Medicaid Eligibility Guide 2026: Who Qualifies and How to Apply

Medicaid is the largest health insurance program in the United States, covering over 90 million Americans. If your income is low, you may qualify for free or near-free health coverage — and many eligible people don't know it.

Medicaid expansion: the key dividing line

The ACA gave states the option to expand Medicaid to cover adults up to 138% of the federal poverty level. Most states accepted — but 10 states still haven't expanded as of 2026.

Expansion states (40 + DC): Adults up to 138% FPL qualify regardless of whether they have children or a disability. This covers millions of low-income working adults.

Non-expansion states (10 states): Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In these states, non-disabled adults without children generally don't qualify for Medicaid even at very low incomes — they may fall into the "coverage gap" (income too high for Medicaid, too low for marketplace subsidies).

2026 Medicaid income limits by family size

In expansion states:

| Family size | 100% FPL | 138% FPL (Medicaid limit) | |---|---|---| | 1 person | $14,580 | $20,120 | | 2 people | $19,720 | $27,213 | | 3 people | $24,860 | $34,306 | | 4 people | $30,000 | $41,400 |

Special eligibility categories

Children: Children's Health Insurance Program (CHIP) covers children in families earning too much for Medicaid but still low income — typically up to 200–300% FPL in most states. This is how many working-class families get their children covered.

Pregnant women: Most states extend Medicaid eligibility to pregnant women up to 185–200% FPL — higher than the standard adult limit.

Seniors and people with disabilities: Different rules apply. Medicare/Medicaid "dual eligibles" (people who qualify for both programs) get comprehensive coverage.

Working people: You can work and still qualify for Medicaid in expansion states — it's based on income, not employment status. Seasonal workers, gig workers, and part-time employees often qualify.

What Medicaid covers

Medicaid must cover the ACA's 10 essential health benefits for most adults. For eligible adults, coverage typically includes:

• Doctor visits and preventive care
• Hospital and emergency care
• Prescription drugs
• Mental health and substance use treatment
• Maternity and newborn care
• Lab tests and imaging

Some states offer optional benefits: dental, vision, non-emergency transportation.

Cost-sharing: Medicaid has very low or no premiums. Copays are minimal — $1–$4 for primary care, $3–$8 for prescriptions in most states. Federal law caps Medicaid cost-sharing at 5% of a household's quarterly income.

How to apply for Medicaid

Online: Apply at healthcare.gov (it screens for both Marketplace and Medicaid eligibility simultaneously) or your state's Medicaid website.

In person: At your local Department of Social Services or Medicaid office.

By phone: Call the Medicaid helpline in your state.

What you'll need:

• Social Security numbers for all household members
• Proof of income (pay stubs, tax returns, or a statement if income varies)
• Proof of citizenship or immigration status
• Proof of residency

Eligibility is typically determined within 45 days. If approved, coverage may be retroactive to the application date or up to 3 months prior.

Frequently Asked Questions

Who qualifies for Medicaid in 2026? Medicaid eligibility varies by state, but generally covers: low-income adults (in expansion states, up to 138% FPL — about $20,120/year for an individual), children (CHIP covers children up to 200–300% FPL in most states), pregnant women, seniors and people with disabilities, and certain immigrant groups. In non-expansion states, eligibility is much more restrictive for non-disabled adults.

What income level qualifies for Medicaid? In the 40 states (plus DC) that expanded Medicaid under the ACA, adults qualify with income up to 138% of the federal poverty level — about $20,120/year for an individual or $41,400 for a family of four in 2026. In the 10 non-expansion states, income limits for adults are typically 20–50% FPL, effectively excluding most working-age adults without children or disabilities.

How do you apply for Medicaid? Apply for Medicaid through your state's Medicaid agency or at healthcare.gov. The online application takes 15–30 minutes and asks about income, household size, and citizenship. Eligibility is typically determined within 45 days (90 days for disability-based Medicaid). Coverage can be retroactive up to 3 months if you were eligible during that period.