Methodology

By the MedicaidCalc Editorial Team · Updated October 5, 2026

This page documents, step by step, what the calculator computes and where each number comes from. The same code produces the calculator’s answers, the worked examples on every state page and the automated tests, so the three cannot drift apart.

1. The poverty line

The household’s annual poverty guideline comes from the 2026 HHS notice: $15,960 for one person plus $5,680 per additional person in the lower 48 and DC; $19,950 + $7,100 in Alaska; $18,360 + $6,530 in Hawaii.^[1] It is divided by 12 because Medicaid tests current monthly income. The 2026 set is treated as current until March 31, 2027; after that, unless newer guidelines have been verified and added, the calculator asks for the figure on your state’s notice.

2. Each state’s standards

Children (by age band), separate CHIP, pregnancy, from-conception coverage, parents and the adult group come from MACPAC’s MACStats data book (February 2026; levels as of July 2025), which records each standard without the 5-point disregard.^[2][3] Every child, pregnancy and adult figure was compared with KFF’s January 2026 survey of state officials; all matched once the disregard is added, except two changes we confirmed with the state: DC’s January 1, 2026 cut to 138%^[8] and South Carolina’s 62% parent limit.^[9][5] For the non-expansion states, where parent limits decide who falls into the coverage gap, the parent standard comes from the state agency’s own 2026 chart (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wyoming); Wisconsin’s 100% adult limit is from MACPAC and KFF.

3. The 5% disregard

Federal rules subtract 5 percentage points of the poverty line from income for the highest group a person can qualify under.^[6] The calculator adds 5 points to the highest standard for each person and judges coverage against that. If several programs apply, it reports the lowest one your income fits without the disregard; in the narrow band where a child is above Medicaid’s standard but within Medicaid plus 5 points and CHIP also covers the range, it says “Medicaid or CHIP” because states label that band differently. When a state chart already includes the disregard (Alabama, Mississippi, Georgia’s “Plus 5%” column), the table value is used as is.

4. Dollar tables and rounding

Limits are computed as annual guideline × (standard + 5) ÷ 100 ÷ 12 and rounded up to the next dollar, which matches how Alabama, Texas and DC round; your income is compared with that rounded figure. Where a state publishes a dollar table (parent limits in Alabama, Florida, Georgia, Mississippi, Texas and Wyoming), the table is used for each household size, Texas’s separate two-parent column included. If a table stops before your household size and the state gives no per-person increment (Wyoming above 10), the row says to ask the agency.

5. Statuses

• Likely eligible — income is at or under the limit for that person’s group.
• Over the limit — with the dollar amount over.
• Income fits — other rules apply — Georgia Pathways, where an 80-hour requirement also applies.
• No pathway — the state has no full-Medicaid group for that person (adults without children in eight states).
• Check with your state — always used for people 65+, blind or disabled, whose programs use SSI-style income counting and an asset test. The row lists the state’s pathways from MACPAC’s 2025 table and the 2026 SSI rate ($994; 300% = $2,982).^[4][7]

6. Tests that keep it honest

Every state and DC has a unit test whose expected limit is hand arithmetic from the cited percentage and poverty line, plus edge cases (zero income, household of 12, invalid input). A date-horizon test fails 45 days before the poverty guidelines or the SSI rate expire without a verified successor. A browser test enters a household on every state page and checks the result, and the build refuses to publish if any two pages are too similar or any page’s metadata is wrong.