Medicaid goes by regular recurring income on a monthly basis. Income can be lumpy so it can be annualized and divided by 12. The key is whether the income is regular and recurring. Each local office has a methodology on how to handle irregular income. It is possible to drop into Medicaid mid year if your income drops, for example your UI ends. Then re-estimate your income and be redetermined. While ACA income is based on calendar year, Medicaid is based on monthly income. You can be on an ACA metal plan for 6 months, then drop into Medicaid for the last 6 months. The ACA subsidy is based on your yearly income for those months you are on a ACA plan. There is no subsidy reconciliation for Medicaid since it is not considered to be insurance and no subsidy is involved.