Do You Qualify for Medicaid — and Will You Keep It?
The One Big Beautiful Bill Act was signed into law on July 4, 2025. It establishes 80-hour monthly Medicaid community engagement requirements for applicable adults ages 19–64, with nationwide implementation beginning by December 31, 2026 (commonly treated as a January 1, 2027 planning date, with states able to implement sooner). Congressional materials citing CBO estimates project 7.5 million more uninsured people in FY2034 tied to Medicaid provisions.
David Duley· Founder & CEO
Published March 29, 2026
Reviewed by Jon Ragsdale for factual accuracy, source quality, and clarity.
Medicaid eligibility is not just an insurance question. It is a rules question. Your coverage can depend on income, state expansion status, household structure, disability status, and increasingly on compliance rules that lawmakers have now changed.
That makes Medicaid a core PRIA topic. A shift in eligibility rules can move a household from low-cost coverage to the Marketplace, into the coverage gap, or out of coverage entirely. Few policy changes are more immediate than losing health insurance because the rules moved.
The One Big Beautiful Bill Act enacted the biggest Medicaid changes in a generation — federal community engagement requirements, tighter eligibility checks, and major federal spending reductions over 10 years. Congressional materials citing CBO estimates project 7.5 million more uninsured people in FY2034 from Medicaid provisions. Enter your details to see where you stand.
How PRIA Approached This
This calculator was written by David Duley and reviewed by Jon Ragsdale. PRIA treats tools like this as household policy-risk explainers, not generic widgets. We separate current law from proposals when relevant, translate public rules into plain English, and present the output as an educational estimate rather than personalized advice.
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Frequently Asked Questions
- What is the income limit for Medicaid in 2026?
- In the 40 states that expanded Medicaid, adults qualify with income up to 138% of the Federal Poverty Level — about $21,597 for an individual or $44,367 for a family of four in 2026. In non-expansion states, limits are much lower: parents may need income below 40% FPL, and childless adults are generally ineligible.
- What states have not expanded Medicaid?
- As of April 1, 2026, 8 states have not adopted traditional Medicaid expansion: Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, and Wyoming. Georgia and Wisconsin use waiver-based expansion pathways, so they should not be grouped with the traditional non-expansion states for work-requirement planning.
- What are the Big Beautiful Bill Medicaid work requirements?
- The One Big Beautiful Bill Act (signed July 4, 2025) requires 80 hours per month of work, education, training, or other qualifying activity for adults ages 19 to 64 in Medicaid expansion who are not exempt, generally beginning January 1, 2027 (with earlier state implementation allowed). Exclusions and exceptions include groups such as pregnant individuals, medically frail individuals, and caregivers of dependents age 13 and under.
- How many people would lose Medicaid under the Big Beautiful Bill?
- After enactment, CBO estimated the reconciliation law would increase the number of uninsured people by 10.0 million in FY2034, with 7.5 million tied to Medicaid provisions.
- What is the Medicaid coverage gap?
- The coverage gap affects people in non-expansion states who earn too much for Medicaid but too little to qualify for ACA Marketplace subsidies (which start at 100% FPL). These individuals have no affordable health coverage option. The Big Beautiful Bill does not address this gap.
- How does Medicaid eligibility differ from Medicare?
- Medicaid is an income-based program for low-income individuals of any age. Medicare is an age-based program primarily for people 65 and older, regardless of income. Some people qualify for both ("dual eligible"). Use our Medicare Premium Calculator to estimate Medicare costs.
- What is Modified Adjusted Gross Income (MAGI) for Medicaid?
- MAGI is the income measure used for most Medicaid eligibility determinations. It includes adjusted gross income plus tax-exempt interest, Social Security benefits, and foreign income. It does not include Supplemental Security Income (SSI).
- Can I get Medicaid if I have a job?
- Yes. Medicaid eligibility is based on income, not employment status. Many Medicaid enrollees work but earn below the income threshold. In expansion states, working adults earning up to about $21,600 per year can qualify.
- What happens to my Medicaid if my income changes?
- States are required to redetermine eligibility periodically. If your income rises above the threshold, you typically get a grace period before losing coverage. Under the One Big Beautiful Bill Act, redetermination checks become more frequent for applicable populations.
- How accurate is this calculator?
- This calculator provides an educational estimate based on federal guidelines and median state thresholds. Actual eligibility depends on your state's specific income limits, asset tests, disability status, and enrollment procedures. Apply through your state Medicaid agency or Healthcare.gov for an official determination.
Medicaid policy is changing fast. Get alerted when Medicaid rules change in your state.
Start Free Watch →Medicaid Eligibility Calculator: The Short Answer
Medicaid eligibility depends first on where you live and then on how your household fits the program rules in that state. Expansion states generally offer a wider path to coverage for low-income adults. Non-expansion states are often much more restrictive, especially for adults without children.
What the Big Beautiful Bill Changes About Medicaid
The One Big Beautiful Bill Act includes the most significant restructuring of Medicaid since the ACA’s Medicaid expansion. Key provisions include:
- Federal work requirements: Non-exempt adults ages 19–64 must document 80 hours per month of work, education, job training, or community service to maintain eligibility
- Eligibility redetermination: More frequent income and identity verification, with coverage terminated for non-compliance
- Per-capita caps: Federal Medicaid spending shift from an open-ended match to per-enrollee limits, forcing states to absorb cost overruns
- $989.7 billion in lower federal outlays over FY2025–FY2034, according to CBO estimates cited in congressional materials
Expansion vs. Non-Expansion States
41 states (including DC) have adopted the ACA’s Medicaid expansion, which covers adults up to 138% of the Federal Poverty Level. In the remaining 10 non-expansion states, childless adults generally cannot qualify for Medicaid regardless of income, and parents face much lower income thresholds — often below 40% FPL.
If you live in a non-expansion state and earn too much for Medicaid but too little for ACA subsidies, you may fall into the “coverage gap” — a group the Big Beautiful Bill does not address.
Why Administrative Rules Matter
Many coverage losses do not come from a person suddenly becoming ineligible on the merits. They come from paperwork, reporting deadlines, identity checks, and recertification failures. That is why changes to redetermination frequency and documentation rules are so important. Administrative friction can function like a benefit cut even when the nominal eligibility threshold stays the same.
Who Is Exempt from Work Requirements?
Under enacted law and CMS implementation guidance, the following groups are excluded from or excepted to the 80-hour monthly requirement:
- Children under 19
- Adults 65 and older
- Pregnant individuals
- People with disabilities receiving SSI or SSDI
- Parents/caregivers of dependents age 13 and under (or disabled dependents)
- Individuals who are medically frail or have special medical needs
- Individuals in substance abuse treatment
What Happens If You Lose Medicaid?
If you lose Medicaid coverage, your options depend on your income. Those between 100–400% FPL can purchase coverage through the ACA Marketplace with premium subsidies. Below 100% FPL in non-expansion states, you may face the coverage gap with no affordable options. Use our Medicare Premium Calculator if you’re approaching 65.
What To Watch Next
If Medicaid matters to your household, watch for changes in work requirements, verification timelines, and state implementation details. The broad federal rule is only part of the story. States determine how aggressively those rules are enforced and how easy it is for eligible people to stay enrolled.
Related Analysis
- Medicaid Changes 2026 — Full implementation timeline, rule deadlines, and what to monitor before 2027
- Medicare Premium Calculator — Estimate your Medicare costs as you age into eligibility
- Child Tax Credit Calculator — See how the Big Beautiful Bill changes your family’s credits