Medicaid

The last day to enroll for 2028 coverage is December 15, 2027. Coverage begins January 1, 2028. If you don’t enroll in a plan by December 15, you can’t get 2028 coverage unless you qualify for a Special Enrollment Period .

Beginning January 1, 2027, people applying for Medicaid must show they are working or participating in another approved activity for at least 80 hours each month to qualify. Those already enrolled will lose coverage if they fail to prove they meet these work requirements. ¹

For the unknowing, Medicaid is an “entitlement program” that provides health care for people with low incomes, limited resources, or certain disabilities.

The concept of Medicaid came about so that the government could provide assistance to financially-strapped families to help them pay of a portion of their medical bills.

It is often described as a “means-tested” program — where applicants are screened for their eligibility and because it is an entitlement program, everyone who is eligible has a right to enroll in Medicaid coverage.

For many poor and low-income children and families — the group who are least likely to be insured, Medicaid is the only available source of free health insurance coverage.

What is Medicaid?

Medicaid is essentially a state as well as federal scheme, wherein states and federal government jointly fund it, while the state authorities manage it. Its primary goal is to assist low income families to pay their medical bills.

This scheme was introduced in the year 1995 and since then, it has been helping the poor get medical benefits that they wouldn’t have been able to afford without it.

Each state operates its own Medicaid program within federal guidelines — each with a different income level required to qualify for the same, higher in some and lower in others.

Who is eligible for Medicaid?

Before the ACA, Medicaid served only children, parents, pregnant women, people with disabilities and seniors; it’s now available to any adult, between the ages of 19 and 65, with income below the predetermined threshold.

The Affordable Care Act (widely known as “Obamacare”) creates a national minimum eligibility standard of 138% of the federal poverty level (FPL), but some states choose not to adopt the Medicaid expansion under the ACA.

Ten (10) states — most of them in the Deep South — have refused to expand Medicaid, leaving some of their poorest residents without health care.

Among those states not currently expanding Medicaid, the average eligibility threshold remains very low at 50% or about $13,660 for a single mother of two, with only two (2) states — Tennessee, and Wisconsin covering parents with incomes at or near poverty.

What is the highest income to qualify for Medicaid?

Medicaid eligibility is largely determined by income relative to the federal poverty level (FPL) and varies by state and covered group, such as children, pregnant women, adults, elderly and disabled, with most states covering adults under 138% FPL in expansion states. Different rules apply for non-expansion states.

48 Contiguous States

Alaska

Hawaii

If your state is expanding Medicaid, you’ll probably qualify for Medicaid coverage, if your income is below $37,702 for a family of three. Income limits are higher in Alaska and Hawaii due to the higher cost of living.

If your state hasn’t expanded Medicaid, you may be eligible for subsidies to buy a private health insurance plan in the Marketplace, if your income is between 100% and 400% of the federal poverty level. That’s an income between $27,320 and $109,280 for a family of three.

One of those subsidies for those who buy insurance through Marketplace is the Advance Premium Tax Credit  (APTC) ² which can be applied directly to your monthly premiums.

Which states did not expand Medicaid?

As of late 2025, these ten (10) states have still not expanded Medicaid:

• Alabama
• Florida
• Georgia (partial expansion)
• Kansas
• Mississippi
• South Carolina
• Tennessee
• Texas
• Wisconsin (partial expansion)
• Wyoming

Georgia provides Medicaid coverage to non-disabled adults aged 19—64 with household income up to 100% of the federal poverty level (FPL). Similar to Georgia, Wisconsin covers nearly all non-elderly adults with income up to 100% of the FPL through its BadgerCare Plus program.

Beyond that, each state uses a different income limit to determine eligibility. In most states, eligibility starts above 138% of the poverty level, about $3,142 per month for a family of three, as Medicaid expansion covers adults with income up to that level.

The District of Columbia has the highest income eligibility limit at 138% of the federal poverty level for a family with children, while Texas has the lowest threshold for parents at just 15%.

New Medicaid work requirement rules in 2027

In July 2025, Congress passed the Big Beautiful Bill, ³ which included several changes to Medicaid eligibility. Among them were new work requirements for adults without dependent children, as well as for parents whose youngest child is over age 13.

According to CBPP, ¹ starting no later than January 1, 2027, Medicaid applicants and enrollees must verify participation in at least 80 hours per month of one or more of the following activities to obtain or maintain coverage:

• Employment
• Work program participation
• Job training
• Enrollment in an educational program (at least half-time)
• Community service
• Any combination of the above

Some states have published how they will apply the rule. North Carolina, for example, says adults ages 19 through 64 can also meet the requirement if their household earns at least $580 a month, and that people with a disability, parents of children under age 14 and pregnant people do not need to meet it. ⁴ Proof of hours or income is required.

Other changes that start with it:

• Renewals every 6 months: Adults covered through Medicaid expansion must renew every 6 months instead of once a year, starting January 1, 2027. ⁴
• Retroactive coverage: Starting January 1, 2027, Medicaid covers eligible care received up to 1 month before you applied (2 months for children, adults 65 and older and people with a disability). Applications filed by December 31, 2026 keep up to 3 months. ⁴
• Non-citizens: Many people who are not U.S. citizens lost Medicaid on October 1, 2026. Green card holders (who generally must also wait 5 years), children under 19, pregnant and postpartum people, Cuban and Haitian entrants and citizens of Micronesia, the Marshall Islands and Palau may still qualify. ⁴

States may choose to implement these revised work requirements as early as 2026, ahead of the federal deadline. As of 2025, Georgia is the only state with an active Medicaid work requirement.

How does the premium tax credit work?

When you apply for coverage in the Health Insurance Marketplace, the Marketplace will estimate the amount of the premium tax credit that you may be eligible, based on your income.

Based upon that estimate, you can choose to receive all, part, or none of the estimated credit as advance payments (APTC) directly to your insurer, lowering monthly premiums — often to $0 for low earners.

If you do not opt for advance credit payments, you may be eligible to claim the credit when you file your taxes for the year (Form 8962), which will lower the amount of taxes owed on that return.

Is there a penalty if I don’t buy health insurance?

Starting with the 2019 plan year (for which you’ll file taxes by July 15, 2020), this penalty no longer applies . Regardless of whether or not your state has expanded Medicaid, you are no longer required by law to have minimum health insurance coverage.

However, some states — including California, Massachusetts, New Jersey, Rhode Island, Vermont, and the District of Columbia — have their own individual health insurance mandate, so it’s a good idea to check with your state or tax preparer to find out if there is a fee for not having health coverage.

How do I apply for Medicaid?

To find out if you and your family qualify for Medicaid, CHIP, or a private insurance plan, create a Marketplace account online at HealthCare.gov  — the official health insurance marketplace.

If your state runs its own Marketplace, it’ll take you there.

You can apply for Medicaid in three ways:

1. Online: Use Medicaid.gov’s state directory  to find the link to your state’s Medicaid application. Alternatively, you can apply through the federal HealthCare.gov  Marketplace, which will send you to your state’s site if your state runs its own exchange.

2. By Phone: Call your state Medicaid agency, or the Marketplace Call Center at 1-800-318-2596 (TTY 1-855-889-4325), to apply with a representative.

3. In Person: Visit a local department of social services, county health department, or local Medicaid office to fill out a paper application with a caseworker.

The steps below describe the Marketplace application.

The enrollment deadline below applies to Marketplace plans. According to HealthCare.gov, you can apply for Medicaid or CHIP at any time of the year. ⁵

The last day to enroll for 2028 coverage is December 15, 2027. Coverage begins January 1, 2028. If you don’t enroll in a plan by December 15, you can’t get 2028 coverage unless you qualify for a Special Enrollment Period .

You may call 24/7 Marketplace helpline at (800) 318-2596 for specific information about enrolling in Medicaid, eligibility, coverage and services for your state.