Medicaid in the United States: 2026 State Expansion, Eligibility, Benefits, and How to Apply
Medicaid is one of the most important public health insurance programs in the United States. It provides free or low-cost health coverage to millions of Americans with limited income, including children, pregnant women, parents, seniors, and people with disabilities.
However, there is an important point that often causes confusion: Medicaid exists in every state, but not every state has adopted the Affordable Care Act (ACA) Medicaid expansion.
As of May 2026, 41 states including Washington, D.C. have adopted the ACA Medicaid expansion, while 10 states have not.
This difference can significantly affect eligibility for low-income adults, especially adults ages 19–64 who do not have dependent children.
Table of Contents
- What Is Medicaid?
- Medicaid Expansion vs. Non-Expansion States
- Which States Have Expanded Medicaid?
- Which States Have Not Expanded Medicaid?
- Medicaid Eligibility Requirements
- Medicaid Benefits and Coverage
- Why Medicaid Benefits Differ by State
- How to Apply for Medicaid
- Medicaid and Immigration Status
- 2027 Medicaid Work Requirements
- Frequently Asked Questions
- Final Takeaway
What Is Medicaid?
Medicaid is a joint federal and state health insurance program. The federal government establishes broad requirements and provides federal funding, while individual states administer their own Medicaid programs.
This means Medicaid is not exactly the same program in every state.
According to the Centers for Medicare & Medicaid Services (CMS), states determine many aspects of their programs, including eligibility rules, covered services, and how services are delivered, within federal requirements.
People who may qualify for Medicaid include:
- Low-income adults
- Children
- Pregnant women
- Parents and caregivers
- Seniors
- People with disabilities
- Certain former foster youth
- Certain qualified non-citizens
The exact requirements depend on the applicant’s circumstances and state.
Medicaid Expansion vs. Non-Expansion States
The most important distinction for adults is whether a state has adopted the ACA Medicaid expansion.
The ACA originally created an expansion pathway for adults with household income up to approximately 138% of the Federal Poverty Level (FPL). The expansion generally covers adults ages 19–64, including adults without dependent children.
Expansion States
In states that adopted the ACA expansion, many low-income adults can qualify primarily based on household income.
For 2026, KFF reports the federal poverty level for an individual used in the ACA expansion analysis at $22,025 annually, with the 138% Medicaid expansion threshold being approximately that amount for an individual.
Non-Expansion States
The situation is very different in the 10 states that have not adopted the ACA expansion.
In these states, simply having a low income does not necessarily make an adult eligible for Medicaid.
Eligibility may instead depend on factors such as:
- Having dependent children
- Pregnancy
- Disability
- Age
- Certain medical conditions
- Other state-specific eligibility categories
KFF reports that, except for special programs in Georgia and Wisconsin, non-expansion states generally do not provide Medicaid to adults under 65 without dependent children solely because of low income.
States That Have Expanded Medicaid in 2026
As of May 2026, the following 41 states including Washington, D.C. have adopted the ACA Medicaid expansion:
| State | Medicaid Expansion |
|---|---|
| Alaska | Yes |
| Arizona | Yes |
| Arkansas | Yes |
| California | Yes |
| Colorado | Yes |
| Connecticut | Yes |
| Delaware | Yes |
| District of Columbia | Yes |
| Hawaii | Yes |
| Idaho | Yes |
| Illinois | Yes |
| Indiana | Yes |
| Iowa | Yes |
| Kentucky | Yes |
| Louisiana | Yes |
| Maine | Yes |
| Maryland | Yes |
| Massachusetts | Yes |
| Michigan | Yes |
| Minnesota | Yes |
| Missouri | Yes |
| Montana | Yes |
| Nebraska | Yes |
| Nevada | Yes |
| New Hampshire | Yes |
| New Jersey | Yes |
| New Mexico | Yes |
| New York | Yes |
| North Carolina | Yes |
| North Dakota | Yes |
| Ohio | Yes |
| Oklahoma | Yes |
| Oregon | Yes |
| Pennsylvania | Yes |
| Rhode Island | Yes |
| South Dakota | Yes |
| Utah | Yes |
| Vermont | Yes |
| Virginia | Yes |
| Washington | Yes |
| West Virginia | Yes |
Important: Washington, D.C. is included in the 41 expansion jurisdictions, although it is not a state.
States That Have NOT Expanded Medicaid
As of May 2026, the 10 states that had not adopted the ACA Medicaid expansion were:
- Alabama
- Florida
- Georgia
- Kansas
- Mississippi
- South Carolina
- Tennessee
- Texas
- Wisconsin
- Wyoming
This does not mean Medicaid does not exist in these states.
Rather, it means these states have not adopted the ACA’s broad adult Medicaid expansion.
This distinction is extremely important when researching Medicaid eligibility.
Who Can Qualify for Medicaid?
Medicaid eligibility is determined by both financial and non-financial requirements.
1. Income
For many adults in expansion states, income is the most important factor.
The ACA expansion generally covers adults with household income up to 138% of FPL, although states’ implementation and eligibility calculations can involve specific rules.
However, income limits differ substantially for:
- Children
- Pregnant women
- Parents
- Seniors
- People with disabilities
- Other eligibility groups
Therefore, someone who does not qualify under one Medicaid category may qualify under another.
2. State Residency
Generally, applicants must be residents of the state where they are applying for Medicaid.
3. Citizenship or Immigration Status
Medicaid eligibility also involves citizenship or immigration requirements.
U.S. citizens and certain qualified non-citizens may qualify if they meet the other requirements. Immigration rules can be complicated, so applicants should verify their individual circumstances with their state Medicaid agency.
4. Household Size
For many MAGI-based Medicaid categories, household size affects the income threshold.
For example, the income limit for a household of four is different from the limit for a single adult.
5. Age and Family Circumstances
Medicaid has separate eligibility pathways for groups such as:
- Children
- Pregnant women
- Parents
- Seniors
- People with disabilities
Therefore, Medicaid should not be viewed simply as an income-based program.
What Does Medicaid Cover?
Medicaid provides broad medical coverage, but the exact benefits can vary by state.
Federal law requires states to provide certain mandatory benefits. These include:
- Inpatient hospital services
- Outpatient hospital services
- Physician services
- Laboratory and X-ray services
- Rural health clinic services
- Federally qualified health center services
- Nursing facility services
- Home health services
- Family planning services
- Certain transportation to medical care
- Certain preventive and screening services
States may also choose to provide optional benefits.
Examples can include:
- Prescription drugs
- Dental services
- Physical therapy
- Occupational therapy
- Personal care services
- Private-duty nursing
- Home and community-based services
- Behavioral health services
- Certain vision-related services
CMS specifically notes that states determine the type, amount, duration, and scope of Medicaid services within broad federal guidelines.
This is why Medicaid benefits can look different from one state to another.
Why Are Medicaid Benefits Different by State?
Medicaid operates as a federal-state partnership.
The federal government establishes broad rules, but states administer their programs.
As a result, two people with similar incomes may have different eligibility or benefits depending on where they live.
For example:
Person A lives in California
They may qualify for Medicaid through California’s Medi-Cal program based on income under the state’s expansion rules.
Person B lives in Texas
Texas has not adopted the ACA Medicaid expansion. A low-income adult without dependent children may therefore not qualify solely because of low income.
This difference is one of the most important issues to understand when researching Medicaid.
How to Apply for Medicaid
One of the advantages of Medicaid is that there is no annual Open Enrollment Period like there is for Marketplace insurance.
You can generally apply for Medicaid at any time during the year.
Step 1: Determine Your State
Medicaid eligibility is handled by the state where you live.
First, identify your state of residence.
Step 2: Check Your Eligibility
Review:
- Household income
- Household size
- Age
- Pregnancy status
- Disability status
- Children in the household
- Citizenship or immigration status
- State residency
Keep in mind that an online eligibility estimate is not the same as an official determination.
CMS recommends contacting the state Medicaid agency for a definitive eligibility determination.
Step 3: Submit an Application
Depending on the state, you may apply:
- Through the state’s Medicaid website
- Through the state’s benefits portal
- Through HealthCare.gov
- By phone
- By mail
- In person
HealthCare.gov explains that if you submit a Marketplace application and appear eligible for Medicaid or CHIP, your information can be securely sent to the state agency for enrollment processing.
Step 4: Provide Verification Documents
Applicants may be asked for information such as:
- Proof of identity
- Proof of income
- Household information
- Social Security information
- Immigration documentation, when applicable
- Proof of state residency
The exact documents depend on the state and eligibility category.
Step 5: Wait for the Eligibility Decision
The state Medicaid agency reviews the application and determines whether the applicant qualifies.
If approved, the state will provide information about enrollment, coverage, and available health plans.
CMS provides a state-by-state directory of Medicaid agencies and specifically recommends contacting the state agency for applications, eligibility questions, application status, replacement cards, and provider information.
Can Medicaid Coverage Start Before You Apply?
Potentially, yes.
Federal Medicaid rules generally allow eligible individuals to receive coverage for certain medical expenses incurred during the three months before the application month, if they would have been eligible during that period.
However, the details can vary depending on the eligibility category and state policies or waivers.
For this reason, someone who recently received a large medical bill should not automatically assume they must pay the entire amount themselves.
It can be worth asking the state Medicaid agency whether retroactive Medicaid coverage is available.
Medicaid and Immigration Status
Medicaid eligibility for immigrants is an area where misinformation is common.
Being a non-U.S. citizen does not automatically mean someone can never receive Medicaid.
Federal rules allow certain qualified non-citizens to qualify, subject to applicable requirements.
However, immigration categories, waiting periods, emergency Medicaid, and state-specific rules can be complicated.
Therefore, immigrants should check their individual situation with the relevant state Medicaid agency rather than relying on general information found online.
Important 2027 Medicaid Changes
People researching Medicaid in 2026 should also be aware that major federal policy changes are scheduled for 2027.
The 2025 federal reconciliation law requires many states to condition Medicaid eligibility for certain adults in the ACA expansion population and some waiver populations on work or community-engagement requirements beginning January 1, 2027, subject to exemptions and implementation rules.
This means Medicaid eligibility rules may become more complicated in the coming years.
Anyone planning to apply or renew Medicaid coverage should therefore check the latest information from their state Medicaid agency instead of relying on an older article.
Medicaid vs. Non-Expansion States: Quick Comparison
| Feature | Expansion State | Non-Expansion State |
|---|---|---|
| Medicaid exists? | Yes | Yes |
| ACA adult expansion? | Yes | No |
| Low-income adults without children | Generally may qualify if income is within expansion limit | Generally cannot qualify solely based on low income |
| Children | Medicaid/CHIP may be available | Medicaid/CHIP may be available |
| Pregnant women | State-specific income limits | State-specific income limits |
| Seniors | Separate eligibility rules | Separate eligibility rules |
| People with disabilities | Separate eligibility rules | Separate eligibility rules |
| Application | State Medicaid agency/Marketplace | State Medicaid agency/Marketplace |
| Open enrollment period | No | No |
The key point is that non-expansion does not mean no Medicaid. It means the state has not adopted the ACA’s broad adult expansion.
Frequently Asked Questions About Medicaid
Is Medicaid free?
Medicaid is generally free or low-cost for eligible individuals, but some states and eligibility categories may have premiums, copayments, or other cost-sharing arrangements.
The amount depends on the state and the person’s eligibility category.
Can I apply for Medicaid anytime?
Yes. Medicaid and CHIP applications can generally be submitted throughout the year.
Can I qualify for Medicaid if I don’t have children?
Yes, particularly if you live in an ACA expansion state and meet the applicable income and other requirements.
In non-expansion states, adults without dependent children generally face much more restrictive eligibility rules.
What if my state did not expand Medicaid?
You should still apply.
HealthCare.gov specifically recommends applying even if your state has not expanded Medicaid because other eligibility categories may apply, including programs for children, pregnant women, people with disabilities, and other groups.
Does Medicaid cover dental care?
Dental coverage varies by state and eligibility category. Dental services are among the benefits states may choose to cover as optional Medicaid benefits.
Can I move to another state to get Medicaid?
Medicaid is generally tied to state residency. Moving to another state does not automatically transfer your Medicaid coverage.
If you move, you should contact the Medicaid agency in your new state and determine whether you qualify there.
Where should I apply?
The safest starting point is your state Medicaid agency.
CMS maintains a state-by-state Medicaid contact directory for applications and eligibility questions.
Final Takeaway
Medicaid is often described as America’s low-income health insurance program, but the reality is more complicated.
The most important distinction is whether your state has adopted the ACA Medicaid expansion.
As of 2026, 41 states including Washington, D.C. have adopted the expansion, while 10 states have not.
For people living in expansion states, low-income adults ages 19–64 may have a relatively straightforward pathway to Medicaid based largely on household income.
In non-expansion states such as Texas, Florida, Alabama, Tennessee, and Wyoming, eligibility for low-income adults can be substantially more restrictive.
At the same time, every state has Medicaid programs for certain groups, including children, pregnant women, seniors, and people with disabilities.
The best approach is therefore not simply to ask “Does my state have Medicaid?”
Instead, ask:
“Has my state adopted Medicaid expansion, and which Medicaid eligibility category applies to me?”
Because state rules can change, applicants should verify their eligibility directly with their state Medicaid agency before making decisions about health coverage. CMS provides official state contact information and application resources through Medicaid.gov.
Sources and Official Resources
- Centers for Medicare & Medicaid Services (CMS) — Medicaid.gov
- KFF — Medicaid Expansion Status by State
- HealthCare.gov — Medicaid & CHIP Eligibility and Application Information
This article reflects information available as of August 2026 and is intended for general educational purposes. Medicaid eligibility is determined by the applicable state Medicaid agency.