Which states are expanding or restricting Medicaid adult eligibility in 2026 and why?
Executive summary
The short answer: reporting does not provide a single, authoritative list of which states are increasing or cutting adult Medicaid eligibility in 2026; instead, national law changes are reshaping state choices and many states are already adjusting rules—some widening income thresholds for long‑term care while others are tightening eligibility for specific groups (notably certain immigrants) or preparing to impose work and more frequent redeterminations under federal law [1] [2] [3] [4]. The dominant drivers are the 2025 federal law changes (often labeled OBBBA/H.R.1), which end expansion incentives and create new verification, work and redetermination requirements that make states likelier to restrict coverage or slow new expansion [4] [5].
1. Expansion landscape: incentives ended, so new state expansions are unlikely
The ACA’s Medicaid expansion once offered an enhanced federal match to encourage states to cover adults up to 138% of the federal poverty level, but the 2025 federal law phases out key incentives (ending the higher match and the two‑year bonus) and thus removes a major financial spur for the remaining non‑expansion states to expand in 2026; KFF and the AMA note that the incentive structure that drove past expansions is ending in 2026, reducing the fiscal case for additional states to add expansion coverage [6] [5].
2. Income and long‑term care limits: modest increases, not broad expansions
On the technical eligibility side, many states raised income caps for long‑term care programs in 2026—typical individual monthly caps increased from about $2,901 to $2,982—so more people may technically meet those narrow program thresholds, but these changes are modest and do not alter the fundamental MAGI‑based adult expansion standard (138% FPL) that applies in expansion states [1] [2].
3. State examples of restrictions: immigrant eligibility and program carve‑outs
Several states and state guidance documents highlight concrete restrictions taking effect in 2026: California’s Medi‑Cal will remove full‑scope federal Medicaid for some immigrant groups and cut certain adult dental benefits for those with unsatisfactory immigration status, driven by a mix of state budget actions and federal H.R.1 provisions [3]; Maryland and Illinois publications flag that some noncitizen groups will lose eligibility for federal Medicaid support starting in late 2026 and that states are changing who qualifies for ACA financial help when immigration status and income interact [7] [8]. These are examples of targeted eligibility restrictions rather than blanket adult disenrollment policies [3] [7] [8].
4. Administrative restrictions coming: redeterminations, work rules and verification
Beyond categorical exclusions, the federal law requires or incentivizes states to do more frequent eligibility checks (moving from 12‑month to 6‑month redeterminations for expansion adults) and to implement “community engagement” or work‑type requirements (e.g., 80 hours/month) beginning in late 2026; federal and state analyses warn that more frequent screening historically raises inadvertent coverage losses even among people who still qualify, and the Congressional Budget Office and other analysts project millions of additional uninsured over coming years as a result [4] [9] [10] [11].
5. What this means for the question “which states are expanding or restricting?”
The contemporaneous reporting shows two clear patterns rather than a tidy state list: (a) technical, narrow increases in some program income caps that slightly broaden eligibility for long‑term care in many states [1] [2]; and (b) a wave of new restrictions and administrative tightening prompted by federal law and state budget choices that are already producing specific cutbacks for immigrant groups and planning for more frequent redeterminations and work rules in multiple states [3] [12] [8] [4]. The sources provided do not deliver a comprehensive, state‑by‑state roster of net expansions versus cuts for adult Medicaid in 2026, so answering definitively which individual states overall expanded or restricted adult eligibility requires state‑level policy trackers (for example, KFF’s ongoing map) beyond the documents cited here [6].