Medicaid is free or very low-cost health coverage for people with limited income. It’s run jointly by states and the federal government, so rules vary by state. In 2027, two big federal changes take effect for many adults: work requirements and more frequent eligibility checks.
Key takeaways
- In expansion states, most adults with income up to 138% FPL qualify ($22,025 for one person, $45,540 for a family of four, based on 2026 guidelines).
- Starting January 1, 2027, many expansion adults ages 19–64 must show 80 hours a month of work, school, volunteering or job training — with exemptions.
- Expansion adults will have eligibility rechecked every six months.
- You can apply any time of year.
Who qualifies for Medicaid
- Adults in expansion states with income up to 138% FPL (40 states plus D.C. have expanded).
- Children — often at higher incomes, through Medicaid or CHIP.
- Pregnant people — usually at higher incomes, with coverage now commonly extended to 12 months after birth.
- People with disabilities and older adults who meet income and asset rules.
- In non-expansion states, adults without children often can’t qualify regardless of income.
New in 2027: work requirements
Under the 2025 federal budget law, adults ages 19 to 64 who get Medicaid through the expansion group (or certain state waiver programs) must show at least 80 hours per month of “community engagement,” such as:
- Paid work
- Community service or volunteering
- Enrollment in school at least half-time
- A work program or job training
- Or monthly income of at least 80 times the federal minimum wage
Who is exempt
Exemptions include pregnant and postpartum people, parents and caregivers of young children or people with disabilities, people who are medically frail (including those with serious or complex medical conditions, disabilities, or substance use disorders), and several other groups. States must verify exemptions, so keep documentation handy.
Watch your mail and online account. States are rolling out new reporting systems. Many people lose coverage not because they’re ineligible, but because they miss a notice or deadline. Update your address and phone number with your state Medicaid agency now.
More frequent renewals
Starting in 2027, expansion adults must have their eligibility redetermined every six months instead of once a year. States may check work requirements even more often. Respond to every renewal notice quickly.
How to apply
- Apply through your state Medicaid agency, or through HealthCare.gov / your state marketplace — they’ll forward your application if you appear eligible.
- Have proof of income, identity, residency and household size ready.
- Respond to any requests for documents promptly.
- Coverage can sometimes be retroactive for recent months — ask your state.
If you lose Medicaid
Losing Medicaid opens a Special Enrollment Period for a Marketplace plan. However, adults who lose Medicaid for not meeting work requirements may not be eligible for Marketplace premium tax credits, so it’s worth acting early to avoid losing coverage.
Frequently asked questions
Do work requirements apply to children or seniors?
No. They apply to non-pregnant expansion adults ages 19–64 who aren’t otherwise exempt. Children, people 65 and older, and people who qualify through disability are not subject to them.
Will I have to pay anything for Medicaid?
Most services are free or have small copays. Starting in 2028, some expansion adults above the poverty line may face modest copays for certain services.
My state hasn’t expanded Medicaid. What are my options?
If your income is at least 100% FPL, you may qualify for Marketplace premium tax credits. See premium tax credits for 2027.
Can I have Medicaid and a job?
Yes. Many Medicaid enrollees work. Eligibility depends on income, not employment status.
Sources: Medicaid.gov; HHS 2026 Poverty Guidelines; CMS guidance on community engagement requirements; KFF. Rules vary by state. For education only — not legal or insurance advice. Last reviewed October 2026.
