Medicaid and CHIP Eligibility: Who Can Qualify and How to Apply

Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of people, but who qualifies depends heavily on where you live. Both are run jointly by the federal government and the states, so the basic framework is national while income limits, benefits and costs vary from state to state.

This guide explains, at a general level, who these programs are designed for, how state choices shape eligibility, what's changing for some adults in 2027 and how to apply. It can't tell you whether you qualify; your state makes that decision when you apply.

This is general information, not legal, insurance or medical advice. For help with your situation, contact your state Medicaid agency, a free Marketplace assister or a legal aid organization in your area.

Who Medicaid is for

As of 2026, HealthCare.gov describes Medicaid as providing coverage in all states for low-income people, including families and children, pregnant women, the elderly and people with disabilities. It adds several points that shape how the program works:

• Medicaid programs must follow federal guidelines, but eligible income levels, coverage and costs can differ from state to state.
• Some state programs pay for care directly; others use private insurance companies to provide Medicaid coverage.
• Benefits differ by state, but all states provide comprehensive coverage.

HealthCare.gov's 2026 guidance also encourages people to apply even if they doubt they qualify on income, because states consider household size, pregnancy, caring for young children, disability, age and other factors.

Expansion states and the 138% figure

The biggest difference between states is whether they have expanded Medicaid to cover adults based on income alone. In states that have, HealthCare.gov's 2026 guidance says you qualify if your household income is below 133% of the federal poverty level, which works out to 138% because of how income is calculated; a few states use a different limit.

To put that in dollars: HealthCare.gov says 2026 poverty figures are used to check Medicaid and CHIP eligibility, and lists $15,960 for one person under the 2026 guidelines. At 138%, that's about $22,025 a year for a single adult in the 48 contiguous states and DC, though your state's exact calculation, and its rules for monthly income, decide the real answer.

In states that haven't expanded, HealthCare.gov's 2026 guidance describes a coverage gap: adults with incomes below the poverty level who don't qualify under the state's existing rules may get neither Medicaid nor savings on a Marketplace plan. HealthCare.gov still recommends applying, and points people in this situation to community health centers, which charge on a sliding scale based on income.

Children, pregnancy and CHIP

CHIP fills in above Medicaid for many families. As of 2026, HealthCare.gov describes it as low-cost coverage for children and pregnant women in families that earn too much to qualify for Medicaid, run in close coordination with each state's Medicaid program. Each state sets its own CHIP eligibility rules.

HealthCare.gov's 2026 CHIP page lists what all states cover, including routine check-ups, immunizations, doctor visits, prescriptions, dental and vision care, hospital care, lab and X-ray services, emergency services and behavioral health services. On cost, it says routine well-child doctor and dental visits are free, some states charge copayments or a monthly premium, and total CHIP costs can't exceed 5% of a family's income for the year.

Coverage is also steadier for kids than it used to be. Medicaid.gov says that, effective January 1, 2024, states must provide 12 months of continuous eligibility for children under 19 in Medicaid and CHIP, so a child generally keeps coverage for a full year once enrolled.

If your children qualify for CHIP, HealthCare.gov's 2026 guidance says they won't be eligible for Marketplace savings, but other family members may still qualify for Marketplace help.

Immigration status rules have changed

HealthCare.gov's 2026 Medicaid and CHIP pages carry a warning that, due to a law change, only lawful permanent residents, Cuban or Haitian entrants and Compact of Free Association migrants are now eligible for full Medicaid or CHIP coverage. CMS's November 18, 2025 bulletin says this change applies beginning October 1, 2026. Depending on the state, lawfully residing children and pregnant women may also qualify. HealthCare.gov notes that some limited forms of Medicaid cover only specific services, such as treatment of an emergency medical condition.

What's changing for some adults in 2027

Public Law 119-21, signed July 4, 2025, made several Medicaid changes that take effect around January 1, 2027. Here is what federal sources say, at a general level:

• Work requirement. A June 2026 CMS fact sheet says that, beginning no later than January 1, 2027, states must require certain adults to show 80 hours per month of qualifying activities, such as work, certain work programs, community service or at least half-time school, or earnings of at least 80 times the federal minimum wage. It applies to non-pregnant adults aged 19 to 64 who aren't enrolled in Medicare and are covered through the Medicaid expansion adult group or certain similar programs. CMS lists exemptions including pregnant or postpartum people, parents and caregivers of a child 13 or under or of a disabled individual, people who are medically frail, American Indians and Alaska Natives, former foster care youth and veterans with a total disability rating.
• More frequent renewals. A November 18, 2025 CMS informational bulletin says that, beginning with renewals scheduled on or after January 1, 2027, states must renew eligibility every 6 months, rather than every 12, for adults in the expansion group.
• Shorter retroactive coverage. Under the rules in place in 2026, the bulletin says states generally must provide retroactive eligibility for up to three months before the month of application. It says that for applications made on or after January 1, 2027, that period is limited to one month for expansion adults and two months for others.

How these rules look in practice depends on your state. If you're enrolled, keep your address and phone number current with your state agency, open every letter and respond to renewal requests by the deadline.

How to apply

Medicaid and CHIP take applications all year, and HealthCare.gov's 2026 guidance says coverage can start immediately if you qualify. You can apply two ways:

• Through the Marketplace application at HealthCare.gov or your state's Marketplace. If anyone looks eligible, your information goes to your state agency, which contacts you about enrollment. You'll also learn whether you qualify for Marketplace savings instead.
• Directly with your state Medicaid agency. HealthCare.gov's Medicaid page lets you pick your state to get the agency's contact information.

If your state denies Medicaid or CHIP, HealthCare.gov's 2026 guidance says it usually sends your information to the Marketplace, and you may qualify for a Marketplace plan with savings. Losing Medicaid or CHIP can also open a Special Enrollment Period; see our guide to Open Enrollment and Special Enrollment Periods for the timing.

Be wary of anyone who asks for money. HealthCare.gov's 2026 fraud guidance says the Marketplace, its assisters and your state will never threaten you or ask for payment to keep or qualify for coverage, and that you shouldn't give money to anyone claiming you must pay them to keep Medicaid or CHIP.

Key takeaways

• Medicaid and CHIP are joint federal and state programs; income limits, benefits and costs vary by state.
• In expansion states, adults can qualify on income alone below an effective 138% of the poverty level, per HealthCare.gov; non-expansion states can leave a coverage gap.
• CHIP covers children and pregnant women in families above Medicaid limits, with total costs capped at 5% of family income, per HealthCare.gov.
• Starting around January 1, 2027, many expansion adults face a work requirement, six-month renewals and shorter retroactive coverage under Public Law 119-21.
• Your state makes the final eligibility decision, and you can apply any time of year.

Sources

• HealthCare.gov, Medicaid and CHIP coverage
• HealthCare.gov, Medicaid expansion and what it means for you
• HealthCare.gov, The Children's Health Insurance Program (CHIP)
• HealthCare.gov, Federal poverty level (glossary)
• Medicaid.gov, Continuous Eligibility for Medicaid and CHIP Coverage
• Centers for Medicare and Medicaid Services, Medicaid Community Engagement Requirement for Certain Individuals Interim Final Rule fact sheet (June 2026)
• CMS Center for Medicaid and CHIP Services, Informational Bulletin on Public Law 119-21 (November 18, 2025)
• HealthCare.gov, How can I protect myself from fraud in the Health Insurance Marketplace?