Federal Poverty Guidelines and Medicaid

The federal poverty guidelines are a set of yearly income figures published by the U.S. Department of Health and Human Services (HHS). They are often called the “federal poverty level” or FPL. They show up across the Medicaid system: in Medicare Savings Program limits, in the minimum income allowance for the spouse at home, in some states’ income rules for older adults and people with disabilities, and in the cost-sharing rules of many programs. This guide explains what the guidelines are, the 2026 figures, and where they matter for Long-Term Care Medicaid.

Figures change periodically. Double-check current amounts before relying on them.

What the guidelines are

Each year HHS updates the poverty guidelines for inflation and publishes them in the Federal Register, usually in January. The guidelines are a simplified version of the Census Bureau’s poverty thresholds and are designed for setting program eligibility. They vary by household size.

There are three sets: one for the 48 contiguous states and the District of Columbia, and separate, higher figures for Alaska and Hawaii.

The 2026 figures

For the 48 contiguous states and DC, the 2026 guidelines are:

Alaska and Hawaii use higher figures. See the HHS notice for those states.

Programs often set limits at a percentage of the guidelines: 100%, 120%, 135%, 150% and so on. For example, 150% of the two-person figure is $32,460 a year, or $2,705 a month.

Where the guidelines matter for long-term care

1. The spouse at home’s minimum income allowance

When one spouse needs long-term care and the other stays at home, federal law guarantees the spouse at home a minimum monthly income, called the Minimum Monthly Maintenance Needs Allowance (MMMNA). It is set at 150% of the two-person poverty guideline, divided by 12.

• From July 1, 2026: $2,705 a month (150% of $21,640 / 12).
• From July 1, 2025 through June 30, 2026: $2,643.75.

The figure updates each July 1, using the guidelines published that year. Alaska and Hawaii have higher figures. See Raising the spousal allowances.

2. The excess shelter standard

The MMMNA can be raised if the spouse at home has high housing costs. The excess shelter standard is 30% of the MMMNA: $811.50 a month from July 1, 2026. Housing costs above that, up to a cap, can increase the allowance.

3. Medicare Savings Programs

Medicare Savings Programs help pay Medicare premiums and, for some people, deductibles and copays. Their income limits are tied to the poverty guidelines:

These limits include a $20 income disregard, which is why they are slightly above the straight percentage. The 2026 resource limits are $9,950 single and $14,910 couple. Many states use higher limits or no asset test. See Dual eligibility.

Medicare Savings Program limits for a calendar year are based on the guidelines published that January, and usually apply from April.

4. State income rules for older adults

Federal law lets states cover older adults and people with disabilities with income up to 100% of the poverty guidelines. Some states use this option, which can matter for home and community care. Each state’s rules are different. See Income limits by state.

5. Waiver programs and cost-sharing

Some home and community-based waiver programs set personal allowances or cost-sharing at a percentage of the guidelines, letting a person at home keep more of their income to pay for rent and food.

What the guidelines do NOT set

Many key Long-Term Care Medicaid figures are not tied to the poverty guidelines:

• The $2,982 special income limit is 300% of the SSI benefit rate, not the poverty guidelines.
• The $2,000 asset limit used by many states comes from the SSI program.
• The CSRA and maximum MMMNA are adjusted by the consumer price index.
• The home equity limit is adjusted by the consumer price index.

See 2026 figures.

Poverty guidelines vs. poverty thresholds

People often mix these up:

• Poverty thresholds come from the Census Bureau and are used for statistics, such as counting how many people are poor.
• Poverty guidelines come from HHS and are used for program eligibility.

Medicaid uses the guidelines.

Timing of updates

Because of these lags, a caseworker may still be using last year’s figure early in the year. Ask which figure applies to your application date.

A worked example

Elaine, 79, lives at home. Her husband Frank, 83, enters a nursing home in August 2026. Elaine’s own income is $1,400 a month. She pays $1,300 a month in rent and utilities.

• Her MMMNA starts at $2,705.
• Her shelter costs, $1,300, are over the $811.50 standard by $488.50. Depending on how the state counts utilities, her MMMNA may rise by that amount, up to the cap of $4,066.50.
• If her allowance becomes $3,193.50, Frank can pay her $1,793.50 a month from his income before the rest goes to the nursing home.

Without the poverty-guideline floor, Elaine could be left with too little to live on.

Common questions

Is the poverty level the same as the Medicaid income limit? Not for nursing home care in most states. Many states use the $2,982 special income limit. The poverty guidelines matter more for Medicare Savings Programs, the spousal allowance and some home care programs.

Does a single person in a nursing home use the poverty guidelines? Usually not to set eligibility. Their income mostly goes to the nursing home, after a personal needs allowance.

Why does my state’s figure differ from the federal one? States choose percentages and sometimes their own disregards, and some states update at different times.

What counts as a household? For the spousal allowance, the guideline used is always the two-person figure. For other programs, household rules vary.

Getting advice

A Certified Medicaid Planner (CMP) can apply the right figures to a family’s situation and help the spouse at home claim every allowance the law provides.

A quick percentage table for 2026

These figures use the 48-state guidelines, rounded to the dollar. Programs that add an income disregard, or that round differently, may show slightly different numbers.

Compare these with the Medicare Savings Program limits above, which are $20 higher for the $20 disregard.

Using the guidelines for home and community care

People who receive care at home, rather than in a nursing home, still have to pay rent, food and utilities. That is why many waiver programs let the person keep a larger maintenance allowance, often set at a percentage of the poverty guidelines or of the SSI benefit rate. A state might, for example, let a waiver participant keep income up to a set percentage of the guidelines before any cost-sharing applies. The exact figures are set by each state and approved by CMS.

Household size

The household size used depends on the program:

• For the MMMNA, the two-person figure is always used, regardless of other family members. Dependent family members get a separate family allowance.
• For Medicare Savings Programs, the household is the person, or the person and spouse.
• For other programs, the state’s rules decide who is in the household.

Why the guidelines matter for planning

Because the spousal allowance and the Medicare Savings Programs are tied to the guidelines, the new figures each year can change:

• how much income the spouse at home may keep;
• whether a person qualifies for help with Medicare premiums;
• in some states, whether a person qualifies for home care coverage.

A small rise in the guidelines can make a household newly eligible for help with premiums, so it is worth rechecking each spring, and again each July when the spousal figures change.

Related guides

• 2026 figures
• Raising the spousal allowances
• Dual eligibility
• Income limits by state

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.