6 min read · Last updated July 06, 2026
- Expansion covers adults 19 to 64 with income up to 138% of the poverty line, which is about $22,025 a year for one person in 2026.
- There is no asset test. Your savings, car, and home do not count toward eligibility for this group.
- Starting in 2026, most expansion adults must show 80 hours a month of work, school, or volunteering to keep coverage.
- You can apply any time of year, and coverage can start retroactively in many states.
In this article
– What Medicaid adult expansion is – Who qualifies in 2026 – What expansion Medicaid covers – How to apply – The new 80-hour work requirement – FAQ
Alma Reyes, 29, a home health aide in Las Vegas who earns about $1,700 a month, went three years without health insurance because she assumed Medicaid only covered children and pregnant women. When a chest infection finally forced her into a clinic, an enrollment counselor pulled up her income and told her she had qualified for full Medicaid the entire time. She is exactly who the adult expansion group was built for.
What Medicaid adult expansion is
Medicaid expansion is the part of the Affordable Care Act that opened Medicaid to low-income adults who do not fit the old categories of parent, pregnant person, senior, or someone with a disability. Before expansion, a childless adult like Alma usually could not get Medicaid at any income. Now, in the roughly 40 states plus Washington, D.C. that have expanded, she can.
The federal government pays 90% of the cost of covering this group, which is why it exists in so many states. Eligibility runs on your Modified Adjusted Gross Income, the same income figure the tax system uses, not on your assets.
Who qualifies in 2026
The core rule is income at or below 138% of the federal poverty line. That figure is technically 133% plus a standard 5% income disregard, which is why you will see both numbers. Here is what 138% looks like in 2026.
| Household size | 138% of poverty (annual) | Monthly |
|---|---|---|
| 1 person | $22,025 | $1,835 |
| 2 people | $29,863 | $2,489 |
| 3 people | $37,702 | $3,142 |
| 4 people | $45,540 | $3,795 |
Beyond income, you must be:
– Age 19 through 64 – A resident of a state that expanded Medicaid – A U.S. citizen or a qualified immigrant (lawful permanent residents generally qualify after a five-year waiting period, with some exceptions for children and pregnant people) – Not entitled to or enrolled in Medicare
If you live in one of the ten states that have not expanded, a childless adult may fall into what is called the coverage gap, earning too much for old-style Medicaid but too little for marketplace subsidies. In that case, still apply, because your children may qualify for CHIP and your situation may change.
What expansion Medicaid covers
Expansion enrollees get comprehensive coverage, not a stripped-down plan. Benefits include:
– Doctor visits and preventive care – Hospital and emergency care – Prescription drugs – Mental health and substance use treatment – Maternity and newborn care – Lab work and screenings
Cost-sharing is minimal. Most expansion enrollees pay little or nothing at the point of care. If you are also over 65 or have Medicare, look instead at the Medicare Savings Programs, which help with premiums and cost-sharing.
How to apply
Medicaid has no open-enrollment window. You can apply any day of the year, and coverage can be backdated in many states to cover bills from the weeks before you applied.
1. Apply through HealthCare.gov or your state Medicaid agency, online, by phone, by mail, or in person. 2. Provide proof of income, your Social Security number, proof of state residency, and immigration status if applicable. 3. If you are found ineligible for Medicaid, your application is passed to the marketplace to check for subsidized private coverage automatically.
For a fuller picture of how expansion changes your options, see how Medicaid expansion impacts your coverage.
The new 80-hour work requirement
This is the biggest change for 2026, and it is where most people will lose coverage if they are not paying attention.
Under the 2025 budget law, most adults in the expansion group must now meet a community engagement requirement to keep their Medicaid. That means at least 80 hours a month of a combination of paid work, job training, community service, or school, or half-time school on its own. You can also meet it by earning at least $580 in a month, which is 80 times the federal minimum wage.
Several groups are exempt, including people who are pregnant, medically frail, caring for a young child or a dependent with a disability, under 19 or 65 or older, or already meeting SNAP or TANF work rules. The requirement applies to non-pregnant adults ages 19 to 64 in the expansion group.
On timing: a federal rule tied to the law takes effect July 31, 2026, and states must have the requirement running by January 1, 2027, though some are starting sooner. Nebraska was first, in May 2026.
Here is the part that catches people. The most common reason enrollees lose coverage under work rules is not that they were not working. It is that they did not report their hours or their exemption at renewal. When your renewal notice arrives, open it the day it comes and report your hours or your exemption, even if you are certain you qualify. Your coverage can be cut for silence.
Why applications and renewals get denied
– Counting gross pay without the deductions your state allows, so your income looks higher than it is – Missing a renewal or redetermination notice, which now come more often under the new law – Not reporting work hours or a valid exemption – Applying in a non-expansion state and falling into the coverage gap – Assuming an asset test applies and not finishing the application
FAQ
Do I qualify if I don’t have children? Yes. That is the whole point of expansion. Adults ages 19 to 64 with no dependents qualify based on income alone, up to 138% of the poverty line, in states that expanded Medicaid.
Does my car or savings count against me? No. The expansion group has no asset or resource test. Your bank balance, your vehicle, and your home do not affect eligibility. Only your monthly income matters.
What if I live in a state that didn’t expand Medicaid? You may fall into the coverage gap. Still apply, because rules and state decisions change, your children may qualify for CHIP, and the marketplace may offer subsidized plans depending on your income.
Do I have to work to keep Medicaid now? In most expansion states, yes, starting in 2026. Non-pregnant adults 19 to 64 must show 80 hours a month of work, school, training, or volunteering, unless they are exempt. Report your hours or exemption at every renewal to avoid losing coverage.
What documents do I need to apply? Proof of income, your Social Security number, proof of state residency, and documentation of immigration status if you are not a U.S. citizen. Having recent pay stubs and a photo ID ready speeds up the process.
Leave a Comment