Medicaid Eligibility in New York: Income Limits & How to Apply
Medicaid Eligibility in New York
New York expanded its Medicaid program under the Affordable Care Act, opening NY Medicaid to adults aged 19-64 whose income falls at or below 138% of the federal poverty level. In 2026, that works out to roughly $21,597 for one person or $44,367 for a family of four.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for NY Medicaid with free or very low-cost coverage. No premiums, no deductibles.
Medicaid expansion in New York covers:
- 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 NY Medicaid
If you're a New York resident trying to understand your health coverage options, you'll find that NY Medicaid is a robust program. It provides coverage for adults with incomes up to 138% of the Federal Poverty Level (FPL), as well as for children, pregnant individuals, seniors, and those with disabilities. For a single individual, that means an income of approximately $1,732 per month in 2024, or $2,351 per month for a couple. New York's Medicaid program is a significant safety net, covering about 7.27 million people in 2024, which is roughly 36.6% of the state's population. This high enrollment demonstrates that it's a widely utilized and essential program for millions of New Yorkers.
If your income is slightly above the Medicaid threshold, you won't be left without options. New York's marketplace, NY State of Health, offers subsidized health plans. If your income is, for instance, between 138% and 400% FPL, you could qualify for Advanced Premium Tax Credits (APTCs) to lower your monthly premiums. New York's benchmark Silver plan averages around $737/month, which is higher than the national average. However, with subsidies, your actual payment could be significantly reduced. For example, individuals with incomes up to 350% FPL can qualify for Silver Supreme plans with lower deductibles and copays, and those up to 400% FPL for Silver Enhanced plans. Keep in mind that changes in your income can shift your eligibility between Medicaid and marketplace subsidies, so it's crucial to report any income changes to ensure you remain in the correct program. New York saw a decline in Medicaid enrollment by 7.2% from its peak in 2023, partly due to the "unwinding" of continuous coverage provisions from the pandemic. If you lost coverage during this period, you can reapply at any time.
NY Medicaid offers comprehensive benefits with little to no cost-sharing for most services. This means you generally won't have deductibles, copayments, or coinsurance for covered medical care. New York also has unique programs and waivers designed to provide additional support. For instance, the state has an approved 1115 waiver, investing $7 billion through March 2027, to create Social Care Networks. These networks connect Medicaid members with health-related social services like housing, nutrition, and transportation, addressing needs beyond traditional medical care. There are also waivers for specific populations, such as children with disabilities, individuals needing nursing home transition services, and those with traumatic brain injuries, providing home and community-based care.
Navigating the application and renewal process can sometimes present challenges. During the recent "unwinding" of continuous coverage, many New Yorkers had to redetermine their eligibility, and some experienced coverage losses. It's essential to keep your contact information updated with your local Medicaid agency to receive important notices. New York has implemented "E14 waivers" to ease the renewal process, which have been extended through June 30, 2025. These waivers aim to prevent eligible individuals from losing coverage due to administrative hurdles. Telehealth policies have also seen changes, with some COVID-era flexibilities expiring, so it's wise to confirm current telehealth coverage for specific services. Your concrete action step should be to visit the NY State of Health website or contact your local Department of Social Services to get personalized guidance and ensure your information is up-to-date.
New York Medicaid Income Limits 2026
The following table shows the key income thresholds for New York 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 NY Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
Marketplace premiums in New York run high — the benchmark Silver plan costs roughly $737/month, significantly above the national average. The silver lining is that subsidy amounts are proportionally larger, keeping net premiums manageable for most subsidized enrollees.
Marketplace Insurance in New York
New York residents who do not qualify for Medicaid can purchase private health insurance through NY State of Health. The average benchmark (second-lowest cost Silver) plan in New York costs approximately $737/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 New York 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.
New York operates its own state-based marketplace, NY State of Health, which manages enrollment and plan selection independently from HealthCare.gov. This can mean different plan options and deadlines than the federal marketplace.
New York's Medicaid program goes beyond the ACA's minimum requirements. NY Medicaid includes comprehensive benefits, and the state's investment in its own marketplace reflects a broader commitment to accessible healthcare coverage.
How to Apply for NY Medicaid
- Start online at NY State of Health — the application automatically screens for NY Medicaid eligibility based on your household income.
- Go through the state directly — New York's Medicaid office accepts applications year-round with no enrollment window.
- Get phone support — New York'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.
You will need to provide proof of income (pay stubs, tax returns), proof of New York residency, Social Security numbers for household members, and information about any current health coverage.
Calculate Your Subsidy in New York
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in New York.
Check Your Eligibility →Frequently Asked Questions
What is the New York Medicaid income cutoff for 2026?
In 2026, the Medicaid income limit in New York 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 New York expanded Medicaid under the ACA?
Yes, New York has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for NY Medicaid.
Am I eligible for health insurance subsidies in New York?
Yes. New York 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 NY State of Health.
What is the name of New York's Medicaid program?
New York's Medicaid program is known as NY Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
What should I do if my NY Medicaid coverage is ending?
If your NY Medicaid 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 NY State of Health. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Can I get Medicaid in New York if I have a job?
Yes. Medicaid eligibility in New York 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 NY Medicaid even if you work full-time. Many NY Medicaid enrollees are working adults.
Should I choose Medicaid or a marketplace plan in New York?
Medicaid (NY Medicaid) is free or very low-cost with no premiums or deductibles. Marketplace plans in New York average $737/month before subsidies — among the highest in the country. If you qualify for Medicaid, it will almost always be the better financial choice. If your income is just above the Medicaid limit, subsidies can still make marketplace coverage affordable.
Medicaid Eligibility in Nearby States
- Connecticut Medicaid Eligibility — Expansion state
- Massachusetts Medicaid Eligibility — Expansion state
- New Jersey Medicaid Eligibility — Expansion state
- Pennsylvania Medicaid Eligibility — Expansion state