2026 Medicaid Income Limits by State: Do You Qualify?

Medicaid is the largest source of health coverage in the United States, covering over 90 million people in 2025. Whether you qualify depends heavily on your state—because expansion status, income limits, and covered benefits vary dramatically. This guide covers every factor you need to know for 2026.

1. 2026 Federal Poverty Level reference table

Medicaid eligibility is expressed as a percentage of the Federal Poverty Level (FPL). The 2026 FPL figures below apply to all states except Alaska and Hawaii, which have higher thresholds:

Note: The 138% FPL figure includes a 5 percentage point income disregard that CMS builds into the ACA expansion calculation—so the formal rule is 133% FPL, but the effective limit is 138% FPL.

2. ACA expansion states: the 138% FPL rule

As of 2026, 41 states plus the District of Columbia have adopted the ACA Medicaid expansion. In these states, any adult under 65 with income at or below 138% FPL qualifies for Medicaid—regardless of whether they have children, a disability, or another categorical requirement.

Key features in expansion states:

• Eligibility is determined by MAGI income only—no asset test for most adults under 65
• Self-employed individuals count net self-employment income (after business expenses)
• Coverage is comprehensive: doctor visits, hospital care, mental health, substance use treatment, and preventive care
• The federal government pays 90% of the cost of newly eligible expansion enrollees (states pay 10%)
• Adults who earn slightly above 138% FPL (up to 400% FPL) qualify for ACA marketplace subsidies instead

Expansion states (as of 2026): Arizona, Arkansas, California, Colorado, Connecticut, Delaware, D.C., Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin.

3. Non-expansion states: lower limits and categorical rules

The 10 states that have not adopted expansion (Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee, Texas, Wyoming, and others) impose much tighter limits—and require applicants to fall into a specific category:

• Pregnant women — typically covered up to 133–200% FPL
• Children — covered through Medicaid or CHIP up to 200–300% FPL
• Parents and caretaker relatives — income limits often 50–100% FPL
• Aged, blind, or disabled individuals — income limits tied to SSI levels (~75% FPL)
• Non-disabled, childless adults — generally ineligible regardless of income in non-expansion states

The result is the “coverage gap”: adults in non-expansion states who earn too much for traditional Medicaid but too little to qualify for marketplace subsidies (which start at 100% FPL) fall into a gap with no affordable coverage options. An estimated 2.8 million people were in this gap as of 2025.

4. MAGI vs. asset-based Medicaid

Two different methodologies determine Medicaid eligibility depending on who is applying:

MAGI-based Medicaid (most adults under 65, children, pregnant women): Eligibility is based on Modified Adjusted Gross Income—essentially your federal taxable income with a few additions. No asset test applies. Income from Social Security, veterans’ benefits, and child support received are excluded.

Asset-based (traditional) Medicaid (aged 65+, blind, or disabled): Eligibility considers both income and countable assets. Typical limits:

• Countable assets: $2,000 for an individual (varies by state; some states have eliminated asset tests)
• Exempt assets: your primary home (if you plan to return), one vehicle, personal belongings, burial funds up to a set amount
• Income limit: typically at or near the SSI level (~$943/month individual in 2026), but states can set their own limits
• Spousal protections: a community spouse (the one not in a nursing home) can retain a “community spouse resource allowance” of up to $157,920 (2026) in countable assets

5. Children and CHIP coverage

Children who don’t qualify for Medicaid may qualify for CHIP (Children’s Health Insurance Program), which covers uninsured children in families with income too high for Medicaid but unable to afford private insurance:

• Most states cover children up to 200–300% FPL through Medicaid or CHIP
• Several states cover up to 400% FPL (California covers up to 322% FPL for full-scope Medicaid for children; New York covers children at all income levels)
• CHIP may have small monthly premiums (typically $50/family or less) and modest copays for higher-income families
• Coverage includes comprehensive pediatric benefits: checkups, immunizations, dental, vision, and mental health
• In some states, CHIP also covers pregnant women and provides presumptive eligibility (temporary coverage while the full application is processed)

6. How to apply and retroactive coverage

Unlike ACA marketplace plans, Medicaid has no open enrollment period. You can apply any time of year through these channels:

1. HealthCare.gov — if you apply for marketplace coverage and your income qualifies for Medicaid, you’ll be screened and transferred automatically
2. State Medicaid agency website — most states have online applications (search “[your state] Medicaid apply”)
3. Local Department of Social Services or Human Services office — in-person or by phone
4. Hospital financial counselors — if you’re already receiving care, the hospital can often help you apply on the spot

Retroactive coverage: Many states allow Medicaid to cover bills from up to 3 months before your application date, as long as you would have been eligible during that period. If you received medical care while uninsured and later enroll in Medicaid, ask your caseworker explicitly about retroactive coverage—it can eliminate thousands of dollars in bills.

7. What Medicaid covers

Medicaid must cover a set of mandatory benefits in every state, and states can add optional benefits:

• Mandatory: Inpatient and outpatient hospital services, physician services, laboratory and X-ray, FQHC and rural health clinic services, nursing facility care, home health services, EPSDT (Early Periodic Screening for children), family planning, and emergency transportation
• Common optional benefits most states cover: Prescription drugs, dental, vision, physical therapy, occupational therapy, hospice, personal care services, and mental health/substance use treatment
• Long-term services and supports (LTSS): Medicaid is the primary payer for nursing home care and home- and community-based services for elderly and disabled individuals—a benefit Medicare does not provide

8. Estate recovery and common billing issues

Medicaid estate recovery is one of the least-understood aspects of the program. Federal law requires states to seek repayment from the estates of deceased beneficiaries who were 55 or older when they received long-term care services. Key facts:

• Recovery is limited to long-term care costs (nursing home, home- and community-based waivers) in most states; some states also pursue recovery for other services
• Recovery cannot occur while a surviving spouse is living, or while a blind or disabled child of any age lives in the home, or while a minor child lives in the home
• Some states allow hardship waivers if recovery would cause an undue hardship for heirs
• Planning strategies exist (e.g., Medicaid-compliant annuities, life estates), but require an elder law attorney

Common Medicaid billing problems to watch for:

• Providers billing you directly for covered Medicaid services (generally illegal—providers who accept Medicaid cannot bill you beyond the required copay)
• Being told a provider “doesn’t accept Medicaid” for an emergency service—emergency care must be provided regardless
• Retroactive eligibility not applied to bills you already received

Frequently asked questions

Sources

• Centers for Medicare & Medicaid Services: Medicaid Eligibility (2026)
• Kaiser Family Foundation: Status of State Medicaid Expansion Decisions (2026)
• HHS: 2026 Federal Poverty Level Guidelines
• KFF: Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies (2025)
• Medicaid.gov: Medicaid Estate Recovery Program