Medicaid and CHIP are not one-size-fits-all programs — eligibility depends on your state, your income, and who is in your household. The fastest way to understand your situation is to find your income on this chart.
| Who you are | Income threshold (2026 approx.) | What you likely qualify for |
|---|---|---|
| Adult in Medicaid expansion state | Below 138% FPL (~$21,600/yr single) | Medicaid — free, enroll anytime |
| Adult in non-expansion state (TX, FL, GA, etc.) | Below ~$9,000/yr single | Very limited Medicaid; marketplace plan may be the only option |
| Pregnant woman (most states) | Up to 185%–200% FPL (varies by state) | Pregnancy Medicaid — apply immediately |
| Child under 19 | Up to 200%–300% FPL (varies by state) | Medicaid or CHIP — covers dental & vision too |
| Adult with disability (SSI recipient) | SSI eligibility | Medicaid automatic with SSI in most states |
| Adult, income 138%–400% FPL | ~$21,600–$62,600/yr single | Marketplace plan with premium tax credits (not Medicaid) |
What Is Medicaid?
Medicaid is a joint federal and state program that provides free or very low-cost health coverage to people with low incomes. It is the largest health coverage program in the United States, covering roughly 80 million people. Unlike ACA marketplace plans, Medicaid enrollment is available year-round — there is no open enrollment period. If you qualify, you can enroll at any time.
Medicaid is administered by individual states within federal guidelines, meaning eligibility rules, covered benefits, and plan options vary by state. Each state sets its own income limits and may expand or restrict optional coverage categories beyond the federal minimum.
Medicaid Expansion Under the ACA
The ACA allowed states to expand Medicaid eligibility to all adults under 65 with incomes up to 138% of the Federal Poverty Level (approximately $21,597/year for a single adult in 2026). As of 2026, 41 states plus Washington D.C. have adopted Medicaid expansion.
In the 10 non-expansion states (including Texas, Florida, and Georgia as of 2026), Medicaid eligibility for adults without children remains very limited — often below 50% FPL. Many low-income adults in non-expansion states fall into a "coverage gap" where they earn too little for marketplace subsidies but do not qualify for Medicaid. For these individuals, marketplace options with subsidy assistance are the primary alternative.
What Does Medicaid Cover?
Medicaid covers a comprehensive set of services, many of which are required by federal law:
- Inpatient and outpatient hospital services
- Physician services and specialist visits
- Prescription drugs (covered under most state programs)
- Laboratory and X-ray services
- Preventive care, including vaccines and screenings
- Mental health and substance use disorder treatment
- Maternity and newborn care
- Long-term care and nursing home coverage (a major advantage over commercial insurance)
- Home health services
- Emergency services
States may also offer optional benefits including dental care, vision care, hearing aids, and additional home and community-based services. Contact your state Medicaid agency for the full list of covered benefits in your state.
What Is CHIP?
The Children's Health Insurance Program (CHIP) is a joint federal-state program that covers children in families who earn too much for Medicaid but cannot afford private insurance. CHIP eligibility typically extends to children in families earning up to 200%–300% FPL, though the exact threshold varies by state. In most states, CHIP covers children from birth through age 18.
CHIP offers comprehensive coverage including routine pediatric care, immunizations, dental care, vision care, emergency services, and mental health care. Premiums and cost-sharing under CHIP are very low — most families pay little to nothing. Enrollment is available year-round.
How to Apply for Medicaid or CHIP
You can apply for Medicaid or CHIP through:
- Healthcare.gov — If you apply for marketplace coverage and appear to qualify for Medicaid or CHIP, the marketplace will transfer your application to your state Medicaid agency
- Your state Medicaid agency directly — Apply online, by phone, in person, or by mail
- A licensed insurance broker — Brokers can help you determine whether you qualify for Medicaid, CHIP, or a marketplace plan, and assist with the application process
Eligibility is determined based on your current monthly income, not your income from the prior year, so you can apply when your income changes.
Medicaid vs. Marketplace: Which Should You Choose?
If you qualify for Medicaid, enrolling in Medicaid rather than a marketplace plan is almost always the right choice. Medicaid has little to no premium, low or no cost-sharing, and comprehensive benefits. Marketplace subsidies cannot be applied to plans if you are eligible for Medicaid. If your income fluctuates between Medicaid-eligible and marketplace-eligible levels, a licensed broker can help you navigate transitions between the two programs. Call (713) 575-9904 for a free consultation.