Medicaid: Who Qualifies, What It Covers, How to Apply, and What Changes Are Coming

What Medicaid is and how it works

Medicaid is a partnership between the federal government and the states. Federal law sets the basic rules and pays a large share of the cost. Each state runs its own program, sets many details, and may use its own name, such as Medi-Cal in California. That is why eligibility and benefits differ from state to state.

Most people on Medicaid get care through a managed care plan, which is a health plan the state contracts with. You pick a plan or are assigned one, and you use doctors in that plan’s network.

Who qualifies for Medicaid

Eligibility depends on your income, household size, age, disability, pregnancy, and immigration status. There are two main paths.

• Income-based (MAGI) groups: children, pregnant people, parents and caretakers, and in expansion states, adults ages 19 to 64. These groups are judged on income only. There is no asset test, so savings do not count against you.
• Aged, blind, and disabled groups: people 65 and older and people with disabilities. These groups often have asset limits, which in many states follow SSI rules of $2,000 for one person. Your home and one car usually do not count.

You must live in the state where you apply. Many lawfully present immigrants qualify after a waiting period, and some groups are covered right away. Federal rules on which immigrants qualify changed on October 1, 2026, so ask your state agency how they apply to you. If you are not sure you qualify, apply anyway. HealthCare.gov recommends applying even if you do not expect to qualify.

Income limits for expansion adults

In expansion states, adults qualify with income up to 138% of the federal poverty level. The table uses the 2026 HHS poverty guidelines for the 48 contiguous states and DC. Alaska and Hawaii have higher guidelines. States may update their charts on different dates, so check your state’s numbers.

Limits for children and pregnant people are higher in every state. Limits for parents in non-expansion states are often much lower.

Expansion and non-expansion states

According to KFF’s tracker, 41 states including DC have adopted the Affordable Care Act expansion. The 10 that have not are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Georgia and Wisconsin cover some low-income adults through special waivers.

In a non-expansion state, adults without children or a disability often cannot get Medicaid at all. If your income is below the poverty level, you may also miss out on Marketplace savings. This is called the coverage gap. HealthCare.gov suggests applying anyway and using community health centers, which charge on a sliding scale.

What Medicaid covers

Federal law requires states to cover certain mandatory benefits, and states can add optional ones.

Most Medicaid services have no premium and little or no copay. For mental health care, see does Medicaid cover therapy?

Medicaid and CHIP for children

The Children’s Health Insurance Program (CHIP) covers children, and in some states pregnant people, in families that earn too much for Medicaid. Well-child and dental checkups are free. Some states charge small copays or monthly premiums, but families never pay more than 5% of their yearly income. One application checks for both programs. You can also call 1-800-318-2596. Read more in our CHIP health insurance guide.

Medicaid and Medicare together

Medicare is federal health insurance for people 65 and older and some people with disabilities. Medicaid is based on income. You can have both, and people who do are called dual eligible. Medicaid can then pay Medicare premiums and copays and cover long-term care that Medicare does not. See our Medicare benefits guide for how the two fit together.

Medicaid changes starting in 2026 and 2027

The 2025 federal budget reconciliation law changes Medicaid for many adults. The main dates, as summarized by KFF, are below. States are still writing their rules, so watch for letters from your state.

How the work requirement works

Expansion adults will need to show 80 hours a month of work, community service, job training, or school, or a mix. According to KFF’s review of the law, people who are exempt include parents and caretakers of children 13 and under, pregnant and postpartum people, and people who are medically frail, which includes many people with disabilities, substance use disorders, or serious medical conditions. The federal government can give a state that is making a good-faith effort extra time, up to December 31, 2028. A few states have chosen to start sooner.

If your state says you did not meet the requirement, you get 30 days to show that you did or that you are exempt, and your coverage continues during that time.

Keeping your coverage at renewal

Your state checks your eligibility at least once a year now, and every six months for expansion adults starting with renewals on or after December 31, 2026. Many people lose coverage only because of paperwork.

• Keep your address, phone, and email up to date with your state agency.
• Open every letter from Medicaid and answer by the deadline.
• Report income or household changes when they happen.
• If you lose coverage, ask about appeal rights and reapply. If you no longer qualify, you can switch to a Marketplace plan.

What documents do I need to apply?

Expect to show photo ID, Social Security numbers for the people applying, proof of income for the last 30 days, and proof of where you live, plus any paper that shows the emergency itself. Our document checklist explains what counts for each item and what to do if something is missing. If you don't have everything yet, apply anyway and ask the office how long you have to bring the rest.

How to apply, step by step

The short version is below. For every application route, timelines, and what happens after you apply, see our full guide on how to apply for Medicaid.

1. Choose how to apply. Apply with your state Medicaid agency, or fill out an application on HealthCare.gov, which sends it to your state if you may qualify. See our Medicaid application online guide.
2. Gather your documents, including ID, Social Security numbers, and income proof.
3. Answer every question about your household and income.
4. Respond to requests for more information quickly.
5. Watch for a decision letter and pick a health plan if asked.
6. Ask about past medical bills. Medicaid may pay bills from up to 3 months before you applied, until that window shortens on January 1, 2027.

Related guides

• Government health insurance assistance
• Children’s Health Insurance Program
• Does Medicaid cover dental implants?
• Help with medical bills after insurance

Frequently asked questions

This guide is general information. Medicaid rules vary by state and are changing under federal law. National Relief Program is an independent website and is not a government agency. Contact your state Medicaid agency for decisions about your case.