Medicaid Eligibility & Income Limits 2026: What You Need to Know

Medicaid is the largest health insurance program in the United States, yet most people have only a vague sense of whether they qualify. The rules change by state, by household size, and by whether your state expanded coverage under the Affordable Care Act. This guide cuts through all of that.

By the end, you'll know: exactly what income limit applies to your household size, which states still haven't expanded Medicaid (and what that means for you), and the concrete steps to enroll. The eligibility check takes about 2 minutes.

Who Qualifies for Medicaid? The Basics

Medicaid is an entitlement program jointly funded by federal and state governments. Each state administers its own program within broad federal rules — meaning the income limits, covered services, and eligibility categories differ significantly from one state to another.

There are four primary eligibility pathways:

1. Traditional Medicaid (Low-Income Adults, Children, Pregnant Women)

Groups covered in every state: children under 19, pregnant women (up to at least 138% FPL in expansion states), parents with dependent children, and people with disabilities. Income limits for these groups vary by state and category.

2. ACA Medicaid Expansion (Adults 19–64)

The Affordable Care Act gave states the option to extend Medicaid to all adults with income up to 138% of the Federal Poverty Level. States that opted in cover nearly all low-income adults regardless of family status or disability. 40 states and DC have expanded Medicaid as of 2026. The remaining 10 have not.

3. Medicare Savings Programs (People 65+ and some people with disabilities)

These programs help people with Medicare pay premiums, deductibles, and coinsurance. Eligibility thresholds are set as a percentage of the Federal Poverty Level and are generally higher than regular Medicaid — making them accessible to people who earn too much for standard Medicaid.

4. Medically Needy / Spend-Down

If your income is above the regular Medicaid limit, some states allow you to qualify by "spending down" — subtracting your medical expenses from your income until you reach the limit. This is called the medically needy pathway.

2026 Federal Poverty Level Reference Table

The table below shows the 2026 FPL thresholds (figures finalized by HHS in early 2026). Medicaid income limits are always calculated based on your gross monthly income before taxes, unless your state uses MAGI-based rules.

For each additional person, add approximately $5,382 per year to the FPL. For more detail on how cost-sharing thresholds work, see our guide to Deductibles, Copays, and Coinsurance.

State-by-State Medicaid Income Limits 2026

Income limits vary significantly between expansion and non-expansion states. In expansion states, the standard limit for adults is 138% FPL. In non-expansion states, adult eligibility is often limited to children, pregnant women, parents at low thresholds, and people with disabilities.

Income limits are for MAGI-based eligibility (most adults). Children and pregnant women often have higher limits due to separate CHIP/family planning programs. Limits are subject to change — verify with your state's Medicaid agency. Use ClaimSage's Eligibility Screener →

The Coverage Gap: What Happens If You Don't Qualify

In states that haven't expanded Medicaid, an adult with an income below the poverty line but above the state's very low Medicaid eligibility threshold falls into what's called the "coverage gap." They're too poor to qualify for ACA marketplace subsidies (which require income above 100% FPL) and too poor to qualify for Medicaid (which in non-expansion states only covers children, parents at very low thresholds, and people with disabilities).

This affects millions of people — particularly in Southern states with the most restrictive Medicaid programs. Texas, for example, only covers parents earning less than 17% of the poverty level (about $3,200/year for a family of three). A parent earning $18,000/year in Texas falls in the coverage gap.

If you're in the coverage gap, here's what to consider:

1. Check if your state has a pending expansion proposal. Several states have debated expansion legislation. Check your state legislature's current session at naic.org.

2. Look at other programs. Hospital financial assistance programs (often called Charity Care) can cover care at non-profit hospitals regardless of immigration or income status. Some states have unique programs (like Louisiana's TAKE CHARGE program for family planning).

3. Look at CHIP for your children. Even if you don't qualify for Medicaid, your children likely qualify for CHIP at much higher income levels — in most states, children in families up to 200%+ FPL are covered.

4. Marketplace coverage with a zero-premium plan. If your income is above 100% FPL, you qualify for ACA marketplace plans with zero-premium options (due to subsidies). If your income is above 400% FPL, you still qualify for subsidies on a sliding scale.

For more on how ACA subsidies interact with Medicaid, see our guide to navigating insurance denials and coverage gaps.

Special Eligibility Groups

Children (CHIP and Medicaid)

Children have the highest income limits of any group. In most states, children under 19 qualify for Medicaid or CHIP at 200–300%+ FPL. Some states (like New York and Connecticut) cover children at 400% FPL or higher through their CHIP programs. If your income is too high for Medicaid, your children likely qualify for CHIP — which offers comprehensive coverage for a low monthly premium.

Pregnant Women

Medicaid covers pregnant women in all states at a minimum of 138% FPL, and many states set the threshold significantly higher — California covers pregnant women up to 213% FPL, New York covers them at 223% FPL. Coverage typically extends through 60 days postpartum in most states; several states have extended postpartum coverage to 12 months. If you're pregnant and unsure of your eligibility, apply immediately — Medicaid backdates coverage to the date of application in most states.

People 65+ and People with Disabilities

People 65+ and those with qualifying disabilities can access Medicaid through different pathways with potentially higher income limits, especially through Medicare Savings Programs (MSPs). The Qualified Medicare Beneficiary (QMB) program helps with Part B premiums for people at 100% FPL. The Specified Low-Income Medicare Beneficiary (SLMB) program covers Part B premiums at 120% FPL. The Extra Help program for Medicare Part D covers prescription drug costs at 150% FPL.

Immigrants

Lawfully present immigrants face a 5-year waiting period before they can enroll in full Medicaid — a policy established by the 1996 welfare reform law. However, states can and do waive this waiting period for children and pregnant women. As of 2025, 23 states have removed the 5-year bar for children, and over 30 states have removed it for pregnant women. Undocumented immigrants are only eligible for emergency Medicaid coverage.

How to Apply for Medicaid

The application process is the same whether you apply through the federal marketplace, your state Medicaid agency, or in person at a local office. All three channels route to the same eligibility determination.

Step 1: Apply through Healthcare.gov

The fastest path is Healthcare.gov — answer the questions about your household and income and the system will route you to your state's Medicaid agency if you appear eligible. You can also call 1-800-318-2596 (available 24/7) to apply by phone.

Step 2: Gather your documents

The application asks for: Social Security number, date of birth, current employer and income info (pay stubs, W-2s), policy numbers for any current health insurance, and immigration/citizenship documents if applicable. If you don't have all documents, apply anyway — states must accept the application and give you time to provide verification.

Step 3: Wait for the determination

States must process regular Medicaid applications within 45 days. If a disability determination is required, the timeline extends to 90 days. If you're pregnant, let the agency know — pregnant women often get faster processing.

Step 4: Report changes

Medicaid eligibility is re-determined annually. You must report changes in income, household size, or address within 10 days. If your income goes up and you lose eligibility, you'll get a 60-day transition period before coverage ends — and you may be eligible for a marketplace plan during that window.

Medicaid vs. Other Coverage: Quick Comparison

Common Medicaid Eligibility Mistakes

Assuming you earn too much. Many people assume they make too much for Medicaid without checking the specific limit for their state and household size. In expansion states, the limit is 138% FPL — which is higher than many assume. A single adult in California earning $18,000/year qualifies.

Not applying after a life change. Getting married, having a child, losing a job, or moving to a new state can change your eligibility. Report changes immediately and re-apply if your circumstances shift.

Confusing Medicaid and marketplace eligibility. They're separate programs. If you're denied Medicaid, you're automatically evaluated for marketplace subsidies — but you need to complete that marketplace application to access them.

Missing the annual re-enrollment period. Some states automatically re-enroll continuing enrollees, but others require you to re-apply each year. Don't assume your coverage will renew without action.