non-expansion state