Medicaid Eligibility 2026: Income Limits by State and New Rules

Medicaid eligibility depends on three things: the state you live in, your household income compared with the federal poverty level (FPL), and the group you fall into: adult, child, pregnant person, senior, or person with a disability. Medicaid is run by each state under federal rules, so the same income can qualify you in one state and not in the next.

The figures below use the 2026 HHS poverty guidelines, published in January 2026. States update their own charts on their own schedule, so treat the dollar amounts as close estimates and confirm with your state Medicaid agency. Rule changes that take effect on January 1, 2027, are covered at the end.

Medicaid expansion vs non-expansion states

The Affordable Care Act let states cover nearly all adults aged 19 to 64 with income up to 138% of FPL (133% plus a standard 5% income disregard). According to KFF's tracker, 41 states including D.C. have adopted this expansion and 10 have not.

	Expansion states	Non-expansion states
States	40 states plus D.C., including California, New York, Pennsylvania, North Carolina, Michigan, Ohio, Arizona and Virginia	Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming
Adults without children	Covered up to 138% FPL	Generally not covered (Wisconsin covers up to 100% FPL by waiver; Georgia has the limited Pathways program)
Parents	Covered up to at least 138% FPL	Covered only at the state's parent limit, often far below the poverty line
People under 100% FPL with no Medicaid	Rare	Can fall into the "coverage gap": too poor for Marketplace subsidies, not eligible for Medicaid

Medicaid income limits for 2026 (expansion adults)

138% of the 2026 poverty guidelines for the 48 contiguous states and D.C.:

Household size	2026 poverty guideline (100%)	138% per year	138% per month
1	$15,960	$22,025	$1,835
2	$21,640	$29,863	$2,489
3	$27,320	$37,702	$3,142
4	$33,000	$45,540	$3,795
5	$38,680	$53,378	$4,448
6	$44,360	$61,217	$5,101

Alaska ($19,950 for one person) and Hawaii ($18,360) have higher poverty guidelines, so their limits are higher. The 138% column is our calculation from the official guideline; your state's chart may round differently.

Who else qualifies: children, pregnancy, seniors and disability

• Children. Every state covers children through Medicaid and the Children's Health Insurance Program (CHIP), with income limits at or above 138% FPL and, in most states, well above 200%.
• Pregnant people. Coverage reaches at least 138% FPL in every state and higher in many. Nearly all states now provide 12 months of postpartum coverage.
• Seniors 65+ and people with disabilities. Eligibility usually runs through the aged, blind and disabled categories. In most states, people receiving SSI qualify automatically. These groups often face an asset test, commonly around $2,000 for an individual, though limits vary.
• Long-term care. Nursing home and home care coverage has its own income and asset rules and a five-year look-back on asset transfers.
• Medically needy. Many states let people with high medical bills "spend down" to eligibility.

How income is counted: MAGI

For children, parents, pregnant people and expansion adults, states use Modified Adjusted Gross Income (MAGI), the same tax-based measure the Marketplace uses. It starts with adjusted gross income from your tax return and adds back untaxed foreign income, tax-exempt interest and non-taxable Social Security benefits. There is no asset test for MAGI groups. Medicaid looks at current monthly income, so a job loss can make you eligible right away.

Household size follows tax filing rules: generally you, your spouse and anyone you claim as a dependent.

New Medicaid rules starting January 1, 2027

Public Law 119-21, signed in July 2025 (CMS calls it the Working Families Tax Cut legislation), changes Medicaid for expansion adults. CMS issued an interim final rule on the work requirement in June 2026.

Community engagement (work requirement)

• Who: non-pregnant adults aged 19 to 64 in the expansion group or similar Section 1115 waiver coverage, not entitled to Medicare. CMS says 43 states and D.C. must implement it.
• When: no later than January 1, 2027. States can start earlier.
• What counts: 80 hours a month of work, community service, a work program or at least half-time school, in any combination, or monthly income of at least 80 times the federal minimum wage ($580 in 2026).
• Exempt groups: parents and caretakers of a child 13 or under or of a person with a disability, pregnant and postpartum people, medically frail people, veterans with a total disability rating, former foster youth, American Indians and Alaska Natives, people in drug or alcohol treatment, people meeting TANF or SNAP work rules, and people in jail or prison.

Six-month renewals

For renewals scheduled on or after January 1, 2027, expansion adults must have their eligibility redetermined every 6 months instead of every 12. New applicants in the expansion group with coverage starting on or after that date get a 6-month eligibility period. Other groups keep annual renewals.

Noncitizen eligibility

From October 1, 2026, federal Medicaid funding for noncitizens is limited mostly to lawful permanent residents, Cuban and Haitian entrants, and citizens of the Compact of Free Association nations. Emergency Medicaid is not affected.

Medicaid eligibility by state: PA, NC and GA

• Pennsylvania (Medical Assistance): expansion state. Adults 19 to 64 qualify up to 138% FPL. Apply through COMPASS or your county assistance office.
• North Carolina: expansion took effect December 1, 2023. Adults 19 to 64 qualify up to 138% FPL. North Carolina's published income chart lists limits for each program, including seniors and people with disabilities. Apply through ePASS or your county Department of Social Services.
• Georgia: non-expansion state. Parents qualify only at very low incomes. Adults 19 to 64 up to 100% FPL may qualify through Georgia Pathways to Coverage if they meet its activity requirement. Children, pregnant people, seniors and people with disabilities have separate programs.

Medicaid eligibility calculator and how to apply

1. Estimate. Use HealthCare.gov's screener or your state's tool. Enter household size and current monthly income.
2. Apply. Apply through your state Medicaid agency or through HealthCare.gov (or your state's marketplace), which forwards your application if you look eligible. You can apply any day of the year.
3. Prove it. Have ID, Social Security numbers, pay stubs or tax returns, and immigration documents if relevant.
4. Retroactive coverage. Medicaid can cover some medical bills from before you applied. The 2025 law shortens this window from 2027, so apply as soon as you need care.
5. Renew on time. Answer every renewal letter. Missing paperwork is a leading reason people lose coverage.

Bottom line

If you live in an expansion state and your household income is under about $22,025 a year for one person or $45,540 for four in 2026, you very likely qualify for Medicaid. In the 10 non-expansion states, low-income adults without children usually do not. Children and pregnant people qualify at higher incomes everywhere. From January 2027, expansion adults should expect work or activity reporting and renewals every six months. People on Medicaid often qualify for food help as well: see SNAP eligibility and the SNAP payment schedule. Social Security and SSI amounts for 2027 are on our COLA 2027 page.

Cover photo: Hubert H. Humphrey Building, headquarters of the U.S. Department of Health and Human Services, Washington, D.C., by Carol M. Highsmith, Library of Congress, public domain, via Wikimedia Commons.