Medicaid Rules That Change

At 18, your child can manage their own Medicaid benefits and make medical decisions privately. You won’t have access to your child’s medical records unless they authorize it. That's why it's important to teach your child how to make health decisions and manage benefits now, so that your child will know how to do them later.

Income-Based Medicaid and Denali KidCare (DKC)

Income-based Medicaid and Denali KidCare (DKC) cover children 18 or younger if the total combined income of everybody who lives in the same household is 208% of the Federal Poverty Guidelines (FPG) or less ($6,761 per month or less for a family of four).

When your child turns 19, Denali KidCare (DKC) eligibility ends. For adults, the income limit for income-based Medicaid is 138% of FPG ($4,486 per month for a family of four). If your child doesn’t qualify for income-based Medicaid as an adult, there are other options:

• If you or your child’s other parent can get employer-sponsored coverage, your child can be on that plan until turning 26.
• If employer-sponsored coverage is not available, your child may get help paying for individual coverage on HealthCare.gov if household income is 138% of FPG or higher.

Note: If your child moves out of your house and you don’t claim your child as a dependent on your taxes, your child might qualify as a single person living alone.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family (per year):
	$18,810
	$6,730
	$18,810
	$6,730
Income-based Medicaid, adults (138% FPG)
Income-based Medicaid, children (208% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Note: Some types of income do not count against these limits, including SSI benefits. Note: Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). For private plans with subsidies, your monthly premium amount depends on your income.

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The Working Disabled Medicaid Buy-In

The Working Disabled Medicaid Buy-In is a Medicaid program that covers people 18 or older who have disabilities, don't get Supplemental Security Income (SSI) or Adult Public Assistance (APA), and make money from work. Depending on their countable income, they could make as much as $95,070 in a year while working and still qualify! When your child turns 18, it can help them earn more while still getting the health coverage they need.

Learn more about the Working Disabled Medicaid Buy-In in DB101's How Health Benefits Work article.

Rules That Don't Change at 18 or 19

Most other eligibility rules for Medicaid and private health insurance don't change when your child turns 18 or 19:

• APA-related Medicaid covers children and adults who get Supplemental Security Income (SSI) benefits or Adult Public Assistance (APA), and some low-income people with disabilities who don't. Note: It may be easier for your child to qualify for APA-related Medicaid as an adult, because parental income is no longer counted and does not affect eligibility.
• Employer-sponsored coverage through your job or your child’s other parent's job has to allow your children to be on the plan until their 26th birthday.
• Individual coverage is an option for children and adults if employer-sponsored coverage is not available. Households may get help paying for it on HealthCare.gov if household income is over 138% of FPG.