Medicaid is the largest health coverage program in the United States, providing free or low-cost health insurance to more than 90 million Americans — including low-income adults, children, pregnant women, elderly adults, and people with disabilities. It is jointly funded by federal and state governments and administered by states within federal guidelines, which means eligibility rules, covered benefits, and program names vary significantly by state.
In 2026, the fundamental structure of Medicaid remains shaped by two major policy frameworks: the Affordable Care Act’s Medicaid expansion (adopted by 41 states and D.C., covering adults up to 138 percent of the Federal Poverty Level) and the traditional Medicaid program, which covers specific categorical groups in all states regardless of expansion status.
Disclaimer: Medicaid eligibility and benefits are state-specific. This article describes general federal Medicaid rules. Contact your state Medicaid agency or visit medicaid.gov for state-specific information.
The Two Pathways to Medicaid Coverage
| Medicaid Pathway | Who It Covers | Income Limit (Federal) | Expansion Status |
|---|---|---|---|
| ACA Expansion Adults | Adults 19–64 without dependent children | 138% FPL (~$20,797 individual) | 41 states + DC (as of 2026) |
| Children (CHIP/Medicaid) | Children 0–18 (CHIP up to 200-300% FPL) | Varies by state | All states |
| Pregnant Women | Pregnant and postpartum (60 days) | 133% FPL minimum; states vary | All states |
| Elderly Adults (65+) | Low-income seniors, nursing home care | Income + asset tests; state-specific | All states |
| People with Disabilities | SSI recipients; other qualifying disabilities | Income and asset tests | All states |
| Medically Needy/Spend-Down | High medical costs relative to income | State-specific thresholds | Optional; not all states |
Medicaid Expansion: The 41-State Coverage for Low-Income Adults
Under ACA Medicaid expansion, states that adopted expansion must cover non-elderly adults with income up to 138 percent of the Federal Poverty Level regardless of family status or disability. In 2026, 138 percent of FPL is approximately $20,797 per year for an individual and $42,875 for a family of four. The federal government pays 90 percent of the costs for expansion adults — a significantly higher match rate than traditional Medicaid.
Nine states as of early 2026 have not adopted Medicaid expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming. In these states, low-income adults without children or a qualifying disability may fall into the ‘coverage gap’ — too high an income to qualify for traditional Medicaid but too low to qualify for ACA Marketplace subsidies (which begin at 100% FPL).
Medicaid Work Requirements in 2026
Several states have sought to impose work requirements as a condition of Medicaid eligibility for non-elderly, non-pregnant, non-disabled expansion adults under Section 1115 waivers. In 2025 and 2026, the political and legal landscape around Medicaid work requirements shifted, with some states receiving new approval to implement them. Work requirement rules vary by state — check your state Medicaid agency for current requirements.
What Medicaid Covers
Federal law requires all state Medicaid programs to cover certain mandatory benefits: inpatient and outpatient hospital services; physician services; laboratory and X-ray services; early and periodic screening, diagnostic, and treatment services (EPSDT) for children; family planning services; nursing facility services; and home health services.
Most state Medicaid programs also cover prescription drugs, dental services (adult dental varies significantly by state), vision care, physical and occupational therapy, mental health services, substance use disorder treatment, and medical transportation. Long-term care services — including nursing home care and home- and community-based waiver services — are a major component of Medicaid spending for elderly and disabled enrollees.
How to Apply for Medicaid in 2026
Medicaid applications are submitted to your state Medicaid agency. In most states, you can apply online through your state’s Medicaid portal or healthcare.gov (for ACA expansion states), in person at local Medicaid offices, by mail, or by phone. Required documentation typically includes: proof of identity; Social Security number; proof of citizenship or immigration status; proof of income; proof of residency; and information about other health insurance coverage.
Medicaid eligibility determinations are made promptly — states are required to process most applications within 45 days (90 days for disability-based applications). If you are denied, you have the right to a fair hearing to challenge the decision.
Medicaid and the Five-Year Bar for Immigrants
Federal law imposes a five-year waiting period before most lawfully residing immigrants can qualify for federally funded Medicaid. However, states may use state funds to cover immigrants during the five-year bar, and some states provide state-funded Medicaid to pregnant women, children, and certain other categories during the waiting period. Emergency Medicaid — covering emergency medical conditions — is available to undocumented and recently arrived immigrants in all states regardless of the five-year bar.
Medicaid Estate Recovery: Planning Consideration for Older Adults
Federal law requires states to seek recovery of Medicaid costs from the estates of deceased Medicaid recipients who were age 55 or older — particularly for nursing home and long-term care costs. Estate recovery rules and exemptions vary by state. This is an important planning consideration for older adults considering Medicaid for long-term care needs. Consulting an elder law attorney before entering long-term care and at least five years before anticipated Medicaid eligibility is generally advisable.
Frequently Asked Questions
Is Medicaid the same as Medicare?
No. Medicaid and Medicare are distinct programs. Medicare is a federal health insurance program primarily for people 65 and older and certain younger people with disabilities, funded through payroll taxes and premiums. Medicaid is a joint federal-state health insurance program for low-income individuals of all ages, funded through general revenues. Some individuals qualify for both — called ‘dual eligibles’ — and receive coordinated coverage.
Can I keep Medicaid if I start working?
In expansion states, you can continue receiving Medicaid as long as your income stays below 138 percent FPL. Several provisions support the transition to work without abrupt coverage loss, including the 12-month continuous eligibility requirement implemented in 2023 for adults, preventing termination within a 12-month period regardless of income changes. Check your state’s current continuous eligibility rules.
What is CHIP and how is it different from Medicaid?
The Children’s Health Insurance Program (CHIP) provides health coverage to children in families whose income is above the Medicaid eligibility limit but still relatively modest. CHIP income limits range from 200 to 300 percent FPL depending on the state — significantly higher than Medicaid eligibility thresholds. CHIP covers comprehensive pediatric services including well-child visits, immunizations, dental, and vision care. In most states, CHIP and Medicaid for children are administered jointly through a single application.
Sources
- Medicaid.gov — medicaid.gov — Medicaid program information, eligibility, and state-specific guidance. Available at: https://www.medicaid.gov/medicaid/eligibility/index.html
- Kaiser Family Foundation — kff.org — Medicaid expansion status and enrollment data. Available at: https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions/
- Centers for Medicare and Medicaid Services — cms.gov — Medicaid mandatory and optional benefits. Available at: https://www.cms.gov/medicaid/benefits
- Benefits.gov — benefits.gov — Medicaid and CHIP eligibility screening tool. Available at: https://www.benefits.gov/benefit/1628
