Medicaid verifies income primarily through automated, electronic data matches with federal, state, and third-party databases, using the applicant’s Social Security Number. Key sources include the Internal Revenue Service (IRS) for tax returns, Social Security Administration (SSA), state wage databases, and unemployment records.
Yes. Some forms of income that are non-taxable or only partially taxable are included in MAGI and affect financial eligibility for premium tax credits and Medicaid.
This makes sense given Medicaid is a need-based program with financial eligibility requirements so they need to verify your assets. Medicaid agencies can check your bank account balances at any financial institution you've used during the month you apply or during a 5 year look-back period.
Some states use a computerized system to cross reference a Medicaid applicant's reported income. For instance, in California, an electronic database, the Income Eligibility Verification System (IEVS), is used to match the income information provided by the applicant to other databases to verify it is accurate.
To protect your savings, we suggest creating an asset protection plan. This plan should include a strategy for transferring your assets to your family or loved ones while still maintaining eligibility for Medicaid. One option includes creating a trust, which can shield your assets from Medicaid.
Follows are the most common reasons for denial.
The most common reason an applicant is denied Medicaid is income or assets above the eligibility criteria. In most states in 2026, an applicant's monthly income must be less than $2,982/month, and their assets (including money in bank accounts) must be less than $2,000.
Eligibility rules differ between states. In states that have expanded Medicaid coverage: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level (FPL), you qualify.
If you don't include taxable income on your return, it can lead to penalties and interest. The IRS may charge penalties and interest beginning from the date they think you owe the tax. There are times when leaving a 1099 off of your tax return doesn't change it.
Medicaid audits are triggered by data analytics flagging unusual billing patterns (like high claim volume, upcoding, or excessive controlled substance billing) and external factors, including beneficiary complaints, whistleblower tips, or law enforcement info, all pointing to potential fraud, waste, or abuse, with issues like missing documentation or services not meeting guidelines also raising red flags.
You can make varying amounts before losing Medicaid, but generally, it's tied to the Federal Poverty Level (FPL), often up to 138% FPL for adults in expansion states, meaning around $22,000/year for an individual, though limits vary significantly by state, family size, age, pregnancy, or disability status, with higher income thresholds (e.g., 300% FPL) for specific programs like those for working people with disabilities or long-term care.
Medicaid and the Asset Test
If your income and assets are above a certain level, you will not qualify for the program. In 2024, the income limit is set at $2,829 per month and the asset limit at $2,000 for an individual. 5 However, different states may set different rates.
Establish an Irrevocable Trust
Cash, property, and investments can be transferred into an irrevocable trust. By doing so, these assets would be removed from Medicaid's calculation. However, this trust would need to be established at least five years before applying for Medicaid to avoid lookback scrutiny.
Want to make your assets virtually untouchable by creditors and lawsuits? Equity stripping may be the answer. This advanced technique involves encumbering your assets with liens or mortgages held by friendly creditors, such as an LLC or trust you control.
Medicaid agencies can and will look at your balance from any bank account you've had in the last five years. They may also conduct property checks using public records like deeds.