Reference Guide: Medicaid Household Rules

For Eligibility Based on Modified Adjusted Gross Income (MAGI) Rules

October 2019

Medicaid eligibility based on modified adjusted gross income (MAGI) household and income rules uses three categories to determine an individual’s household size:

  • Tax filers not claimed as a tax dependent
  • Tax dependents (with three exceptions)
  • Non-filers not claimed as a tax dependent

Separate determinations of household size are made for each member of a family, and the categories are based on expected filing status. MAGI rules apply to children, pregnant women, parents and caretaker relatives, and adults in states that have expanded Medicaid eligibility. Seniors and people eligible for Medicaid based on a disability use different household and income rules.

This reference guide walks through the Medicaid household rules for MAGI Medicaid eligibility.

Additional Resources

OE7 Webinar: Determining Households and Income for the PTC and Medicaid

Guide: The Health Care Assister’s Guide to Tax Rules