Medicaid eligibility 2026, who qualifies and how to apply

Who qualifies for Medicaid in 2026?

Medicaid eligibility runs on two tracks. Children, pregnant people, parents, and other adults under 65 qualify through MAGI-based rules, income measured as modified adjusted gross income against the federal poverty level, with no asset test. People who are 65 or older, blind, or disabled can instead qualify through the older aged/blind/disabled pathway, which does count assets and uses different limits set state by state. This page covers the MAGI-based adult and family pathway, the one behind the "138% of FPL" figure most people search for.

The specific cutoff also depends on which state you live in. Children and pregnant people qualify at higher income limits than childless adults in nearly every state. The 138% of FPL threshold below is specifically the expansion-adult limit, the group the ACA added in states that opted in.

What is the federal poverty level, and how does it decide Medicaid eligibility?

The federal poverty level (FPL) is a set of income thresholds the Department of Health and Human Services (HHS) publishes every January, one figure per household size. Medicaid, the ACA marketplace, and several other programs all use the same FPL table, expressed as a percentage, to set their income cutoffs. "138% of FPL" means 138% of that year's poverty line for your household size.

HHS updates the guidelines each January, and states are expected to start using the new figures for MAGI-based Medicaid and CHIP once they take effect. The 2026 guidelines below are the current, in-effect numbers as of this writing.

Why is the Medicaid expansion threshold 138% of FPL, not 133%?

The Affordable Care Act's statutory expansion limit is actually 133% of FPL. But the same law also built in a flat 5% income disregard for everyone whose Medicaid eligibility is based on MAGI: an applicant's counted income is treated as 5 percentage points lower than their actual income relative to the FPL. States apply that disregard automatically, so in practice the effective cutoff is 133% + 5%, or 138% of FPL. You do not need to calculate the disregard yourself; it is built into the limit.

What are the 2026 Medicaid income limits by household size?

The table below shows the 2026 federal poverty guidelines for the 48 contiguous states and DC, and the 138% of FPL threshold used for Medicaid expansion-adult eligibility in states that expanded. Alaska and Hawaii use separate, higher HHS guidelines (Alaska: $19,950 for one person, $41,250 for a family of four in 2026; Hawaii: $18,360 for one person, $37,950 for a family of four), so residents of those two states should apply the same 138% math to their own state's figures.

Source: U.S. Department of Health and Human Services, ASPE, 2026 Poverty Guidelines. 138% and monthly figures are calculated from the published 100% FPL amounts (annual figure x 1.38, rounded to the nearest dollar; monthly is the annual 138% figure divided by 12, rounded).

Worked example. A parent with two kids, a household of three, earning $3,000 a month ($36,000 a year) in an expansion state, compares against the household-of-three row above: $37,702 a year, or $3,142 a month. Because $36,000 is under $37,702, and $3,000 a month is under $3,142 a month, this household qualifies for Medicaid on income alone, even though $36,000 sounds like too much for "welfare" to most people. That gap between the sticker-shock assumption and the real 138% line is why a large share of eligible people never apply.

Do I qualify for Medicaid?

Run through these in order:

1. Check your state's expansion status. If your state expanded Medicaid (see the list below), the 138% of FPL threshold in the table above applies to you as a childless adult or parent. If your state did not expand, skip to the coverage gap section: you may need to meet a lower, state-set limit instead.
2. Compare your household's MAGI to the FPL table for your household size. Household size generally follows your expected tax household (yourself, your spouse if you have one, and anyone you claim as a dependent), the same rule the ACA marketplace uses.
3. If you are pregnant or have kids, check the higher category limits. Every state sets pregnancy and children's Medicaid/CHIP limits above the standard adult limit, often well above 138% of FPL, so a household that misses the adult cutoff can still get the kids or a pregnant parent covered.
4. If you are 65+, blind, or disabled, income alone will not decide it. You would instead be evaluated under the aged/blind/disabled pathway, which has its own state-set income and asset limits, not the MAGI 138% figure above.
5. When in doubt, apply anyway. There is no penalty for applying and getting denied, and eligibility workers, not a self-check, make the final call using your state's actual rules.

Does it matter which state I live in? Expansion vs. non-expansion states

Yes, enormously. The ACA gave states the option, not the requirement, to expand Medicaid to all adults under 138% of FPL. As of 2026, 40 states plus DC have adopted the expansion; 10 states have not: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. (Georgia and Wisconsin each run a narrower, state-specific coverage program for some low-income adults, but neither counts as full ACA expansion.)

In an expansion state, a childless adult with no kids and no disability can qualify for Medicaid purely on income, up to 138% of FPL. In a non-expansion state, that same childless adult typically cannot get Medicaid at any income level, no matter how low, because most non-expansion states never created a Medicaid category for childless, non-disabled adults at all. Parents can still qualify in non-expansion states, but usually only at a much lower income limit than 138% of FPL, often well under 50% of FPL in some of the strictest states.

What is the Medicaid "coverage gap"?

The coverage gap is the income range where a person in a non-expansion state qualifies for neither Medicaid nor an ACA marketplace subsidy. It exists because marketplace premium tax credits only start at 100% of FPL (the ACA's authors assumed everyone under that line would get Medicaid instead), but non-expansion states often cap Medicaid eligibility for adults well below 100% of FPL, or exclude childless adults from adult Medicaid altogether. Anyone whose income falls between their state's low Medicaid cutoff and 100% of FPL is stuck in the middle: too poor for a marketplace credit, not poor enough (or the wrong category) for Medicaid. See how ACA marketplace tax credits work for why the 100% FPL floor exists on that side.

The gap only exists in the 10 non-expansion states listed above. If your state expanded Medicaid, it does not apply to you: your eligibility runs to 138% of FPL, past the marketplace's 100% FPL floor, so no income level leaves you covered by neither program.

What does Medicaid actually cover?

Every state's Medicaid program must cover a federally required set of "mandatory" benefits, regardless of which optional benefits it adds on top. The mandatory list includes:

• Inpatient and outpatient hospital services
• Physician services
• Laboratory and X-ray services
• Nursing facility services (for those 21 and older)
• Home health services
• Family planning services and supplies
• Rural health clinic and federally qualified health center services
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), a full pediatric benefit for everyone under 21
• Transportation to medical appointments

States can add optional benefits, prescription drugs, dental, vision, and physical therapy are common examples, and coverage details (which providers, which drugs, what prior authorization looks like) vary by state. But the mandatory list above is the floor every state Medicaid program has to clear, unlike marketplace plans where the essential health benefits are the only thing guaranteed and cost-sharing varies by metal tier.

How do I apply for Medicaid?

You can apply for Medicaid in two ways, and they lead to the same coverage:

• Directly through your state Medicaid agency. Every state runs its own Medicaid application, online, by phone, by mail, or in person, and its own agency makes the eligibility determination.
• Through healthcare.gov (or your state's ACA exchange). If you apply for marketplace coverage and your income comes in under your state's Medicaid limit, healthcare.gov routes your application to your state Medicaid agency automatically, so you do not have to apply twice.

You will need to document household income, household size, state residency, and citizenship or immigration status. Most states also allow "presumptive eligibility," temporary coverage that starts immediately while your full application is processed, for pregnant people and some other groups.

Is there an open enrollment period for Medicaid?

No. Unlike ACA marketplace plans, Medicaid has no annual open enrollment window and no special enrollment period requirement. You can apply any day of the year, and if you are found eligible, coverage is often backdated to cover medical bills from up to three months before you applied, depending on your state. This is one of the most consequential and least-known facts about Medicaid: a job loss, a pay cut, or reduced hours can make you newly eligible mid-year, and there is nothing stopping you from applying the same week it happens. If you are also weighing COBRA continuation coverage after a layoff, checking your new, lower income against the table above costs nothing and takes a few minutes.

The flat truth

Medicaid eligibility for most working-age adults is a single comparison: your household's MAGI against 138% of the federal poverty level for your household size, if your state expanded Medicaid. Below that line, in an expansion state, you almost certainly qualify regardless of what you own. Above it, or in one of the 10 states that never expanded, you are into marketplace-subsidy territory or, in the worst case, the coverage gap where neither program reaches you. There is no enrollment deadline forcing you to figure this out once a year: check the table, and if your income has changed, check it again.

For the fuller decision tree, employer coverage vs. COBRA vs. marketplace vs. Medicaid, see the insurance hub.