How do Medicaid income eligibility limits in 2026 differ between expansion and non-expansion states?
Executive summary
Medicaid expansion states use the ACA expansion threshold — roughly 138% of the Federal Poverty Level (FPL) for non‑elderly adults — as the primary income eligibility cutoff for adults, while non‑expansion states generally keep much lower, often highly variable limits tied to traditional eligibility groups (for parents, pregnant people, children, seniors, and people with disabilities) and can be as low as the mid‑30s percent of FPL for parents in non‑expansion states (median ~35% FPL) [1] [2]. The expansion raised adult eligibility to about 138% FPL (KFF cites $21,597 for an individual in 2025 as the 138% FPL benchmark) while non‑expansion states leave many low‑income adults in a “coverage gap” and maintain much lower parent/child income caps [3] [2].
1. Expansion states: a single, income‑based adult cutoff that changed the map
The Affordable Care Act’s expansion created a clear, relatively high income cutoff for adults — states that adopted expansion cover nearly all adults 18–65 with incomes up to about 138% of FPL, and qualification is based on income alone rather than parental status or disability, which markedly simplified adult eligibility in expansion states [1] [4]. KFF’s tracking notes the ACA expansion covers adults up to 138% FPL and gives the federal benchmark ($21,597 for an individual in 2025) that defines what “138%” looks like in dollars [3]. Analysts also explain that the statutory 133% limit effectively functions as 138% because of a 5% income disregard in MAGI rules [4].
2. Non‑expansion states: patchwork rules, lower cutoffs, and the coverage gap
In states that did not adopt expansion, Medicaid eligibility for adults remains narrow and scattered across traditional categories: only pregnant people, parents (at widely varying limits), seniors, and people with disabilities qualify in many cases, leaving childless adults largely ineligible regardless of how low their incomes are [5] [2]. The Center on Budget and Policy Priorities and other analyses highlight that, in the remaining non‑expansion states, the median income limit for parents was just about 35% of poverty — a figure that places many poor adults below the threshold for any coverage and produces the so‑called “coverage gap” affecting over a million people [2] [6].
3. Dollars and mechanics: MAGI rules, FPL percentages, and state variation
Medicaid income limits are expressed as percentages of the Federal Poverty Level and depend on how states count income; most MAGI‑based adult determinations use Modified Adjusted Gross Income and apply the 5% FPL disregard that makes 133% effectively 138% for expansion adults [4]. Outside of the expansion adult group, states use different floors and sometimes different metrics (for example, long‑term care and elderly Medicaid often use separate monthly caps tied to the Federal Benefit Rate rather than FPL), so income cutoffs for seniors and people seeking nursing‑home coverage vary widely across states [7] [8] [9].
4. Who is affected: the coverage gap and population concentrations
The policy consequence is geographic concentration of the uninsured: most people in the coverage gap live in Southern non‑expansion states, with Texas, Florida, and Georgia accounting for large shares of those left without an eligibility pathway despite very low incomes [10] [6]. Multiple sources estimate more than a million people would become Medicaid‑eligible if all states adopted expansion; non‑expansion states retain much lower parent eligibility cutoffs — in some places single‑digit percentages of FPL historically — though specific state numbers vary and must be checked locally [2] [6].
5. Policy shifts in 2026: new federal rules change incentives and conditions
Federal law changes enacted in 2025 alter the fiscal and administrative landscape for 2026. The temporary enhanced federal match that encouraged expansion sunsets Jan. 1, 2026, and new federal rules impose work/community engagement and more frequent redeterminations for some expansion populations by the end of 2026, which could affect how many people remain enrolled even in expansion states [11] [12] [5]. The legislation also differentiates payment caps and other financing rules between expansion and non‑expansion states, which may change states’ calculus going forward [11] [12].
6. Limitations and where reporting is thin
Available sources establish broad differences (138% FPL in expansion states versus much lower, variable cutoffs in non‑expansion states) and document policy changes for 2026, but they do not provide a single, nationwide table comparing every state’s exact 2026 numerical income limits for all eligibility groups; for state‑specific monthly caps (especially for seniors, institutional care, and HCBS waivers) you must consult state agencies or the state‑by‑state compilations cited [7] [8] [13]. Sources cited here are explicit about state variation and about MAGI/non‑MAGI rules that complicate direct comparisons [4] [9].
7. Bottom line for readers
If you live in an expansion state, adult income eligibility is straightforward and roughly at 138% FPL; if you live in a non‑expansion state, adult Medicaid income limits remain fragmented and typically much lower, producing a persistent coverage gap that policy changes in 2026 may exacerbate or shift rather than resolve [1] [2] [11]. For exact 2026 dollar cutoffs for your situation (parents vs. elderly vs. nursing‑home applicants), state Medicaid offices and the state tables referenced in the sources must be consulted [7] [8] [13].