diff --git a/changelog.d/medicaid-medically-needy-limits.fixed.md b/changelog.d/medicaid-medically-needy-limits.fixed.md
new file mode 100644
index 00000000000..10cf60e5fef
--- /dev/null
+++ b/changelog.d/medicaid-medically-needy-limits.fixed.md
@@ -0,0 +1 @@
+Turned on the Medicaid medically needy pathway for aged, blind and disabled people in Arkansas, Iowa, Illinois, New Jersey and North Dakota, turned it off in Arizona, Idaho, Indiana, New Mexico and Nevada, which have no such program, and updated medically needy income and asset limits in 14 states and DC, including Vermont's protected income level and DC's 2019-2022 levels, tying them to the poverty guideline or the SSI federal benefit rate where state rules do, with New York and North Dakota rounding the monthly level up to the dollar and Illinois rounding it to the nearest dollar through 2024 and dropping the cents from 2025.
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml
index f78bce94897..af0ab731519 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/disabled.yaml
@@ -1,4 +1,5 @@
 description: Whether people with disabilities can qualify for Medicaid under the 'medically needy' pathway.
+# NOTE: Like every other state's, the AR, IA, IL, ND and NJ switches date from 2015-01-01, while their income and asset limits start in 2018, so 2015-2017 use the 2018 limits.
 metadata:
   label: Medicaid medically needy pathway for people with disabilities
   breakdown:
@@ -7,15 +8,34 @@ metadata:
   reference:
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: KFF, Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2026, Appendix Table 4
+      href: https://www.kff.org/medicaid/medicaid-eligibility-levels-for-older-adults-and-people-with-disabilities-non-magi-in-2026/
+    - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down
+      href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1
+    - title: "Iowa Administrative Code 441-75.8 - Medically needy #page 20,24"
+      href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=20
+    - title: Illinois Department of Human Services Policy Manual PM 15-08-00 - Spenddown
+      href: https://www.dhs.state.il.us/page.aspx?item=16536
+    - title: New Jersey DMAHS, Medically Needy Segment fact sheet
+      href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1
+    - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2
+    - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1
+    - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels
+      href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm
+    - title: North Dakota Administrative Code 75-02-02.1-26(1) - Asset limits, medically needy aged, blind, and disabled
+      href: https://ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=40
 
 AK:
   2015-01-01: false
 AL:
   2015-01-01: false
 AR:
-  2015-01-01: false
-AZ:
   2015-01-01: true
+AZ:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 CA:
   2015-01-01: true
 CO:
@@ -33,13 +53,15 @@ GA:
 HI:
   2015-01-01: true
 IA:
-  2015-01-01: false
-ID:
   2015-01-01: true
-IL:
+ID:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
   2015-01-01: false
-IN:
+IL:
   2015-01-01: true
+IN:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 KS:
   2015-01-01: true
 KY:
@@ -65,17 +87,19 @@ MT:
 NC:
   2015-01-01: true
 ND:
-  2015-01-01: false
+  2015-01-01: true
 NE:
   2015-01-01: true
 NH:
   2015-01-01: true
 NJ:
-  2015-01-01: false
-NM:
   2015-01-01: true
+NM:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 NV:
-  2015-01-01: true
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 NY:
   2015-01-01: true
 OH:
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml
index 95b66a8b8bf..b1d55e332d7 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/categories/senior.yaml
@@ -1,4 +1,5 @@
 description: Whether seniors can qualify for Medicaid under the 'medically needy' pathway.
+# NOTE: Like every other state's, the AR, IA, IL, ND and NJ switches date from 2015-01-01, while their income and asset limits start in 2018, so 2015-2017 use the 2018 limits.
 metadata:
   label: Medicaid medically needy pathway for seniors
   breakdown:
@@ -7,15 +8,34 @@ metadata:
   reference:
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: KFF, Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2026, Appendix Table 4
+      href: https://www.kff.org/medicaid/medicaid-eligibility-levels-for-older-adults-and-people-with-disabilities-non-magi-in-2026/
+    - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down
+      href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1
+    - title: "Iowa Administrative Code 441-75.8 - Medically needy #page 20,24"
+      href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=20
+    - title: Illinois Department of Human Services Policy Manual PM 15-08-00 - Spenddown
+      href: https://www.dhs.state.il.us/page.aspx?item=16536
+    - title: New Jersey DMAHS, Medically Needy Segment fact sheet
+      href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1
+    - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2
+    - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1
+    - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels
+      href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm
+    - title: North Dakota Administrative Code 75-02-02.1-26(1) - Asset limits, medically needy aged, blind, and disabled
+      href: https://ndlegis.gov/information/acdata/pdf/75-02-02.1.pdf#page=40
 
 AK:
   2015-01-01: false
 AL:
   2015-01-01: false
 AR:
-  2015-01-01: false
-AZ:
   2015-01-01: true
+AZ:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 CA:
   2015-01-01: true
 CO:
@@ -33,13 +53,15 @@ GA:
 HI:
   2015-01-01: true
 IA:
-  2015-01-01: false
-ID:
   2015-01-01: true
-IL:
+ID:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
   2015-01-01: false
-IN:
+IL:
   2015-01-01: true
+IN:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 KS:
   2015-01-01: true
 KY:
@@ -65,17 +87,19 @@ MT:
 NC:
   2015-01-01: true
 ND:
-  2015-01-01: false
+  2015-01-01: true
 NE:
   2015-01-01: true
 NH:
   2015-01-01: true
 NJ:
-  2015-01-01: false
-NM:
   2015-01-01: true
+NM:
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 NV:
-  2015-01-01: true
+  # No medically needy pathway for aged, blind or disabled people (KFF 2018, 2026).
+  2015-01-01: false
 NY:
   2015-01-01: true
 OH:
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml
index 2e95d5e4ff9..dc218d5281d 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/couple.yaml
@@ -6,8 +6,38 @@ metadata:
   unit: currency-USD
   period: month
   reference:
+    - title: Iowa Administrative Code 441-75.8(5)"a" - Medically needy resource limit
+      href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=22
+    - title: New Jersey DMAHS, Medically Needy Segment fact sheet
+      href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1
+    - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2
+    - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: California Welfare and Institutions Code 14005.62(a), (c), (d)
+      href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=14005.62
+    - title: "California DHCS All County Welfare Directors Letter 21-31, Asset Limit Changes for Non-MAGI Medi-Cal (Phase I) #page 2-4"
+      href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/21-31.pdf#page=2
+    - title: "California DHCS All County Welfare Directors Letter 22-25, Elimination of Asset Limits for Non-MAGI Medi-Cal Programs #page 1-2"
+      href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/22-25.pdf#page=1
+    - title: "California DHCS All County Welfare Directors Letter 25-14, Reinstatement of Asset Limits for Non-MAGI Medi-Cal Programs #page 1,8-9"
+      href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf#page=1
+    - title: Illinois Department of Human Services Policy Manual PM 07-02-01 - Asset Limits
+      href: https://www.dhs.state.il.us/page.aspx?Item=14876
+    - title: New York DOH GIS 22 MA/01, Attachment I, 2022 SSI-Related Medicaid Income and Resource Levels
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma01_att1.pdf#page=2
+    - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=2
+    - title: New York DOH GIS 23 MA/02, Attachment 1, 2023 Income and Resource Standards
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/23ma02_att1.pdf#page=2
+    - title: New York DOH GIS 24 MA/01, Attachment 1, 2024 Income and Resource Standards
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/24ma01_att1.pdf#page=2
+    - title: New York DOH GIS 25 MA/03, Attachment 1, 2025 Income and Resource Standards
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/25ma03_att1.pdf#page=2
+    - title: New York DOH GIS 26 MA/05, Attachment 1, 2026 Income and Resource Standards
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/26ma05_att1.pdf#page=2
 
 AK:
   2018-01-01: -.inf
@@ -19,6 +49,9 @@ AZ:
   2018-01-01: -.inf
 CA:
   2018-01-01: 3_000
+  2022-07-01: 195_000
+  2024-01-01: .inf
+  2026-01-01: 195_000
 CO:
   2018-01-01: -.inf
 CT:
@@ -39,6 +72,7 @@ ID:
   2018-01-01: -.inf
 IL:
   2018-01-01: 3_000
+  2023-05-12: 17_500
 IN:
   2018-01-01: -.inf
 KS:
@@ -79,6 +113,11 @@ NV:
   2018-01-01: -.inf
 NY:
   2018-01-01: 22_200
+  2022-01-01: 24_600
+  2023-01-01: 40_821
+  2024-01-01: 42_312
+  2025-01-01: 43_781
+  2026-01-01: 44_796
 OH:
   2018-01-01: -.inf
 OK:
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml
index c4a1ae47ba1..671d6701178 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/assets/individual.yaml
@@ -6,8 +6,38 @@ metadata:
   unit: currency-USD
   period: month
   reference:
+    - title: Iowa Administrative Code 441-75.8(5)"a" - Medically needy resource limit
+      href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=22
+    - title: New Jersey DMAHS, Medically Needy Segment fact sheet
+      href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1
+    - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2
+    - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: California Welfare and Institutions Code 14005.62(a), (c), (d)
+      href: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=14005.62
+    - title: "California DHCS All County Welfare Directors Letter 21-31, Asset Limit Changes for Non-MAGI Medi-Cal (Phase I) #page 2-4"
+      href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/21-31.pdf#page=2
+    - title: "California DHCS All County Welfare Directors Letter 22-25, Elimination of Asset Limits for Non-MAGI Medi-Cal Programs #page 1-2"
+      href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/22-25.pdf#page=1
+    - title: "California DHCS All County Welfare Directors Letter 25-14, Reinstatement of Asset Limits for Non-MAGI Medi-Cal Programs #page 1,8-9"
+      href: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/25-14.pdf#page=1
+    - title: Illinois Department of Human Services Policy Manual PM 07-02-01 - Asset Limits
+      href: https://www.dhs.state.il.us/page.aspx?Item=14876
+    - title: New York DOH GIS 22 MA/01, Attachment I, 2022 SSI-Related Medicaid Income and Resource Levels
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma01_att1.pdf#page=2
+    - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=2
+    - title: New York DOH GIS 23 MA/02, Attachment 1, 2023 Income and Resource Standards
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/23ma02_att1.pdf#page=2
+    - title: New York DOH GIS 24 MA/01, Attachment 1, 2024 Income and Resource Standards
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/24ma01_att1.pdf#page=2
+    - title: New York DOH GIS 25 MA/03, Attachment 1, 2025 Income and Resource Standards
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/25ma03_att1.pdf#page=2
+    - title: New York DOH GIS 26 MA/05, Attachment 1, 2026 Income and Resource Standards
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/26ma05_att1.pdf#page=2
 
 AK:
   2018-01-01: -.inf
@@ -19,6 +49,9 @@ AZ:
   2018-01-01: -.inf
 CA:
   2018-01-01: 2_000
+  2022-07-01: 130_000
+  2024-01-01: .inf
+  2026-01-01: 130_000
 CO:
   2018-01-01: -.inf
 CT:
@@ -39,6 +72,7 @@ ID:
   2018-01-01: -.inf
 IL:
   2018-01-01: 2_000
+  2023-05-12: 17_500
 IN:
   2018-01-01: -.inf
 KS:
@@ -79,6 +113,11 @@ NV:
   2018-01-01: -.inf
 NY:
   2018-01-01: 15_150
+  2022-01-01: 16_800
+  2023-01-01: 30_182
+  2024-01-01: 31_175
+  2025-01-01: 32_396
+  2026-01-01: 33_038
 OH:
   2018-01-01: -.inf
 OK:
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml
index 9f31964c2e0..71f7af89140 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple.yaml
@@ -1,4 +1,5 @@
-description: Maximum income for a couple to qualify for Medicaid under the 'medically needy' pathway.
+description: States limit monthly income for a couple to this amount under the Medicaid medically needy program.
+# NOTE: From the date a state's fpg_rate or ssi_rate is positive, the formula uses that rate instead of this amount. IL, MN, ND, UT and WA use a rate from 2018 and have no dollar entry.
 metadata:
   label: Medicaid medically needy pathway for couples income limit
   breakdown:
@@ -6,15 +7,95 @@ metadata:
   unit: currency-USD
   period: month
   reference:
+    - title: Iowa Administrative Code 441-75.8(7) - Medically needy income level
+      href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=24
+    - title: New Jersey DMAHS, Medically Needy Segment fact sheet
+      href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1
+    - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2
+    - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1
+    - title: CMS approval of Kansas State Plan Amendment KS-25-0019, medically needy income level
+      href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=7
+    - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down
+      href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1
+    - title: Arkansas DHS Medical Services Policy Manual (September 2026), O-710 Medically Needy Income Levels
+      href: https://humanservices.arkansas.gov/wp-content/uploads/MS-Policy-9.26-New.pdf#page=435
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: Connecticut State Plan Amendment CT-22-0031, Medically Needy Income Level (effective July 1, 2022)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-22-0031.pdf#page=7
+    - title: Connecticut State Plan Amendment CT-24-0003, Medically Needy Income Level (effective January 1, 2024)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-24-0003.pdf#page=7
+    - title: Connecticut State Plan Amendment CT-24-0006, Medically Needy Income Level (effective March 1, 2024)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-24-0006.pdf#page=7
+    - title: Connecticut State Plan Amendment CT-25-0013, Medically Needy Income Level (effective March 1, 2025)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-25-0013.pdf#page=7
+    - title: Connecticut State Plan Amendment CT-26-0006, Medically Needy Income Level (effective March 1, 2026)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-26-0006.pdf#page=7
+    - title: Connecticut DSS Program Standards Chart (effective March 1, 2026), HUSKY C Medically Needy Income Limit
+      href: https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/fact-sheets-and-issue-briefs/fact-sheets/dss-program-standards-chart-effective-030126.pdf
+    - title: "District of Columbia Municipal Regulations 29-901.1, Medically Needy Income Levels (50 DCR 8467, October 10, 2003) #page 1-2"
+      href: https://dbh.dc.gov/sites/default/files/dc/sites/dmh/publication/attachments/GrievanceFinalRulemaking.pdf#page=1
+    - title: District of Columbia DHCF Non-MAGI Spend Down Notice (2023 Medically Needy Income Limit)
+      href: https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/documents/%2316%20Non%20MAGI%20Spend%20Down%20Notice.pdf#page=2
+    - title: District of Columbia DHCF Spend Down Fact Sheet (revised September 2024)
+      href: https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/service_content/attachments/Spend_Down_Fact_Sheet.pdf#page=2
+    - title: KFF, Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2026, Appendix Table 4
+      href: https://www.kff.org/medicaid/medicaid-eligibility-levels-for-older-adults-and-people-with-disabilities-non-magi-in-2026/
+    - title: New Hampshire State Plan Amendment NH-23-0029, Medically Needy Income Level (effective January 1, 2023)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/NH-23-0029.pdf#page=7
+    - title: New Hampshire State Plan Amendment NH-25-0012, Medically Needy Income Level (effective January 1, 2025)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0012.pdf#page=7
+    - title: New Hampshire State Plan Amendment NH-25-0019, Medically Needy Income Level (effective July 1, 2025)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0019.pdf#page=7
+    - title: New York DOH GIS 22 MA/01, Attachment I, 2022 SSI-Related Medicaid Income and Resource Levels
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma01_att1.pdf#page=2
+    - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1
+    - title: Rhode Island 210-RICR-40-00-3, Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations (version effective January 1, 2020)
+      href: https://rules.sos.ri.gov/Regulations/part/210-40-00-3?reg_id=10945
+    - title: Rhode Island 210-RICR-40-00-3, section 3.2.8(A)(8), Medically Needy Income Limit
+      href: https://rules.sos.ri.gov/regulations/part/210-40-00-3
+    - title: Rhode Island State Plan Amendment RI-21-0004, Medically Needy Income Level (effective January 1, 2021)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-21-0004.pdf#page=4
+    - title: Rhode Island State Plan Amendment RI-22-0003, Medically Needy Income Level (effective January 1, 2022)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0003.pdf#page=7
+    - title: Rhode Island State Plan Amendment RI-23-0005, Medically Needy Income Level (effective January 1, 2023)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-23-0005.pdf#page=7
+    - title: Rhode Island State Plan Amendment RI-24-0003, Medically Needy Income Level (effective January 1, 2024)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-24-0003.pdf#page=7
+    - title: Rhode Island State Plan Amendment RI-25-0003, Medically Needy Income Level (effective January 1, 2025)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-25-0003.pdf#page=7
+    - title: Rhode Island State Plan Amendment RI-26-0001, Medically Needy Income Level (effective January 1, 2026)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-26-0001.pdf#page=7
+    - title: Vermont Health Benefits Eligibility and Enrollment Rule, Part 2, section 8.06 - Medically-needy coverage group
+      href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-2-Eligibility-Standards.pdf#page=19
+    - title: "Vermont Health Benefits Eligibility and Enrollment Rule, Part 5, section 29.14 - Determination of countable income #page 50-52"
+      href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-5-Financial-Methodologies.pdf#page=50
+    - title: Vermont DCF Bulletin 17-26, P-2420 Eligibility maximums for MABD, effective 1/1/18
+      href: https://outside.vermont.gov/dept/DCF/Shared%20Documents/ESD/Rules-Adopted/B17-26.pdf#page=3
+    - title: Vermont DVHA 2020 MABD PIL FPL Income Chart, effective 1/1/2020
+      href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2020%20MABD%20PIL%20Chart%20FINAL.pdf
+    - title: Vermont DVHA 2021 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2021%20Standards%20Change%20for%20Healthcare%20Updated%201.14.21.pdf#page=1
+    - title: Vermont DVHA 2022 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2022%20Standards%20Change%20for%20Healthcare%20Draft%20FINAL%20V.2%20corrected.pdf#page=1
+    - title: Vermont DVHA 2023 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/documents/2023%20Standards%20Change%20for%20Healthcare%20FINAL%20%28with%2010-1-23%20DR%20Numbers%29%20%28003%29.pdf#page=1
+    - title: Vermont DVHA 2024 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/documents/2024%20Standards%20Change%20for%20Healthcare%20FINAL%20Corrected%2012.19.pdf#page=1
+    - title: Vermont DVHA 2025 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/documents/2025%20Standards%20Change%20for%20Healthcare%20FINAL.pdf#page=1
+    - title: Vermont DVHA 2026 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/documents/Standards_Change_for_Healthcare_2026.pdf#page=1
 
 AK:
   2018-01-01: -.inf
 AL:
   2018-01-01: -.inf
 AR:
-  2018-01-01: 217
+  2018-01-01: 216.66
 AZ:
   2018-01-01: -.inf
 CA:
@@ -23,8 +104,22 @@ CO:
   2018-01-01: -.inf
 CT:
   2018-01-01: 696
+  2022-07-01: 879
+  2024-01-01: 946
+  2024-03-01: 980
+  2025-03-01: 1_128
+  2026-03-01: 1_153
 DC:
   2018-01-01: 652
+  # NOTE: KFF 2018 reports DC's own $652 for couples; the 29 DCMR 901.1 method applies from 2019.
+  2019-01-01: 704.58
+  2020-01-01: 718.33
+  2021-01-01: 725.83
+  2022-01-01: 762.92
+  2023-01-01: 821.67
+  2024-01-01: 851.67
+  2025-01-01: 881.25
+  2026-01-01: 901.67
 DE:
   2018-01-01: -.inf
 FL:
@@ -37,8 +132,6 @@ IA:
   2018-01-01: 483
 ID:
   2018-01-01: -.inf
-IL:
-  2018-01-01: 1_372
 IN:
   2018-01-01: -.inf
 KS:
@@ -55,8 +148,6 @@ ME:
   2018-01-01: 341
 MI:
   2018-01-01: 1_372
-MN:
-  2018-01-01: 1_098
 MO:
   2018-01-01: -.inf
 MS:
@@ -65,12 +156,13 @@ MT:
   2018-01-01: 525
 NC:
   2018-01-01: 317
-ND:
-  2018-01-01: 1_139
 NE:
   2018-01-01: 392
 NH:
   2018-01-01: 675
+  2023-01-01: 1_033
+  2025-01-01: 1_066
+  2025-07-01: 1_093
 NJ:
   2018-01-01: 434
 NM:
@@ -79,6 +171,7 @@ NV:
   2018-01-01: -.inf
 NY:
   2018-01-01: 1_233
+  2022-01-01: 1_367
 OH:
   2018-01-01: -.inf
 OK:
@@ -89,6 +182,14 @@ PA:
   2018-01-01: 442
 RI:
   2018-01-01: 947
+  2019-01-01: 958
+  2020-01-01: 975
+  2021-01-01: 992
+  2022-01-01: 1_050
+  2023-01-01: 1_133
+  2024-01-01: 1_175
+  2025-01-01: 1_208
+  2026-01-01: 1_242
 SC:
   2018-01-01: -.inf
 SD:
@@ -97,14 +198,21 @@ TN:
   2018-01-01: 258
 TX:
   2018-01-01: 216
-UT:
-  2018-01-01: 1_372
 VA:
   2018-01-01: 659
 VT:
+  # The protected income level (PIL) outside Chittenden County, the same for
+  # one and two people (HBEE 8.06(b), 29.14). The higher PIL inside Chittenden
+  # County is not modeled. No 2019 PIL was found, so 2018's value stays in
+  # force through 2019.
   2018-01-01: 1_041
-WA:
-  2018-01-01: 750
+  2020-01-01: 1_091
+  2021-01-01: 1_100
+  2022-01-01: 1_166
+  2023-01-01: 1_258
+  2024-01-01: 1_300
+  2025-01-01: 1_333
+  2026-01-01: 1_375
 WV:
   2018-01-01: 275
 WI:
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml
new file mode 100644
index 00000000000..f77c9f8f5ea
--- /dev/null
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/couple_uses_individual_limit.yaml
@@ -0,0 +1,113 @@
+description: States apply the one-person medically needy income limit to a married couple under the Medicaid program, if this is true.
+metadata:
+  unit: bool
+  period: year
+  label: Medicaid medically needy couple uses the individual income limit
+  breakdown:
+    - state_code
+  reference:
+    - title: Washington Administrative Code 182-519-0050(5) - Monthly income and countable resource standards for medically needy (MN)
+      href: https://app.leg.wa.gov/WAC/default.aspx?cite=182-519-0050
+
+AK:
+  2018-01-01: false
+AL:
+  2018-01-01: false
+AR:
+  2018-01-01: false
+AZ:
+  2018-01-01: false
+CA:
+  2018-01-01: false
+CO:
+  2018-01-01: false
+CT:
+  2018-01-01: false
+DC:
+  2018-01-01: false
+DE:
+  2018-01-01: false
+FL:
+  2018-01-01: false
+GA:
+  2018-01-01: false
+HI:
+  2018-01-01: false
+IA:
+  2018-01-01: false
+ID:
+  2018-01-01: false
+IL:
+  2018-01-01: false
+IN:
+  2018-01-01: false
+KS:
+  2018-01-01: false
+KY:
+  2018-01-01: false
+LA:
+  2018-01-01: false
+MA:
+  2018-01-01: false
+MD:
+  2018-01-01: false
+ME:
+  2018-01-01: false
+MI:
+  2018-01-01: false
+MN:
+  2018-01-01: false
+MO:
+  2018-01-01: false
+MS:
+  2018-01-01: false
+MT:
+  2018-01-01: false
+NC:
+  2018-01-01: false
+ND:
+  2018-01-01: false
+NE:
+  2018-01-01: false
+NH:
+  2018-01-01: false
+NJ:
+  2018-01-01: false
+NM:
+  2018-01-01: false
+NV:
+  2018-01-01: false
+NY:
+  2018-01-01: false
+OH:
+  2018-01-01: false
+OK:
+  2018-01-01: false
+OR:
+  2018-01-01: false
+PA:
+  2018-01-01: false
+RI:
+  2018-01-01: false
+SC:
+  2018-01-01: false
+SD:
+  2018-01-01: false
+TN:
+  2018-01-01: false
+TX:
+  2018-01-01: false
+UT:
+  2018-01-01: false
+VA:
+  2018-01-01: false
+VT:
+  2018-01-01: false
+WA:
+  2018-01-01: true
+WI:
+  2018-01-01: false
+WV:
+  2018-01-01: false
+WY:
+  2018-01-01: false
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml
new file mode 100644
index 00000000000..6a95b4ffdcc
--- /dev/null
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/fpg_rate.yaml
@@ -0,0 +1,69 @@
+description: States set the medically needy income limit at this share of the federal poverty guideline for a household of one or two under the Medicaid program.
+# NOTE: States not listed, or with a share of zero, use the dollar limits in individual.yaml and couple.yaml.
+metadata:
+  unit: /1
+  period: year
+  label: Medicaid medically needy income limit as a share of the poverty guideline
+  breakdown:
+    - state_code
+  reference:
+    - title: Illinois Public Aid Code, 305 ILCS 5/5-2(2)(a)(ii) - Classes of persons eligible
+      href: https://www.ilga.gov/Documents/legislation/ilcs/documents/030500050K5-2.htm
+    - title: Illinois Department of Human Services Policy Manual PM 15-06-02-a - Community Standard
+      href: https://www.dhs.state.il.us/page.aspx?item=16507
+    - title: Illinois Department of Human Services Policy Manual PM 15-06-02-c - Standard for a client living with a spouse
+      href: https://www.dhs.state.il.us/page.aspx?item=16512
+    - title: Illinois Department of Human Services Policy Manual PM 15-08-00 - Spenddown
+      href: https://www.dhs.state.il.us/page.aspx?item=16536
+    - title: 89 Illinois Administrative Code 120.20(a) - Need standard, aged, blind, or disabled
+      href: https://www.ilga.gov/ftp/JCAR/AdminCode/089/089001200B00200R.html
+    - title: Minnesota Statutes 256B.056, subdivisions 1c(a), 4(a) and 5c(b)
+      href: https://www.revisor.mn.gov/statutes/cite/256B.056
+    - title: Laws of Minnesota 2017, 1st Special Session, chapter 6, article 4, section 20
+      href: https://www.revisor.mn.gov/laws/2017/1/Session+Law/Chapter/6/
+    - title: Laws of Minnesota 2019, 1st Special Session, chapter 9, article 7, section 21
+      href: https://www.revisor.mn.gov/laws/2019/1/Session+Law/Chapter/9/
+    - title: Minnesota DHS Eligibility Policy Manual 2.3.3.4 - Spenddown standards
+      href: https://hcopub.dhs.state.mn.us/epm/2_3_3_4.htm
+    - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 - Medically needy income levels
+      href: https://www.nd.gov/dhs/policymanuals/51005/510_05_85_40.htm
+    - title: North Dakota Manual Letter 3702, Federal Poverty Level Updates (April 1, 2023)
+      href: https://www.nd.gov/dhs/policymanuals/51003/Content/ML/2023/ML%203702%20Federal%20Poverty%20Level%20Updates%2004-01-2023.pdf#page=6
+    - title: North Dakota State Plan Amendment ND-23-0034 (effective January 1, 2024)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/ND-23-0034.pdf#page=2
+    - title: North Dakota Manual Letter 3776, ACA Medically Needy (effective January 1, 2024)
+      href: https://www.nd.gov/dhs/policymanuals/51003/Content/ML/2023/ML%203776%20-ACA%20Med%20Needy.pdf#page=1
+    - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 (archived, ML 3896), 90% of poverty from April 1, 2024
+      href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2025/3896/510_05_85_40.htm
+    - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1
+    - title: New York State Plan Amendment NY-23-0001 (effective January 1, 2023)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/NY-23-0001.pdf#page=5
+    - title: Utah Administrative Code R414-304-9(2) - Income Deductions
+      href: https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R414-304-9
+    - title: Utah Code 26B-3-108(9)(b)
+      href: https://le.utah.gov/xcode/Title26B/Chapter3/26B-3-S108.html
+    - title: Wisconsin Statutes 49.47(4)(c)1
+      href: https://docs.legis.wisconsin.gov/statutes/statutes/49/iv/47/4/c
+    - title: Wisconsin DHS Operations Memo 19-26, SSI-Related Medicaid Medically Needy Income Limit Increase
+      href: https://web.archive.org/web/20251031224345id_/https://www.dhs.wisconsin.gov/dms/memos/ops/dms-ops-2019-26.pdf#page=2
+    - title: Wisconsin Medicaid Eligibility Handbook (EBD) 39.4.1 - Elderly, Blind, or Disabled Assets and Income Table
+      href: https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/39/39.4.htm
+
+IL:
+  2018-01-01: 1
+MN:
+  2018-01-01: 0.8
+  2019-06-01: 0.81
+  2022-07-01: 1
+ND:
+  2018-01-01: 0.83
+  2024-01-01: 0.9
+NY:
+  2018-01-01: 0
+  2023-01-01: 1.38
+UT:
+  2018-01-01: 1
+WI:
+  2018-01-01: 0
+  2019-09-01: 1
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml
new file mode 100644
index 00000000000..2c3f8f7613c
--- /dev/null
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_down_monthly.yaml
@@ -0,0 +1,14 @@
+description: Illinois rounds the monthly medically needy income limit down to a whole dollar under the Medicaid program, if this is true.
+values:
+  # IDHS tables drop the cents from 2025 ($1,762 for $1,762.50 for two; $2,220 for $2,220.83 for three).
+  2018-01-01: false
+  2025-01-01: true
+metadata:
+  unit: bool
+  period: year
+  label: Illinois Medicaid medically needy income limit rounded down to a whole dollar
+  reference:
+    - title: Illinois DHS Workers' Action Guide WAG 25-03-02(2), AABD 100% FPL monthly income standards ($1,803 for two in 2026)
+      href: https://www.dhs.state.il.us/page.aspx?item=21741
+    - title: Illinois DHS WAG 25-03-02(2), 2025 Monthly Income Standards, AABD 100% FPL ($1,762 for two) (archived May 15, 2025)
+      href: https://web.archive.org/web/20250515155649/https://www.dhs.state.il.us/page.aspx?item=21741
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_to_nearest_monthly.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_to_nearest_monthly.yaml
new file mode 100644
index 00000000000..6a16b28bcce
--- /dev/null
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/il/rounds_to_nearest_monthly.yaml
@@ -0,0 +1,17 @@
+description: Illinois rounds the monthly medically needy income limit to the nearest whole dollar under the Medicaid program, if this is true.
+values:
+  # KFF 2018 ($1,012 / $1,372) and IDHS 2019-2024 tables round to the nearest dollar
+  # ($1,133 / $1,526 in 2022; $2,072 for $2,071.67 for three in 2023).
+  2018-01-01: true
+  2025-01-01: false
+metadata:
+  unit: bool
+  period: year
+  label: Illinois Medicaid medically needy income limit rounded to the nearest whole dollar
+  reference:
+    - title: "KFF, Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey, Appendix Table 3 (2018), Illinois $1,012 / $1,372"
+      href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: Illinois DHS WAG 25-03-02(2), 2022 Income Standards, AABD 100% FPL ($1,133 / $1,526) (archived September 28, 2022)
+      href: https://web.archive.org/web/20220928154002/https://www.dhs.state.il.us/page.aspx?item=21741
+    - title: Illinois DHS WAG 25-03-02(2), 2024 Monthly Income Standards, AABD 100% FPL ($1,255 / $1,703) (archived July 15, 2024)
+      href: https://web.archive.org/web/20240715015033/https://www.dhs.state.il.us/page.aspx?item=21741
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml
index 031fbb3c93c..e57ea1c221a 100644
--- a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/individual.yaml
@@ -1,4 +1,5 @@
-description: Maximum income for an individual to qualify for Medicaid under the 'medically needy' pathway.
+description: States limit monthly income for an individual to this amount under the Medicaid medically needy program.
+# NOTE: From the date a state's fpg_rate or ssi_rate is positive, the formula uses that rate instead of this amount. IL, MN, ND, UT and WA use a rate from 2018 and have no dollar entry.
 metadata:
   label: Medicaid medically needy pathway for individuals income limit
   breakdown:
@@ -6,15 +7,95 @@ metadata:
   unit: currency-USD
   period: month
   reference:
+    - title: Iowa Administrative Code 441-75.8(7) - Medically needy income level
+      href: https://www.legis.iowa.gov/docs/iac/chapter/441.75.pdf#page=24
+    - title: New Jersey DMAHS, Medically Needy Segment fact sheet
+      href: https://web.archive.org/web/20260514003440id_/https://www.nj.gov/humanservices/dmahs/clients/medicaid/medically_needy_fact_sheet.pdf#page=1
+    - title: N.J.A.C. 10:70-1.2 - Purpose of the Medically Needy Manual
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-1-2
+    - title: N.J.A.C. 10:70-5.1 - Resource eligibility limits
+      href: https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-10-70-5-1
+    - title: CMS approval of Kansas State Plan Amendment KS-25-0019, medically needy income level
+      href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=7
+    - title: Arkansas DHS Division of County Operations, Health Care Eligibility Quick Reference (January 2025), AABD Adult Spend Down
+      href: https://humanservices.arkansas.gov/wp-content/uploads/Quick-Reference.pdf#page=1
+    - title: Arkansas DHS Medical Services Policy Manual (September 2026), O-710 Medically Needy Income Levels
+      href: https://humanservices.arkansas.gov/wp-content/uploads/MS-Policy-9.26-New.pdf#page=435
     - title: "Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey | KFF"
       href: https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/
+    - title: Connecticut State Plan Amendment CT-22-0031, Medically Needy Income Level (effective July 1, 2022)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-22-0031.pdf#page=7
+    - title: Connecticut State Plan Amendment CT-24-0003, Medically Needy Income Level (effective January 1, 2024)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-24-0003.pdf#page=7
+    - title: Connecticut State Plan Amendment CT-24-0006, Medically Needy Income Level (effective March 1, 2024)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-24-0006.pdf#page=7
+    - title: Connecticut State Plan Amendment CT-25-0013, Medically Needy Income Level (effective March 1, 2025)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-25-0013.pdf#page=7
+    - title: Connecticut State Plan Amendment CT-26-0006, Medically Needy Income Level (effective March 1, 2026)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/CT-26-0006.pdf#page=7
+    - title: Connecticut DSS Program Standards Chart (effective March 1, 2026), HUSKY C Medically Needy Income Limit
+      href: https://portal.ct.gov/dss/-/media/departments-and-agencies/dss/fact-sheets-and-issue-briefs/fact-sheets/dss-program-standards-chart-effective-030126.pdf
+    - title: "District of Columbia Municipal Regulations 29-901.1, Medically Needy Income Levels (50 DCR 8467, October 10, 2003) #page 1-2"
+      href: https://dbh.dc.gov/sites/default/files/dc/sites/dmh/publication/attachments/GrievanceFinalRulemaking.pdf#page=1
+    - title: District of Columbia DHCF Non-MAGI Spend Down Notice (2023 Medically Needy Income Limit)
+      href: https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/documents/%2316%20Non%20MAGI%20Spend%20Down%20Notice.pdf#page=2
+    - title: District of Columbia DHCF Spend Down Fact Sheet (revised September 2024)
+      href: https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/service_content/attachments/Spend_Down_Fact_Sheet.pdf#page=2
+    - title: KFF, Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2026, Appendix Table 4
+      href: https://www.kff.org/medicaid/medicaid-eligibility-levels-for-older-adults-and-people-with-disabilities-non-magi-in-2026/
+    - title: New Hampshire State Plan Amendment NH-23-0029, Medically Needy Income Level (effective January 1, 2023)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/NH-23-0029.pdf#page=7
+    - title: New Hampshire State Plan Amendment NH-25-0012, Medically Needy Income Level (effective January 1, 2025)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0012.pdf#page=7
+    - title: New Hampshire State Plan Amendment NH-25-0019, Medically Needy Income Level (effective July 1, 2025)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/NH-25-0019.pdf#page=7
+    - title: New York DOH GIS 22 MA/01, Attachment I, 2022 SSI-Related Medicaid Income and Resource Levels
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma01_att1.pdf#page=2
+    - title: New York DOH GIS 22 MA/11, Increase of Medicaid Medically Needy Income Level to 138% of the Federal Poverty Level
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/22ma11.pdf#page=1
+    - title: Rhode Island 210-RICR-40-00-3, Medicaid Integrated Health Care Coverage, SSI Financial Eligibility Determinations (version effective January 1, 2020)
+      href: https://rules.sos.ri.gov/Regulations/part/210-40-00-3?reg_id=10945
+    - title: Rhode Island 210-RICR-40-00-3, section 3.2.8(A)(8), Medically Needy Income Limit
+      href: https://rules.sos.ri.gov/regulations/part/210-40-00-3
+    - title: Rhode Island State Plan Amendment RI-21-0004, Medically Needy Income Level (effective January 1, 2021)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-21-0004.pdf#page=4
+    - title: Rhode Island State Plan Amendment RI-22-0003, Medically Needy Income Level (effective January 1, 2022)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-22-0003.pdf#page=7
+    - title: Rhode Island State Plan Amendment RI-23-0005, Medically Needy Income Level (effective January 1, 2023)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-23-0005.pdf#page=7
+    - title: Rhode Island State Plan Amendment RI-24-0003, Medically Needy Income Level (effective January 1, 2024)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-24-0003.pdf#page=7
+    - title: Rhode Island State Plan Amendment RI-25-0003, Medically Needy Income Level (effective January 1, 2025)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-25-0003.pdf#page=7
+    - title: Rhode Island State Plan Amendment RI-26-0001, Medically Needy Income Level (effective January 1, 2026)
+      href: https://www.medicaid.gov/medicaid/spa/downloads/RI-26-0001.pdf#page=7
+    - title: Vermont Health Benefits Eligibility and Enrollment Rule, Part 2, section 8.06 - Medically-needy coverage group
+      href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-2-Eligibility-Standards.pdf#page=19
+    - title: "Vermont Health Benefits Eligibility and Enrollment Rule, Part 5, section 29.14 - Determination of countable income #page 50-52"
+      href: https://humanservices.vermont.gov/sites/ahsnew/files/documents/HBEE-Part-5-Financial-Methodologies.pdf#page=50
+    - title: Vermont DCF Bulletin 17-26, P-2420 Eligibility maximums for MABD, effective 1/1/18
+      href: https://outside.vermont.gov/dept/DCF/Shared%20Documents/ESD/Rules-Adopted/B17-26.pdf#page=3
+    - title: Vermont DVHA 2020 MABD PIL FPL Income Chart, effective 1/1/2020
+      href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2020%20MABD%20PIL%20Chart%20FINAL.pdf
+    - title: Vermont DVHA 2021 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2021%20Standards%20Change%20for%20Healthcare%20Updated%201.14.21.pdf#page=1
+    - title: Vermont DVHA 2022 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/doc_library/2022%20Standards%20Change%20for%20Healthcare%20Draft%20FINAL%20V.2%20corrected.pdf#page=1
+    - title: Vermont DVHA 2023 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/documents/2023%20Standards%20Change%20for%20Healthcare%20FINAL%20%28with%2010-1-23%20DR%20Numbers%29%20%28003%29.pdf#page=1
+    - title: Vermont DVHA 2024 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/documents/2024%20Standards%20Change%20for%20Healthcare%20FINAL%20Corrected%2012.19.pdf#page=1
+    - title: Vermont DVHA 2025 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/documents/2025%20Standards%20Change%20for%20Healthcare%20FINAL.pdf#page=1
+    - title: Vermont DVHA 2026 Standards Change for Healthcare
+      href: https://dvha.vermont.gov/sites/dvha/files/documents/Standards_Change_for_Healthcare_2026.pdf#page=1
 
 AK:
   2018-01-01: -.inf
 AL:
   2018-01-01: -.inf
 AR:
-  2018-01-01: 108
+  2018-01-01: 108.33
 AZ:
   2018-01-01: -.inf
 CA:
@@ -23,8 +104,21 @@ CO:
   2018-01-01: -.inf
 CT:
   2018-01-01: 523
+  2022-07-01: 653
+  2024-01-01: 700
+  2024-03-01: 723
+  2025-03-01: 835
+  2026-03-01: 851
 DC:
   2018-01-01: 652
+  2019-01-01: 669.35
+  2020-01-01: 682.42
+  2021-01-01: 689.54
+  2022-01-01: 724.77
+  2023-01-01: 780.58
+  2024-01-01: 809.08
+  2025-01-01: 837.19
+  2026-01-01: 856.58
 DE:
   2018-01-01: -.inf
 FL:
@@ -37,8 +131,6 @@ IA:
   2018-01-01: 483
 ID:
   2018-01-01: -.inf
-IL:
-  2018-01-01: 1_012
 IN:
   2018-01-01: -.inf
 KS:
@@ -55,8 +147,6 @@ ME:
   2018-01-01: 315
 MI:
   2018-01-01: 1_012
-MN:
-  2018-01-01: 810
 MO:
   2018-01-01: -.inf
 MS:
@@ -65,12 +155,13 @@ MT:
   2018-01-01: 525
 NC:
   2018-01-01: 242
-ND:
-  2018-01-01: 840
 NE:
   2018-01-01: 392
 NH:
   2018-01-01: 591
+  2023-01-01: 888
+  2025-01-01: 916
+  2025-07-01: 939
 NJ:
   2018-01-01: 367
 NM:
@@ -79,6 +170,7 @@ NV:
   2018-01-01: -.inf
 NY:
   2018-01-01: 842
+  2022-01-01: 934
 OH:
   2018-01-01: -.inf
 OK:
@@ -89,6 +181,14 @@ PA:
   2018-01-01: 425
 RI:
   2018-01-01: 903
+  2019-01-01: 917
+  2020-01-01: 933
+  2021-01-01: 950
+  2022-01-01: 1_008
+  2023-01-01: 1_092
+  2024-01-01: 1_133
+  2025-01-01: 1_167
+  2026-01-01: 1_200
 SC:
   2018-01-01: -.inf
 SD:
@@ -97,14 +197,21 @@ TN:
   2018-01-01: 241
 TX:
   2018-01-01: 104
-UT:
-  2018-01-01: 1_012
 VA:
   2018-01-01: 493
 VT:
+  # The protected income level (PIL) outside Chittenden County, the same for
+  # one and two people (HBEE 8.06(b), 29.14). The higher PIL inside Chittenden
+  # County is not modeled. No 2019 PIL was found, so 2018's value stays in
+  # force through 2019.
   2018-01-01: 1_041
-WA:
-  2018-01-01: 750
+  2020-01-01: 1_091
+  2021-01-01: 1_100
+  2022-01-01: 1_166
+  2023-01-01: 1_258
+  2024-01-01: 1_300
+  2025-01-01: 1_333
+  2026-01-01: 1_375
 WV:
   2018-01-01: 200
 WI:
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_up_monthly.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_up_monthly.yaml
new file mode 100644
index 00000000000..50e188d6a67
--- /dev/null
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/rounds_up_monthly.yaml
@@ -0,0 +1,21 @@
+description: States round the monthly medically needy income limit up to the next whole dollar under the Medicaid program, if this is true.
+metadata:
+  unit: bool
+  period: year
+  label: Medicaid medically needy income limit rounded up to a whole dollar
+  breakdown:
+    - state_code
+  reference:
+    - title: New York DOH GIS 26 MA/05, Attachment I, SSI-Related Medicaid Income Level $1,836 / $2,489 (138% FPL)
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/26ma05_att1.pdf#page=2
+    - title: New York DOH GIS 25 MA/03, Attachment I, SSI-Related Medicaid Income Level $1,800 / $2,433 (138% FPL)
+      href: https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/25ma03_att1.pdf#page=2
+    - title: North Dakota Manual Letter 3702, medically needy income levels $1,009 / $1,364 (83% FPL)
+      href: https://www.nd.gov/dhs/policymanuals/51003/Content/ML/2023/ML%203702%20Federal%20Poverty%20Level%20Updates%2004-01-2023.pdf#page=6
+    - title: North Dakota Non-ACA Medicaid Manual 510-05-85-40 (archived, ML 3896), medically needy income level $1,130 (90% FPL)
+      href: https://www.nd.gov/dhs/policymanuals/51005/Archived%20Documents/2025/3896/510_05_85_40.htm
+
+ND:
+  2018-01-01: true
+NY:
+  2018-01-01: true
diff --git a/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml
new file mode 100644
index 00000000000..4240fcfd4ec
--- /dev/null
+++ b/policyengine_us/parameters/gov/hhs/medicaid/eligibility/categories/medically_needy/limit/income/ssi_rate.yaml
@@ -0,0 +1,23 @@
+description: States set the medically needy income limit at this share of the Supplemental Security Income federal benefit rate under the Medicaid program.
+# NOTE: States not listed, or with a share of zero, use the dollar limits in individual.yaml and couple.yaml.
+metadata:
+  unit: /1
+  period: year
+  label: Medicaid medically needy income limit as a share of the SSI federal benefit rate
+  breakdown:
+    - state_code
+  reference:
+    - title: "CMS approval of Kansas State Plan Amendment KS-25-0019, medically needy income disregard to the SSI federal benefit rate #page 2,46"
+      href: https://www.medicaid.gov/medicaid/spa/downloads/KS-25-0019.pdf#page=2
+    - title: Kansas Medical Assistance Standards, KEESM Appendix F-8 (January 2026), Income Standards for Independent Living
+      href: https://www.kancare.ks.gov/home/showpublisheddocument/6204/639013856776770000#page=3
+    - title: Washington Administrative Code 182-519-0050(5) - Monthly income and countable resource standards for medically needy (MN)
+      href: https://app.leg.wa.gov/WAC/default.aspx?cite=182-519-0050
+    - title: Washington State Register 12-20-001, amending WAC 182-519-0050
+      href: https://lawfilesext.leg.wa.gov/law/wsr/2012/20/12-20-001.htm
+
+KS:
+  2018-01-01: 0
+  2025-07-01: 1
+WA:
+  2018-01-01: 1
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml
index b0321c9414c..b6eb2c88179 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_in_medicaid_medically_needy_category.yaml
@@ -31,3 +31,62 @@
     state_code: TX
   output:
     is_in_medicaid_medically_needy_category: false
+
+- name: Case 3, disabled adults in Arkansas, Iowa, Illinois, North Dakota and New Jersey are in a medically needy category.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 50
+        meets_ssi_disability_criteria: true
+      person2:
+        age: 50
+        meets_ssi_disability_criteria: true
+      person3:
+        age: 50
+        meets_ssi_disability_criteria: true
+      person4:
+        age: 50
+        meets_ssi_disability_criteria: true
+      person5:
+        age: 50
+        meets_ssi_disability_criteria: true
+    households:
+      household1:
+        members: [person1]
+        state_code: AR
+      household2:
+        members: [person2]
+        state_code: IA
+      household3:
+        members: [person3]
+        state_code: IL
+      household4:
+        members: [person4]
+        state_code: ND
+      household5:
+        members: [person5]
+        state_code: NJ
+  output:
+    # Iowa 441-75.8(2)"c" (SSI-related persons), the NJ fact sheet (blind or
+    # disabled), NDAC 75-02-02.1-26(1) (aged, blind and disabled groups), the
+    # AR AABD spend down and IL PM 15-06-02-c cover disabled people.
+    is_in_medicaid_medically_needy_category: [true, true, true, true, true]
+
+- name: Case 4, a senior and a disabled adult in Arizona, which has no medically needy pathway for them, are not in a medically needy category.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 40
+        meets_ssi_disability_criteria: true
+    households:
+      household:
+        members: [person1, person2]
+        state_code: AZ
+  output:
+    # KFF 2026 lists no medically needy pathway for older adults or people
+    # with disabilities in Arizona (likewise ID, IN, NM and NV).
+    is_in_medicaid_medically_needy_category: [false, false]
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml
index 0d83bd5f24d..7703179e97a 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.yaml
@@ -408,3 +408,371 @@
     # = 6,264.
     ssi_countable_income: [19_760, 29_760]
     is_medically_needy_for_medicaid: [true, false]
+
+- name: Case 14, Arkansas senior qualifies after medical spenddown.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 14_160
+    medicaid_medically_needy_medical_expenses: 13_000
+    ssi_countable_resources: 1_500
+    state_code: AR
+  output:
+    # Limit 108.33 x 12 = 1,299.96. 14,160 is over it; 14,160 - 13,000 = 1,160 is not.
+    is_in_medicaid_medically_needy_category: true
+    is_medically_needy_for_medicaid: true
+
+- name: Case 15, Iowa senior qualifies after medical spenddown.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 14_160
+    medicaid_medically_needy_medical_expenses: 9_000
+    ssi_countable_resources: 8_000
+    state_code: IA
+  output:
+    # Limit 483 x 12 = 5,796. 14,160 - 9,000 = 5,160; assets 8,000 are under 10,000.
+    is_in_medicaid_medically_needy_category: true
+    is_medically_needy_for_medicaid: true
+
+- name: Case 16, New Jersey senior above the optional aged, blind and disabled limit qualifies after medical spenddown.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 18_000
+    medicaid_medically_needy_medical_expenses: 14_000
+    ssi_countable_resources: 4_000
+    state_code: NJ
+  output:
+    # 18,000 is over NJ's 100% FPL optional limit (15,960) and the SSI rate (11,928).
+    # Limit 367 x 12 = 4,404; 18,000 - 14,000 = 4,000. Assets 4,000 equal the limit.
+    is_in_medicaid_medically_needy_category: true
+    is_medically_needy_for_medicaid: true
+
+- name: Case 17, Illinois senior qualifies after medical spenddown.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 20_000
+    medicaid_medically_needy_medical_expenses: 5_000
+    ssi_countable_resources: 17_500
+    state_code: IL
+  output:
+    # Limit 15,960 (100% FPG). 20,000 - 5,000 = 15,000; assets 17,500 equal the limit.
+    is_in_medicaid_medically_needy_category: true
+    is_medically_needy_for_medicaid: true
+
+- name: Case 18, North Dakota senior qualifies after medical spenddown.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 18_364
+    medicaid_medically_needy_medical_expenses: 4_000
+    ssi_countable_resources: 2_500
+    state_code: ND
+  output:
+    # Limit 0.9 x 15,960 = 14,364. 18,364 - 4,000 = 14,364, equal to the limit;
+    # assets 2,500 are under 3,000.
+    is_in_medicaid_medically_needy_category: true
+    is_medically_needy_for_medicaid: true
+
+- name: Case 19, California senior with assets exactly at the reinstated 2026 limit qualifies.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 26_400
+    medicaid_medically_needy_medical_expenses: 19_500
+    ssi_countable_resources: 130_000
+    state_code: CA
+  output:
+    # 26,400 is over the Aged and Disabled FPL limit (138% FPL, 22,024.80) and the
+    # SSI and SSP payment level. Limit 600 x 12 = 7,200; 26,400 - 19,500 = 6,900.
+    # Assets equal the 130,000 limit.
+    is_in_medicaid_medically_needy_category: true
+    is_medically_needy_for_medicaid: true
+
+- name: Case 20, New York senior with assets at the 2026 resource level qualifies.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 25_000
+    medicaid_medically_needy_medical_expenses: 5_000
+    ssi_countable_resources: 33_038
+    state_code: NY
+  output:
+    # Limit 1,836 x 12 = 22,032 (GIS 26 MA/05). 25,000 - 5,000 = 20,000; assets 33,038 equal
+    # the 2026 resource level.
+    is_in_medicaid_medically_needy_category: true
+    is_medically_needy_for_medicaid: true
+
+- name: Case 21, California senior one dollar over the reinstated 2026 asset limit is ineligible.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 26_400
+    medicaid_medically_needy_medical_expenses: 19_500
+    ssi_countable_resources: 130_001
+    state_code: CA
+  output:
+    # Income passes (6,900 <= 7,200); assets 130,001 exceed 130,000.
+    is_medically_needy_for_medicaid: false
+
+- name: Case 22, California senior with large assets qualifies in 2024, when non-MAGI asset limits did not apply.
+  period: 2024
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 26_400
+    medicaid_medically_needy_medical_expenses: 19_500
+    ssi_countable_resources: 1_000_000
+    state_code: CA
+  output:
+    # ACWDL 22-25: no asset limit from January 1, 2024. Limit 600 x 12 = 7,200;
+    # 26,400 - 19,500 = 6,900.
+    is_medically_needy_for_medicaid: true
+
+- name: Case 23, New York senior with resources exactly at each year's level qualifies.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: {2022: 70, 2023: 71, 2024: 72, 2025: 73, 2026: 74}
+        is_adult_for_medicaid: {2022: false, 2023: false, 2024: false, 2025: false, 2026: false}
+        is_optional_senior_or_disabled_for_medicaid: {2022: false, 2023: false, 2024: false, 2025: false, 2026: false}
+        is_ssi_recipient_for_medicaid: {2022: false, 2023: false, 2024: false, 2025: false, 2026: false}
+        ssi_countable_income: {2022: 25_000, 2023: 25_000, 2024: 25_000, 2025: 25_000, 2026: 25_000}
+        medicaid_medically_needy_medical_expenses: {2022: 15_000, 2023: 5_000, 2024: 5_000, 2025: 5_000, 2026: 5_000}
+        ssi_countable_resources: {2022: 16_800, 2023: 30_182, 2024: 31_175, 2025: 32_396, 2026: 33_038}
+    households:
+      household:
+        members: [person1]
+        state_code: {2022: NY, 2023: NY, 2024: NY, 2025: NY, 2026: NY}
+  output:
+    # 2022: 25,000 - 15,000 = 10,000 <= 934 x 12 = 11,208.
+    # 2023-2026: 20,000 <= 12 x 1,677, 1,732, 1,800 and 1,836 (20,124, 20,784, 21,600, 22,032).
+    # Resources equal each year's level (GIS 22 MA/11 p2; the 2023-2026 GIS
+    # attachments).
+    is_medically_needy_for_medicaid:
+      2022: true
+      2023: true
+      2024: true
+      2025: true
+      2026: true
+
+- name: Case 24, New York, California and Illinois couples with resources exactly at the 2026 couple limits qualify.
+  period: 2026
+  input:
+    people:
+      person1:
+        age: 70
+        is_tax_unit_head: true
+        is_adult_for_medicaid: false
+        is_optional_senior_or_disabled_for_medicaid: false
+        is_ssi_recipient_for_medicaid: false
+        ssi_countable_income: 20_000
+        medicaid_medically_needy_medical_expenses: 6_000
+        ssi_countable_resources: 22_398
+      person2:
+        age: 68
+        is_tax_unit_spouse: true
+        is_adult_for_medicaid: false
+        is_optional_senior_or_disabled_for_medicaid: false
+        is_ssi_recipient_for_medicaid: false
+        ssi_countable_income: 20_000
+        medicaid_medically_needy_medical_expenses: 6_000
+        ssi_countable_resources: 22_398
+      person3:
+        age: 72
+        is_tax_unit_head: true
+        is_adult_for_medicaid: false
+        is_optional_senior_or_disabled_for_medicaid: false
+        is_ssi_recipient_for_medicaid: false
+        ssi_countable_income: 18_000
+        medicaid_medically_needy_medical_expenses: 12_500
+        ssi_countable_resources: 97_500
+      person4:
+        age: 70
+        is_tax_unit_spouse: true
+        is_adult_for_medicaid: false
+        is_optional_senior_or_disabled_for_medicaid: false
+        is_ssi_recipient_for_medicaid: false
+        ssi_countable_income: 18_000
+        medicaid_medically_needy_medical_expenses: 12_500
+        ssi_countable_resources: 97_500
+      person5:
+        age: 71
+        is_tax_unit_head: true
+        is_adult_for_medicaid: false
+        is_optional_senior_or_disabled_for_medicaid: false
+        is_ssi_recipient_for_medicaid: false
+        ssi_countable_income: 14_000
+        medicaid_medically_needy_medical_expenses: 3_500
+        ssi_countable_resources: 8_750
+      person6:
+        age: 69
+        is_tax_unit_spouse: true
+        is_adult_for_medicaid: false
+        is_optional_senior_or_disabled_for_medicaid: false
+        is_ssi_recipient_for_medicaid: false
+        ssi_countable_income: 14_000
+        medicaid_medically_needy_medical_expenses: 3_500
+        ssi_countable_resources: 8_750
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3, person4]
+      marital_unit3:
+        members: [person5, person6]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+        tax_unit_is_joint: true
+      tax_unit2:
+        members: [person3, person4]
+        tax_unit_is_joint: true
+      tax_unit3:
+        members: [person5, person6]
+        tax_unit_is_joint: true
+    spm_units:
+      spm_unit1:
+        members: [person1, person2]
+      spm_unit2:
+        members: [person3, person4]
+      spm_unit3:
+        members: [person5, person6]
+    households:
+      household1:
+        members: [person1, person2]
+        state_code: NY
+      household2:
+        members: [person3, person4]
+        state_code: CA
+      household3:
+        members: [person5, person6]
+        state_code: IL
+  output:
+    # NY: 40,000 - 12,000 = 28,000 <= 2,489 x 12 = 29,868; assets 44,796.
+    # CA: 36,000 - 25,000 = 11,000 <= 934 x 12 = 11,208; assets 195,000.
+    # IL: 28,000 - 7,000 = 21,000 <= 1,803 x 12 = 21,636; assets 17,500 (PM 07-02-01).
+    is_medically_needy_for_medicaid: [true, true, true, true, true, true]
+
+- name: Case 25, Vermont senior with income after medical expenses at the 2026 protected income level qualifies.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 20_000
+    medicaid_medically_needy_medical_expenses: 3_500
+    ssi_countable_resources: 1_500
+    state_code: VT
+  output:
+    # HBEE 8.06(b): income at or below the PIL. 1,375 x 12 = 16,500;
+    # 20,000 - 3,500 = 16,500, equal to the limit.
+    is_medically_needy_for_medicaid: true
+
+- name: Case 26, Vermont senior with income after medical expenses one dollar a month over the 2026 protected income level is ineligible.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 20_000
+    medicaid_medically_needy_medical_expenses: 3_488
+    ssi_countable_resources: 1_500
+    state_code: VT
+  output:
+    # 20,000 - 3,488 = 16,512, or 1,376 a month, over 1,375.
+    is_medically_needy_for_medicaid: false
+
+- name: Case 27, Illinois senior with assets at the 17,500 limit qualifies in 2024.
+  period: 2024
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 20_000
+    medicaid_medically_needy_medical_expenses: 6_000
+    ssi_countable_resources: 17_500
+    state_code: IL
+  output:
+    # Limit 15,060 (100% FPG, 2024). 20,000 - 6,000 = 14,000; assets 17,500 equal
+    # the limit from 2023-05-12, first read in 2024 (PM 07-02-01).
+    is_in_medicaid_medically_needy_category: true
+    is_medically_needy_for_medicaid: true
+
+- name: Case 28, New York senior at the published 1,836 monthly level qualifies in 2026.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 22_032
+    medicaid_medically_needy_medical_expenses: 0
+    ssi_countable_resources: 1_000
+    state_code: NY
+  output:
+    # GIS 26 MA/05: 1,836 x 12 = 22,032 (138% FPL is 1,835.40, rounded up).
+    is_medically_needy_for_medicaid: true
+
+- name: Case 29, New York senior one dollar a year above the published level does not qualify in 2026.
+  period: 2026
+  input:
+    age: 70
+    is_adult_for_medicaid: false
+    is_optional_senior_or_disabled_for_medicaid: false
+    is_ssi_recipient_for_medicaid: false
+    ssi_countable_income: 22_033
+    medicaid_medically_needy_medical_expenses: 0
+    ssi_countable_resources: 1_000
+    state_code: NY
+  output:
+    # 22,033 is above the published 22,032 (1,836 x 12).
+    is_medically_needy_for_medicaid: false
+
+- name: Case 30, Illinois couple above the published 1,803 monthly level does not qualify in 2026.
+  period: 2026
+  input:
+    people:
+      person1: {age: 70, is_tax_unit_head: true, is_adult_for_medicaid: false, is_optional_senior_or_disabled_for_medicaid: false, is_ssi_recipient_for_medicaid: false, ssi_countable_income: 21_640, medicaid_medically_needy_medical_expenses: 0, ssi_countable_resources: 1_000}
+      person2: {age: 68, is_tax_unit_spouse: true, is_adult_for_medicaid: false, is_optional_senior_or_disabled_for_medicaid: false, is_ssi_recipient_for_medicaid: false, ssi_countable_income: 0, medicaid_medically_needy_medical_expenses: 0, ssi_countable_resources: 0}
+    marital_units:
+      marital_unit: {members: [person1, person2]}
+    tax_units:
+      tax_unit: {members: [person1, person2]}
+    households:
+      household: {members: [person1, person2], state_code: IL}
+  output:
+    # WAG 25-03-02(2): 1,803 x 12 = 21,636 (21,640 / 12 = 1,803.33, cents dropped).
+    is_medically_needy_for_medicaid: [false, false]
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml
new file mode 100644
index 00000000000..a3ca7c189d8
--- /dev/null
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.yaml
@@ -0,0 +1,604 @@
+- name: Case 1, Connecticut couple and individual dollar limits from 2023 to 2027.
+  period: 2027
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 74
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+      tax_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2023: CT, 2024: CT, 2025: CT, 2026: CT, 2027: CT}
+  output:
+    # Outputs are [couple, couple, individual]. The annual variable reads the
+    # amount in force on January 1, times 12: 2023 879 / 653 (2022-07-01);
+    # 2024 946 / 700 (2024-01-01); 2025 980 / 723 (2024-03-01);
+    # 2026 1,128 / 835 (2025-03-01); 2027 1,153 / 851 (2026-03-01).
+    medicaid_medically_needy_income_limit:
+      2023: [10_548, 10_548, 7_836]
+      2024: [11_352, 11_352, 8_400]
+      2025: [11_760, 11_760, 8_676]
+      2026: [13_536, 13_536, 10_020]
+      2027: [13_836, 13_836, 10_212]
+
+- name: Case 2, District of Columbia couple and individual dollar limits from 2023 to 2026.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 74
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+      tax_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2023: DC, 2024: DC, 2025: DC, 2026: DC}
+  output:
+    # Outputs are [couple, couple, individual]: 821.67 / 780.58, 851.67 / 809.08,
+    # 881.25 / 837.19 and 901.67 / 856.58, each times 12.
+    medicaid_medically_needy_income_limit:
+      2023: [9_860.04, 9_860.04, 9_366.96]
+      2024: [10_220.04, 10_220.04, 9_708.96]
+      2025: [10_575, 10_575, 10_046.28]
+      2026: [10_820.04, 10_820.04, 10_278.96]
+
+- name: Case 3, Kansas uses its 475-dollar limit for 2025; the July 2025 switch to the SSI rate applies from 2026 in this annual variable.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    state_code: KS
+  output:
+    # 475 x 12 = 5,700.
+    medicaid_medically_needy_income_limit: 5_700
+
+- name: Case 4, Kansas couple uses the SSI couple rate from July 2025.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: KS
+  output:
+    # 1,491 x 12 = 17,892.
+    medicaid_medically_needy_income_limit: [17_892, 17_892]
+
+- name: Case 5, Minnesota uses 100 percent of the poverty guideline.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    state_code: MN
+  output:
+    # 1.00 x 15,960 = 15,960.
+    medicaid_medically_needy_income_limit: 15_960
+
+- name: Case 6, New Hampshire couple and individual dollar limits in 2023, 2025 and 2026.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 74
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+      tax_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2023: NH, 2025: NH, 2026: NH}
+  output:
+    # Outputs are [couple, couple, individual]: 1,033 / 888 (2023-01-01),
+    # 1,066 / 916 (2025-01-01) and 1,093 / 939 (2025-07-01, first read in 2026),
+    # each times 12.
+    medicaid_medically_needy_income_limit:
+      2023: [12_396, 12_396, 10_656]
+      2025: [12_792, 12_792, 10_992]
+      2026: [13_116, 13_116, 11_268]
+
+- name: Case 7, New York couple uses 138 percent of the poverty guideline.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: NY
+  output:
+    # 1.38 x 21,640 / 12 = 2,488.60, rounded up to 2,489 (GIS 26 MA/05):
+    # 2,489 x 12 = 29,868.
+    medicaid_medically_needy_income_limit: [29_868, 29_868]
+
+- name: Case 8, Rhode Island couple and individual dollar limits from 2019 to 2026.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 74
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+      tax_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2019: RI, 2020: RI, 2021: RI, 2022: RI, 2023: RI, 2024: RI, 2025: RI, 2026: RI}
+  output:
+    # Outputs are [couple, couple, individual]: the MNIL updated each January 1,
+    # times 12 (958 / 917 in 2019 up to 1,242 / 1,200 in 2026).
+    medicaid_medically_needy_income_limit:
+      2019: [11_496, 11_496, 11_004]
+      2020: [11_700, 11_700, 11_196]
+      2021: [11_904, 11_904, 11_400]
+      2022: [12_600, 12_600, 12_096]
+      2023: [13_596, 13_596, 13_104]
+      2024: [14_100, 14_100, 13_596]
+      2025: [14_496, 14_496, 14_004]
+      2026: [14_904, 14_904, 14_400]
+
+- name: Case 9, Utah couple uses 100 percent of the two-person poverty guideline.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: UT
+  output:
+    # 1.00 x 21,640 = 21,640.
+    medicaid_medically_needy_income_limit: [21_640, 21_640]
+
+- name: Case 10, Washington couple uses the one-person SSI rate.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: WA
+  output:
+    # 994 x 12 = 11,928.
+    medicaid_medically_needy_income_limit: [11_928, 11_928]
+
+- name: Case 11, Wisconsin uses 100 percent of the poverty guideline.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    state_code: WI
+  output:
+    # 1.00 x 15,960 = 15,960.
+    medicaid_medically_needy_income_limit: 15_960
+
+- name: Case 12, Illinois couple uses 100 percent of the two-person poverty guideline.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+    marital_units:
+      marital_unit:
+        members: [person1, person2]
+    tax_units:
+      tax_unit:
+        members: [person1, person2]
+    households:
+      household:
+        members: [person1, person2]
+        state_code: IL
+  output:
+    # 21,640 / 12 = 1,803.33, with the cents dropped (WAG 25-03-02(2)):
+    # 1,803 x 12 = 21,636.
+    medicaid_medically_needy_income_limit: [21_636, 21_636]
+
+- name: Case 13, North Dakota uses 90 percent of the poverty guideline.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    age: 70
+    state_code: ND
+  output:
+    # 0.9 x 15,960 = 14,364.
+    medicaid_medically_needy_income_limit: 14_364
+
+- name: Case 14, New York uses its dollar limit in 2022 and 138 percent of the poverty guideline from 2023.
+  period: 2023
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 74
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+      tax_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2022: NY, 2023: NY}
+  output:
+    # Outputs are [couple, couple, individual]. 2022: 1,367 / 934 times 12.
+    # 2023: 1.38 x 19,720 / 12 = 2,267.80 and 1.38 x 14,580 / 12 = 1,676.70,
+    # rounded up to 2,268 and 1,677 a month.
+    medicaid_medically_needy_income_limit:
+      2022: [16_404, 16_404, 11_208]
+      2023: [27_216, 27_216, 20_124]
+
+- name: Case 15, Minnesota uses 80 percent of the poverty guideline in 2019 and 81 percent in 2020.
+  period: 2020
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 74
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+      tax_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2019: MN, 2020: MN}
+  output:
+    # Outputs are [couple, couple, individual]. 2019: 0.8 x 16,910 and
+    # 0.8 x 12,490. The June 2019 rate of 0.81 is first read in 2020:
+    # 0.81 x 17,240 and 0.81 x 12,760.
+    medicaid_medically_needy_income_limit:
+      2019: [13_528, 13_528, 9_992]
+      2020: [13_964.4, 13_964.4, 10_335.6]
+
+- name: Case 16, North Dakota uses 83 percent of the poverty guideline in 2023.
+  period: 2023
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 74
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+      tax_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2023: ND}
+  output:
+    # Outputs are [couple, couple, individual]: 0.83 x 19,720 / 12 = 1,363.97
+    # and 0.83 x 14,580 / 12 = 1,008.45, rounded up to 1,364 and 1,009 a month
+    # (ML 3702).
+    medicaid_medically_needy_income_limit:
+      2023: [16_368, 16_368, 12_108]
+
+- name: Case 17, Wisconsin uses its dollar limit in 2019 and 100 percent of the poverty guideline from 2020.
+  period: 2020
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 74
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+      tax_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2019: WI, 2020: WI}
+  output:
+    # Outputs are [couple, couple, individual]. 2019: 592 for one or two
+    # people, times 12. The September 2019 rate is first read in 2020.
+    medicaid_medically_needy_income_limit:
+      2019: [7_104, 7_104, 7_104]
+      2020: [17_240, 17_240, 12_760]
+
+- name: Case 18, Vermont uses its protected income level outside Chittenden County from 2018 to 2026.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1:
+        age: 70
+      person2:
+        age: 68
+      person3:
+        age: 74
+    marital_units:
+      marital_unit1:
+        members: [person1, person2]
+      marital_unit2:
+        members: [person3]
+    tax_units:
+      tax_unit1:
+        members: [person1, person2]
+      tax_unit2:
+        members: [person3]
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2018: VT, 2019: VT, 2020: VT, 2021: VT, 2022: VT, 2023: VT, 2024: VT, 2025: VT, 2026: VT}
+  output:
+    # Outputs are [couple, couple, individual]. The PIL is the same for one and
+    # two people, effective each January 1, times 12: 1,041 (2018, kept in
+    # 2019), 1,091, 1,100, 1,166, 1,258, 1,300, 1,333 and 1,375.
+    medicaid_medically_needy_income_limit:
+      2018: [12_492, 12_492, 12_492]
+      2019: [12_492, 12_492, 12_492]
+      2020: [13_092, 13_092, 13_092]
+      2021: [13_200, 13_200, 13_200]
+      2022: [13_992, 13_992, 13_992]
+      2023: [15_096, 15_096, 15_096]
+      2024: [15_600, 15_600, 15_600]
+      2025: [15_996, 15_996, 15_996]
+      2026: [16_500, 16_500, 16_500]
+
+- name: Case 19, Arkansas, Iowa and New Jersey couple and individual dollar limits in 2026.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1: {age: 70}
+      person2: {age: 68}
+      person3: {age: 74}
+      person4: {age: 70}
+      person5: {age: 68}
+      person6: {age: 74}
+      person7: {age: 70}
+      person8: {age: 68}
+      person9: {age: 74}
+    marital_units:
+      marital_unit1: {members: [person1, person2]}
+      marital_unit2: {members: [person3]}
+      marital_unit3: {members: [person4, person5]}
+      marital_unit4: {members: [person6]}
+      marital_unit5: {members: [person7, person8]}
+      marital_unit6: {members: [person9]}
+    tax_units:
+      tax_unit1: {members: [person1, person2]}
+      tax_unit2: {members: [person3]}
+      tax_unit3: {members: [person4, person5]}
+      tax_unit4: {members: [person6]}
+      tax_unit5: {members: [person7, person8]}
+      tax_unit6: {members: [person9]}
+    households:
+      household1: {members: [person1, person2, person3], state_code: AR}
+      household2: {members: [person4, person5, person6], state_code: IA}
+      household3: {members: [person7, person8, person9], state_code: NJ}
+  output:
+    # AR: 216.66 / 108.33 x 12; IA: 483 / 483 x 12; NJ: 434 / 367 x 12.
+    medicaid_medically_needy_income_limit: [2_599.92, 2_599.92, 1_299.96, 5_796, 5_796, 5_796, 5_208, 5_208, 4_404]
+
+- name: Case 20, North Dakota uses 90 percent of the poverty guideline from 2024 and Minnesota 100 percent from 2023.
+  period: 2024
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1: {age: 70}
+      person2: {age: 70}
+    marital_units:
+      marital_unit1: {members: [person1]}
+      marital_unit2: {members: [person2]}
+    tax_units:
+      tax_unit1: {members: [person1]}
+      tax_unit2: {members: [person2]}
+    households:
+      household1: {members: [person1], state_code: {2023: MN, 2024: MN}}
+      household2: {members: [person2], state_code: {2023: ND, 2024: ND}}
+  output:
+    # [MN, ND]. 2023: 100% and 83% of 14,580 (ND 1,008.45 rounds up to 1,009 a month).
+    # 2024: 100% and 90% of 15,060 (ND 1,129.50 rounds up to 1,130, ML 3896).
+    medicaid_medically_needy_income_limit:
+      2023: [14_580, 12_108]
+      2024: [15_060, 13_560]
+
+- name: Case 21, aged parent claimed as a dependent on a married child's joint return uses the individual limit.
+  period: 2026
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1: {age: 50, is_tax_unit_head: true}
+      person2: {age: 48, is_tax_unit_spouse: true}
+      person3: {age: 78, is_tax_unit_dependent: true}
+    marital_units:
+      marital_unit1: {members: [person1, person2]}
+      marital_unit2: {members: [person3]}
+    tax_units:
+      tax_unit: {members: [person1, person2, person3]}
+    households:
+      household: {members: [person1, person2, person3], state_code: NY}
+  output:
+    # 42 CFR 435.602: the unit is the individual or married couple, not the tax unit.
+    # person3 is unmarried: 1.38 x 15,960 / 12 = 1,835.40, rounded up to 1,836, x 12.
+    medicaid_medically_needy_income_limit: [29_868, 29_868, 22_032]
+
+- name: Case 22, District of Columbia couple and individual limits from 2019 to 2022 follow 29 DCMR 901.1.
+  period: 2022
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1: {age: 70}
+      person2: {age: 68}
+      person3: {age: 74}
+    marital_units:
+      marital_unit1: {members: [person1, person2]}
+      marital_unit2: {members: [person3]}
+    tax_units:
+      tax_unit1: {members: [person1, person2]}
+      tax_unit2: {members: [person3]}
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2019: DC, 2020: DC, 2021: DC, 2022: DC}
+  output:
+    # Couple: 50% of the two-person guideline / 12; individual: 95% of that.
+    medicaid_medically_needy_income_limit:
+      2019: [8_454.96, 8_454.96, 8_032.2]
+      2020: [8_619.96, 8_619.96, 8_189.04]
+      2021: [8_709.96, 8_709.96, 8_274.48]
+      2022: [9_155.04, 9_155.04, 8_697.24]
+
+- name: Case 23, Illinois rounds to the nearest dollar from 2018 to 2024 and drops the cents in 2025.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      person1: {age: 70}
+      person2: {age: 68}
+      person3: {age: 74}
+    marital_units:
+      marital_unit1: {members: [person1, person2]}
+      marital_unit2: {members: [person3]}
+    tax_units:
+      tax_unit1: {members: [person1, person2]}
+      tax_unit2: {members: [person3]}
+    households:
+      household:
+        members: [person1, person2, person3]
+        state_code: {2018: IL, 2022: IL, 2024: IL, 2025: IL}
+  output:
+    # Outputs are [couple, couple, individual]. KFF 2018; WAG 25-03-02(2), AABD 100% FPL.
+    # 2018: 16,460 / 12 = 1,371.67 to 1,372; 12,140 / 12 = 1,011.67 to 1,012.
+    # 2022: 18,310 / 12 = 1,525.83 to 1,526; 13,590 / 12 = 1,132.50 to 1,133.
+    # 2024: 20,440 / 12 = 1,703.33 to 1,703; 15,060 / 12 = 1,255 exactly.
+    # 2025: 21,150 / 12 = 1,762.50, cents dropped, 1,762; 15,650 / 12 = 1,304.17 to 1,304.
+    medicaid_medically_needy_income_limit:
+      2018: [16_464, 16_464, 12_144]
+      2022: [18_312, 18_312, 13_596]
+      2024: [20_436, 20_436, 15_060]
+      2025: [21_144, 21_144, 15_648]
diff --git a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml
index 4cf3c9c0b0f..dd7d9a1821c 100644
--- a/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml
+++ b/policyengine_us/tests/policy/baseline/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_medical_expenses.yaml
@@ -28,17 +28,19 @@
     is_optional_senior_or_disabled_for_medicaid: false
     # Isolate spenddown from the separate SSI-recipient Medicaid pathway.
     is_ssi_recipient_for_medicaid: false
-    employment_income: 27_020
+    employment_income: 35_020
     ssi_countable_resources: 1_000
     state_code: KS
     health_insurance_premiums: 2_000
     pre_tax_health_insurance_premiums: 4_000
     medicare_enrolled: false
   output:
-    # (27,020 - 4,000 - 12 * (20 + 65)) / 2 = 11,000.
+    # (35,020 - 4,000 - 12 * (20 + 65)) / 2 = 15,000.
+    # 15,000 - 2,000 = 13,000 is over the 2026 limit of 12 * 994 = 11,928;
+    # deducting the 4,000 pretax premium again would pass at 9,000.
     is_ssi_aged_blind_disabled: true
-    ssi_earned_income: 23_020
-    ssi_countable_income: 11_000
+    ssi_earned_income: 31_020
+    ssi_countable_income: 15_000
     medicaid_medically_needy_medical_expenses: 2_000
     is_ssi_recipient_for_medicaid: false
     is_medically_needy_for_medicaid: false
diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.py
index 01e6b76825e..633c16213f9 100644
--- a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.py
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/is_medically_needy_for_medicaid.py
@@ -62,11 +62,7 @@ def formula(person, period, parameters):
         mn = ma.eligibility.categories.medically_needy
         is_joint = marital_unit.nb_persons() == 2
         state = person.household("state_code_str", period)
-        income_limit = MONTHS_IN_YEAR * where(
-            is_joint,
-            mn.limit.income.couple[state],
-            mn.limit.income.individual[state],
-        )
+        income_limit = person("medicaid_medically_needy_income_limit", period)
         asset_limit = where(
             is_joint,
             mn.limit.assets.couple[state],
diff --git a/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py
new file mode 100644
index 00000000000..dd644e12c12
--- /dev/null
+++ b/policyengine_us/variables/gov/hhs/medicaid/eligibility/categories/medically_needy/medicaid_medically_needy_income_limit.py
@@ -0,0 +1,65 @@
+from policyengine_us.model_api import *
+from policyengine_us.variables.gov.hhs.tax_unit_fpg import fpg
+
+
+class medicaid_medically_needy_income_limit(Variable):
+    value_type = float
+    entity = Person
+    label = "Medicaid medically needy income limit"
+    unit = USD
+    definition_period = YEAR
+    reference = (
+        "https://www.ecfr.gov/current/title-42/section-435.811",
+        "https://www.ecfr.gov/current/title-42/section-435.602",
+    )
+
+    def formula(person, period, parameters):
+        p = parameters(
+            period
+        ).gov.hhs.medicaid.eligibility.categories.medically_needy.limit.income
+        state = person.household("state_code_str", period)
+        # SSI financial responsibility rules (42 CFR 435.602): the unit is
+        # the individual or the married couple, not the tax filing unit.
+        is_couple = person.marital_unit.nb_persons() == 2
+        # Some states apply the one-person limit to a couple.
+        same_limit = p.couple_uses_individual_limit[state].astype(bool)
+        uses_couple_limit = is_couple & ~same_limit
+        dollar_limit = where(uses_couple_limit, p.couple[state], p.individual[state])
+        state_group = person.household("state_group_str", period)
+        unit_fpg = fpg(where(uses_couple_limit, 2, 1), state_group, period, parameters)
+        ssi = parameters(period).gov.ssa.ssi.amount
+        fbr = where(uses_couple_limit, ssi.couple, ssi.individual)
+        fpg_rate = p.fpg_rate[state]
+        ssi_rate = p.ssi_rate[state]
+        fpg_limit = fpg_rate * unit_fpg
+        # Some states publish the monthly level in whole dollars. Fix the
+        # monthly amount at cent precision first, so floating-point noise
+        # cannot move an exact whole dollar (as in medicaid_income_level).
+        fpg_monthly = np.round(fpg_limit / MONTHS_IN_YEAR, 2)
+        # Illinois rounds to the nearest dollar before 2025, then drops the cents.
+        in_il = state == "IL"
+        rounds_down = in_il & p.il.rounds_down_monthly
+        # Half a dollar rounds up ($1,132.50 to $1,133 in 2022); np.round
+        # would round it to the even dollar.
+        rounds_to_nearest = in_il & p.il.rounds_to_nearest_monthly
+        fpg_limit = select(
+            [
+                p.rounds_up_monthly[state].astype(bool),
+                rounds_down,
+                rounds_to_nearest,
+            ],
+            [
+                np.ceil(fpg_monthly) * MONTHS_IN_YEAR,
+                np.floor(fpg_monthly) * MONTHS_IN_YEAR,
+                np.floor(fpg_monthly + 0.5) * MONTHS_IN_YEAR,
+            ],
+            default=fpg_limit,
+        )
+        return select(
+            [fpg_rate > 0, ssi_rate > 0],
+            [
+                fpg_limit,
+                ssi_rate * fbr * MONTHS_IN_YEAR,
+            ],
+            default=dollar_limit * MONTHS_IN_YEAR,
+        )