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How does the 2026 FPL affect Medicaid and CHIP eligibility in each state?
Executive summary
The 2026 federal poverty level (FPL) numbers will determine Medicaid and CHIP income eligibility in each state once states adopt the 2026 FPL (states typically switch between February and April) — until then, programs use the 2025 FPL figures (the 2025 FPL is currently in use for Medicaid/CHIP eligibility until early 2026) [1]. States set different eligibility cutoffs as percentages of FPL: children’s CHIP/Medicaid ranges commonly from roughly 170% up to 400% FPL in state practice, and adult Medicaid in expansion states generally uses about 133% (effectively 138% with the 5% disregard) as the cutoff [2] [3] [4] [5].
1. How the “2026 FPL” mechanically changes state eligibility — a simple clock
Federal poverty guidelines are updated annually by HHS; states typically begin using the new FPL for Medicaid and CHIP eligibility between February and April of the year after release, so the 2026 FPL will start governing state determinations when each state implements that update (many switch in Feb–Apr 2026) [1]. Available sources do not mention exact state-by-state switch dates for the 2026 update beyond this general timing [1].
2. What percentages of FPL states actually use for CHIP and children’s coverage
Medicaid.gov shows that states set CHIP/Medicaid eligibility for children at widely varying percentages of FPL — the documented national spread is “as low as 170% up to 400% of the FPL” depending on state options and program design [2]. CMS’s state table presents detailed state-by-state MAGI-based income levels (expressed as percent of FPL) and notes California and other states use separate CHIP designs; those tables are the official source for the precise cutoffs in each state [3].
3. Adult Medicaid: expansion states vs non‑expansion states
Under the ACA expansion framework, Medicaid eligibility for adults in expansion states is based on income up to 133% of FPL (effectively 138% after the 5% income disregard), and most states chose to expand Medicaid [4] [5]. States that have not expanded Medicaid continue to use their prior, typically much lower, parental or adult eligibility rules, which vary by state and may be expressed in dollar amounts rather than percent-of-FPL [6] [7].
4. Why the 5% “disregard” matters for real-world eligibility
Federal regulations allow an automatic 5 percentage-point income disregard when determining MAGI-based eligibility; CMS and MACPAC explain that the effective eligibility thresholds are often 5 percentage points higher than the nominal percent shown, which is why “133%” often functions as about 138% in expanded states [6] [7]. This administrative detail means small changes in the FPL level can slightly change who qualifies, because the dollar value representing a given percent-of-FPL moves each year [1] [6].
5. State-level detail: where to look for the exact 2026 cutoffs
CMS maintains a state-by-state table of Medicaid, CHIP, and Basic Health Program MAGI eligibility levels (percent of FPL) that is the authoritative source for each state’s cutoffs [3]. KFF and MACPAC also compile state eligibility summaries and percent-of-FPL charts [8] [6] [7]. For any single state’s 2026 income thresholds after the HHS release, consult the CMS eligibility table and the state Medicaid/CHIP agency pages cited in those tables [3].
6. Practical impacts — who might gain or lose coverage when the 2026 FPL is adopted
Because eligibility thresholds are expressed as percent of FPL, an increase in the FPL raises the dollar amounts that correspond to each percentage [1]. In expansion states, the adult eligibility dollar cutoff tied to 133% FPL will rise or fall with the FPL update, potentially moving some low-income adults into or out of eligibility. For children, many states already set comparatively high percent-of-FPL cutoffs (up to several hundred percent) so the practical effect depends on each state’s chosen percentage and whether the state uses dollar caps or percent rules [2] [3].
7. Limitations and disagreements in sources
CMS and MACPAC provide the percent-of-FPL framework and state tables, but they do not list the exact calendar day each state will begin using the 2026 FPL (states vary in timing) [1] [3] [6]. Healthinsurance.org explains the common operational timing (states move to new FPL numbers in Feb–Apr) and notes Marketplace vs Medicaid timing differences for subsidy calculations [1]. KFF compiles state-by-state data but its datasets are updated on their own schedule, so readers should verify with CMS/state pages for the most current numeric cutoffs [8] [3].
Bottom line: The 2026 FPL will change the dollar thresholds tied to each state’s percent-of-FPL eligibility rules once each state implements the update (typically Feb–Apr), but which people are affected depends entirely on the percent-of-FPL each state uses for specific groups (children, pregnant women, parents, adults), as documented in CMS’s state eligibility tables and supplemental compilations from MACPAC and KFF [3] [6] [8].