Medicaid Eligibility in 2026: Income Limits, Expansion States, and How to Apply

Medicaid is the largest source of health coverage in the United States, jointly funded by the federal government and the states and run by each state within federal rules. Because every state runs its own program, Medicaid eligibility can differ dramatically depending on where you live. A single adult earning a modest wage might qualify in one state and be ineligible across the border. This guide explains the main eligibility categories, how income is measured, what is changing under recent federal law, how to apply.

Who Medicaid covers

Federal law requires states to cover certain mandatory groups and allows them to cover optional groups. Broadly, Medicaid serves:

Children in low- and moderate-income families, often together with the Children’s Health Insurance Program (CHIP).
Pregnant people, with coverage that most states now extend for 12 months postpartum.
Parents and caretaker relatives with low incomes.
Adults ages 19 to 64 without dependent children, in states that adopted the Affordable Care Act expansion.
Older adults and people with disabilities, including many who receive Supplemental Security Income.
People who need long-term care, including nursing home care, who meet income and asset rules.

Expansion vs non-expansion states

The Affordable Care Act allowed states to expand Medicaid to nearly all adults with incomes up to 138 percent of the federal poverty level (FPL). Most states, plus the District of Columbia, have adopted expansion. A minority have not, and in those states many low-income adults without children cannot qualify for Medicaid at all, regardless of how little they earn. People in that situation with incomes at or above 100 percent of FPL can often get subsidized marketplace coverage instead; those below 100 percent may fall into what is called the coverage gap.

Check your state’s current status on Medicaid.gov or HealthCare.gov, because states periodically change their programs through legislation or ballot measures.

How income is measured: MAGI

For most children, pregnant people, parents, and expansion adults, eligibility uses modified adjusted gross income (MAGI), the same tax-based method used for marketplace subsidies. Key features:

Income is based on current monthly income for Medicaid, not just last year’s tax return.
Household size follows tax filing rules, including spouses and tax dependents.
Child support received, veterans’ benefits, gifts, and Supplemental Security Income are generally not counted.
There is no asset test for MAGI groups.

The federal poverty guidelines are updated each year by the Department of Health and Human Services. For 2025, 100 percent of FPL in the 48 contiguous states was $15,650 for a household of one and $32,150 for a household of four; Alaska and Hawaii have higher guidelines. Under expansion, 138 percent of FPL for one person was therefore roughly $21,600 per year. Always check the current year’s figures, which are typically published in January.

Non-MAGI groups

People qualifying based on age 65 or older, blindness, or disability, as well as those seeking long-term care coverage, are usually evaluated under different rules that include asset limits. Many states set an asset limit of $2,000 for an individual, though limits vary and some states have raised or eliminated them for certain programs. Homes, one vehicle, and some personal property are usually exempt.

Children and CHIP

Children qualify at higher income levels than adults. Every state covers children in families up to at least 200 percent of FPL through Medicaid or CHIP, and many go much higher, in some states above 300 percent. CHIP may charge modest premiums or copays. If you are not sure whether your children qualify, apply anyway; the agency will screen for both programs.

Pregnancy coverage

Pregnant people qualify at higher income levels than other adults in every state, and coverage includes prenatal care, delivery, and postpartum care. Under a federal option that nearly every state has adopted, postpartum Medicaid lasts 12 months after pregnancy ends. Some states also cover pregnant people regardless of immigration status through CHIP’s unborn child option.

Recent federal changes: work requirements and more frequent checks

The budget reconciliation law enacted in July 2025, often called the One Big Beautiful Bill Act, made significant changes to Medicaid that phase in over the coming years. Key provisions include:

Community engagement requirements. Beginning no later than the end of 2026, with possible state extensions, expansion adults ages 19 to 64 will generally need to show at least 80 hours per month of work, community service, job training, education, or a combination, unless they qualify for an exemption. Exemptions include parents and caretakers of dependent children under 14, pregnant people, medically frail individuals, people with certain disabilities, and others defined in the law.
More frequent eligibility redeterminations. Expansion adults will have eligibility renewed every six months rather than annually.
Cost-sharing. States must impose some cost-sharing for expansion adults with incomes above the poverty level, with protections for certain services.

Implementation details depend on federal guidance and state choices, and several provisions may change through litigation or future legislation. If you are an expansion adult, keep your contact information current with your state agency and watch for notices so you do not lose coverage over paperwork.

Immigration status

Lawful permanent residents generally must wait five years before qualifying for full Medicaid, though states can waive the waiting period for children and pregnant people. Refugees, asylees, and certain other groups are eligible without the waiting period. Undocumented immigrants are not eligible for full federal Medicaid but may receive emergency Medicaid for emergency conditions, including labor and delivery. Some states use their own funds to cover additional groups. Applying for a child who is a citizen does not require parents to disclose their own immigration status beyond what is needed.

How to apply

You can apply for Medicaid at any time of year; there is no enrollment period.

Online through your state Medicaid agency’s website or through HealthCare.gov, which forwards applications to the state if you appear eligible.
By phone with your state agency.
In person at a local social services or human services office.
By mail with a paper application.

Gather documents such as pay stubs, tax returns, Social Security numbers for household members applying, proof of citizenship or immigration status, and proof of residence. States verify much of this electronically, but having documents ready speeds the process.

Federal rules generally require states to decide applications within 45 days, or 90 days for disability-based applications. Coverage can be retroactive up to three months before the month you applied for some groups, which can help with recent medical bills, though some states have narrowed retroactive coverage through waivers, and recent federal law shortens it further.

Keeping your coverage

Medicaid coverage must be renewed periodically. During the “unwinding” that followed the end of the pandemic continuous coverage requirement, many people lost coverage for procedural reasons, such as not returning forms, even though they were still eligible. To protect your coverage:

Update your mailing address, phone, and email with the agency.
Open and respond to all mail from the Medicaid agency.
Report changes in income or household size within the required timeframe.
If you lose coverage for paperwork reasons, ask about reconsideration periods, which let you restore coverage without a new application.

If you are denied

You have the right to a fair hearing if your application is denied or coverage is terminated. Notices must explain the reason and the deadline to request a hearing. If you request a hearing before your coverage ends, you can often keep benefits while the appeal is pending. Legal aid organizations frequently help with Medicaid appeals at no cost.

What Medicaid covers

Federal law requires coverage of mandatory benefits including inpatient and outpatient hospital services, physician services, laboratory and X-ray services, nursing facility services for adults, home health services, and early and periodic screening, diagnostic, and treatment (EPSDT) services for children under 21. EPSDT is particularly broad, requiring states to cover medically necessary care for children even if the service is optional for adults. Optional benefits that most states cover include prescription drugs, dental care for adults, vision services, physical therapy, and case management. Most beneficiaries receive care through managed care plans that contract with the state, and you may be asked to choose a plan and primary care provider shortly after approval.

Medicaid and Medicare together

People who qualify for both programs are called dual eligibles. Medicaid can pay Medicare premiums, deductibles, and copays through Medicare Savings Programs, and full duals receive Extra Help with Part D drug costs automatically. Special plans, called dual eligible special needs plans, coordinate both programs’ benefits.

Frequently Asked Questions

Can I have Medicaid and a job?

Yes. Many Medicaid enrollees work in jobs that do not offer affordable coverage. Eligibility depends on income, not employment status.

Does Medicaid cover adults without children?

In expansion states, yes, for adults with incomes up to 138 percent of FPL. In most non-expansion states, generally no.

Can I apply if I already have other insurance?

Yes. Medicaid can be secondary to other coverage and may pay costs your primary insurance does not.

This article is for general informational purposes only and is not legal, medical, tax, or financial advice. Rules vary by state and change over time; confirm details with the relevant agency or a licensed professional.