On this page
Medicaid covers tens of millions of Americans with little to no premiums or cost sharing, but eligibility is a patchwork of federal floors and state choices. Here is who qualifies in 2026, what the income limits look like in dollars, and where the gaps are.
The 138% rule in expansion states
In the 40 states plus Washington, DC that have expanded Medicaid, adults with household income up to 138% of the federal poverty level qualify. Using the 2026 poverty guidelines, that means:
- Single person: up to about $22,025 per year
- Household of two: up to about $29,863 per year
- Family of four: up to about $45,540 per year
There is no open enrollment for Medicaid. If your income qualifies, you can apply any day of the year, and coverage can be retroactive up to three months before your application in most states. Children, pregnant women, and people with disabilities often qualify at higher income thresholds than the 138% adult standard.
The ten states that have not expanded
As of 2026, ten states have not adopted Medicaid expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In nine of those ten, there is a coverage gap: adults earning below the poverty level do not qualify for Medicaid under the state’s stricter rules, and also do not qualify for marketplace subsidies, which start at 100% of the poverty level. About 1.4 million people sit in that gap, with Texas, Florida, and Georgia accounting for most of them.
Wisconsin is the exception. It covers adults up to the poverty level through its own program, so there is no gap there, just no expansion above it. Georgia runs a partial expansion with a work requirement instead of full expansion.
What counts as income
Medicaid uses modified adjusted gross income, the same measure as the marketplace. Count wages, self-employment income, unemployment, and Social Security. Some income is excluded, and the program applies a 5% income disregard, which is why the effective limit is often described as 138% rather than 133%. Assets generally do not count for the expansion adult group, which surprises people who assume Medicaid always has an asset test. It does for some categories, like long-term care, but not for standard adult expansion coverage.
Work requirements are coming
A federal reconciliation law signed in July 2025 requires states to condition Medicaid eligibility for expansion-group adults on meeting work requirements starting January 1, 2027. States are still building the systems to implement this, and the details will vary by state. If you are on expansion Medicaid, watch your state’s notices through 2026, because the renewal process is about to get more demanding.
How to apply
Apply through your state’s Medicaid agency or through the marketplace at Healthcare.gov, which forwards your application to the state if you look Medicaid-eligible. Have Social Security numbers, income documentation, and proof of address ready. States must process most applications within 45 days. If you are denied and think the decision is wrong, you have the right to appeal, and you should, because income miscalculations in either direction are common.
If your income is just above the Medicaid line, the marketplace is your next stop. Subsidies start at 100% of the poverty level in every state, so there is usually a subsidized option waiting. Our guides to costs after subsidies and COBRA vs marketplace vs Medicaid cover the handoff between the two programs.
