What Is Medicaid? Eligibility, Coverage & How to Apply in 2026

The number of beneficiaries receiving Medicaid is more than 80 million, according to CMS data, making it the largest health insurance program in the United States. Medicaid is jointly funded by the federal and state governments, and is income-based rather than age- or senior-focused, unlike Medicare. Every state has its own Medicaid program that varies greatly in who is eligible, what services are covered, and how to enroll. Federal government has minimum standards. States add atop.

This is a guide to Medicaid and how to apply for Medicaid 2026, as well as understanding what it is, who is eligible, what it covers, and how income limits are calculated. Data is from Medicaid.gov, CMS and KFF state Medicaid trackers. 

What is Medicaid?

What is Medicaid? It's a state-funded health insurance plan that covers low-income Americans, such as children, pregnant people, parents, adults, senior citizens and people with disabilities. Both the federal government and individual states share the cost of Medicaid, and the federal share varies by state, dependent on the state's per-capita income: that share is 50% to 78%.

KFF research estimates that approximately 60% of people in a nursing home receive their payment from Medicaid. Additionally, more than 4 out of 10 births are paid for by Medicaid and over 50 percent of children with special health care needs are served by Medicaid.

See our Medicare vs Medicaid guide for comparison to Medicare. Although it's easy to confuse their names, the two programs are different, and are for different populations and subject to different rules. 

Medicaid eligibility: who qualifies in 2026

Medicaid eligibility is determined by your state, your income, your household size, and which eligibility category you fall into. Federal law requires every state to cover certain groups, called "mandatory eligibility groups":

• Pregnant people and infants up to 138% of the Federal Poverty Level (FPL)

• Children under 19 in low-income households

• Parents and caretaker relatives at low income levels (varies by state)

• People receiving Supplemental Security Income (SSI)

• Older adults (65+) and people with disabilities at low income/asset levels

• Foster care youth up to age 26

States can also cover "optional eligibility groups" with federal matching funds. The most significant optional group is the ACA Medicaid expansion population: adults under 65 with income up to 138% of the FPL. As of 2026, 41 states and the District of Columbia have expanded Medicaid; 9 states have not.

For Medicaid income limits, the 138% of FPL benchmark for 2026 translates to roughly:

Eligibility rules also include asset tests for certain populations (especially seniors and people seeking long-term care coverage). Younger working-age adults applying through the ACA expansion typically don't face an asset test. Always verify with your state's Medicaid agency.

Medicaid coverage: what it includes

Medicaid coverage is more comprehensive than most private insurance for the populations it serves. Federal law requires every state Medicaid program to cover specific "mandatory benefits":

• Inpatient and outpatient hospital services

• Physician services

• Laboratory and X-ray services

• Family planning services and supplies

• Federally Qualified Health Center and Rural Health Clinic services

• Nurse midwife services

• Nursing facility services for adults 21 and older

• Home health services for those who qualify for nursing facility care

• EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) for children under 21

• Transportation to medical appointments

States may also cover "optional benefits," including prescriptions, dental services, vision services, physical therapy, mental health and substance use services, hospice, intermediate care facility services, and Home and Community-Based Services (HCBS) waivers for long-term care.

The variation across states is significant. Some states provide rich optional benefits like full adult dental coverage. Others provide only emergency dental for adults. See our Medicaid dental for adults state-by-state guide for the full breakdown.

For specialty care, see our eye doctors that accept Medicaid and dermatologists that accept Medicaid guides.

Medicaid benefits for adults vs children

Medicaid for adults and Medicaid for children operate under different federal rules.

Children's Medicaid (and CHIP): Federal EPSDT requirements mandate comprehensive preventive, diagnostic, and treatment services for children. Every state must cover full dental, vision, hearing, mental health, and most other services for Medicaid-eligible children at no cost. Coverage is uniform.

Adult Medicaid: Outside of mandatory benefits, optional services vary dramatically by state. An adult on Medicaid in California has very different coverage than an adult on Medicaid in Texas, even though both are technically on "Medicaid."

About 25% of all U.S. children are covered by Medicaid or CHIP combined, per CMS enrollment data.

How to apply for Medicaid

How to apply for medicaid in 2026 has three main paths, depending on your state:

1. Online through Healthcare.gov. If your state uses the federal marketplace, you can apply through Healthcare.gov. The system automatically forwards qualifying applications to your state's Medicaid agency.

2. Online through your state's Medicaid portal. Most states have their own application website. Examples include Covered California, NY State of Health, and ABE Illinois (covered in detail in our Medicaid Illinois guide).

3. By phone, mail, or in person at a county social services office. Every state offers paper or in-person applications for people who can't use online systems.

Documents typically needed:

• Proof of identity (driver's license, passport, birth certificate)

• Proof of citizenship or eligible immigration status

• Proof of income (recent pay stubs, tax returns, Social Security/disability award letters)

• Proof of residency (utility bill, lease, mortgage statement)

• Proof of household composition (marriage certificate, birth certificates of children)

• Information about other health coverage if applicable

• Information about assets, for certain eligibility categories (long-term care, seniors, people with disabilities)

Application processing timelines are typically 30 days for non-disability applications and up to 90 days for disability-based applications. Some states process faster, particularly for emergency situations.

Medicaid income limits in 2026

Medicaid income limits depend on your state, household size, and the eligibility category. The most common benchmark is 138% of the Federal Poverty Level for the ACA expansion population.

Note that these numbers reflect 2025 federal poverty guidelines (used for 2026 Medicaid eligibility determinations made in early 2026). HHS issues new guidelines each January.

Income for Medicaid purposes is calculated using Modified Adjusted Gross Income (MAGI) for most populations, which is similar to your federal income tax AGI. For seniors, people with disabilities, and long-term care applicants, different income and asset rules apply.

Hawaii and Alaska have higher Federal Poverty Level thresholds than the 48 contiguous states. Income limits in those two states are correspondingly higher.

Dual eligible Medicare and Medicaid

About 12.5 million Americans qualify for both Medicare and Medicaid, called "dual eligible." If you're 65+ with low income, you may qualify for both programs. Medicare becomes your primary insurer, and Medicaid covers premiums, copays, and services Medicare doesn't (especially long-term care). For details, see our Medicare vs Medicaid guide.