Getting a letter saying your Medicaid is ending is stressful, but it does not have to mean a gap in health coverage. Whether your income changed, you missed a renewal deadline, or your state flagged an eligibility issue, you have real options and in many cases you have more time than you think.
This guide walks through exactly what to do after losing Medicaid coverage, in the order you should do it.
Step 1: Read the Termination Notice Carefully
Before anything else, read the notice your state sent. Federal law requires states to mail a notice at least 10 days before your Medicaid ends. That notice must explain:
- The reason your coverage is being terminated
- The date coverage ends
- Your right to appeal and how to do it
- The deadline to file an appeal
The reason matters because it determines your best next move. If coverage is ending because your income went up, you pivot quickly to the ACA marketplace. If it's ending due to a paperwork issue or a state data error, you may be able to appeal and keep coverage while the appeal is pending.
Save the notice. You will need the date of action and case number for any appeal or marketplace application.
Step 2: Appeal If You Think the Decision Is Wrong
Federal law gives every Medicaid enrollee the right to a fair hearing. This is guaranteed under 42 CFR § 431.220 and applies in all 50 states. A fair hearing is a formal administrative proceeding where you can present your side to a state-appointed judge.
When appealing makes sense:
- Your state made a data or paperwork error
- You submitted renewal documents but your state claims it never received them
- Your income was calculated incorrectly
- You have a disability or medical condition that should qualify you under a different pathway
How to appeal:
- Submit a written appeal request before the deadline on your notice. Deadlines vary by state -- some give you 30 days from the notice date, others allow up to 90 days.
- Deliver your appeal in person to your local Medicaid office if possible, and ask for a date-stamped copy. This protects you if there is a dispute over whether you met the deadline.
- If you need faster action due to a serious medical need, request an expedited (emergency) fair hearing.
A critical point: if you request a fair hearing before your termination date, most states must continue your Medicaid coverage while the appeal is pending. This is called "aid paid pending" and can keep you insured for weeks or months while the process plays out.
If you lose the fair hearing, you still have the right to appeal in state court.
Step 3: Enroll in ACA Marketplace Coverage (Even If You're Not Done Appealing)
Losing Medicaid triggers a Special Enrollment Period (SEP) for the ACA marketplace. You do not have to wait for open enrollment. You can enroll in a marketplace plan:
- Up to 60 days before your Medicaid ends (start shopping now)
- Up to 90 days after your Medicaid coverage ends (in most states)
Do not wait until the last day. If you start the enrollment before coverage ends, you can line up your new plan to start the day after Medicaid stops, with zero gap in coverage.
You can apply at HealthCare.gov or through your state's marketplace if your state runs its own exchange. Check your eligibility quickly at the CoveredUSA screener to see what programs you qualify for based on your current income and household size.
2026 ACA Subsidy Income Limits
If your income is too high for Medicaid but not very high, you likely qualify for subsidized marketplace coverage. Here are the 2026 federal poverty level thresholds used for ACA premium tax credit eligibility:
| Household Size | 100% FPL | 138% FPL (Medicaid expansion cutoff) | 400% FPL |
|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
Note: In states that have expanded Medicaid, you qualify for Medicaid up to 138% FPL. If your income is above that, you move into marketplace subsidy territory. In non-expansion states, there can be a coverage gap if your income falls below 100% FPL -- you earn too much for the limited Medicaid but too little for marketplace subsidies.
Important change for 2026: the enhanced premium tax credits that were in place from 2021 through 2025 have expired. Marketplace premiums are higher on average in 2026 than they were the past few years. Even so, premium tax credits are still available for incomes between 100% and 400% FPL, and some people with higher incomes may still qualify depending on the cost of plans in their area.
What If You're in the Coverage Gap?
If you live in a state that has not expanded Medicaid and your income is below 100% FPL, you may find yourself in the coverage gap: your income is too high for your state's Medicaid but too low to qualify for marketplace subsidies.
As of 2026, ten states have not expanded Medicaid, and nine of them have coverage gaps affecting low-income adults. Those states are: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.
If you're in one of these states with a coverage gap income, your options are narrower but not zero:
- Community health centers: Federally Qualified Health Centers (FQHCs) charge on a sliding-fee scale based on income. Many offer primary care, dental, and prescription services for very low or no cost.
- State pharmaceutical assistance programs: Some states have separate programs for prescription drug assistance outside of Medicaid.
- Hospital charity care: Most hospitals are required to have charity care policies. If you need inpatient care, ask the hospital's financial assistance office before or right after your visit.
- Free clinics: Many metropolitan and rural areas have volunteer-staffed free clinics for uninsured patients.
Other Coverage Options to Check
Depending on your situation, you may qualify for programs beyond the ACA marketplace:
CHIP (Children's Health Insurance Program): If you have children, they may qualify for CHIP even if you no longer qualify for Medicaid. CHIP covers children in families with incomes too high for Medicaid but not able to afford private insurance. Income limits vary by state but are generally between 200% and 300% FPL for children.
Medicare: If you are 65 or older, or have a qualifying disability, you may be eligible for Medicare. Losing Medicaid does not affect Medicare eligibility, and many people qualify for both (called dual eligibility).
Medicare Savings Programs: If you have Medicare but are low-income, these programs can help pay Medicare premiums and cost-sharing. Learn more at coveredusa.org/medicare-eligibility.
Medicaid for specific populations: Some states have separate Medicaid programs for pregnant women, people with disabilities, or adults in specific situations with higher income thresholds than standard Medicaid. It's worth asking your state office whether any of these apply to you.
Employer coverage: If you recently started a job or your employer offers coverage, losing Medicaid can trigger a Special Enrollment Period with your employer as well. The employer SEP is typically 30 days from the loss of other coverage.
Step-by-Step Action Plan
Here is the condensed version if you want to move quickly:
- Read your termination notice -- note the end date and the reason
- Decide whether to appeal -- if the decision looks wrong, file a written appeal before the deadline and ask for aid paid pending
- Check your income against 2026 Medicaid and ACA thresholds to know which program fits
- Apply for marketplace coverage using your Medicaid loss as a Special Enrollment Period -- you can start this now at coveredusa.org/screener
- Enroll in your new plan before your Medicaid end date so coverage starts immediately after
- Ask about CHIP for any children in your household
- Contact a community health center if you end up in the coverage gap with no other options
Check your eligibility now at CoveredUSA -- it takes 2 minutes.
Frequently Asked Questions
How long do I have to appeal a Medicaid termination?
The deadline varies by state. Some states give you 30 days from the date on the termination notice; others allow up to 90 days. Check the notice itself for the exact deadline in your state. If you miss it, you generally lose the right to appeal that specific decision, though you can reapply for Medicaid at any time.
Can I keep my Medicaid while my appeal is being reviewed?
In most cases, yes. If you file your appeal before your termination date, your state is typically required to continue your Medicaid coverage while the fair hearing is pending. This is known as "aid paid pending." Check your notice or call your state Medicaid office to confirm this applies in your situation.
What is the Special Enrollment Period after losing Medicaid?
When you lose Medicaid, you qualify for a Special Enrollment Period on the ACA marketplace. You can enroll in a marketplace plan up to 60 days before your Medicaid ends and up to 90 days after it ends (in most states). You do not have to wait for the annual open enrollment window.
Will I qualify for ACA subsidies after losing Medicaid?
If your income is between 100% and 400% of the federal poverty level and you lose Medicaid eligibility, you almost certainly qualify for premium tax credits on the marketplace. For a single person, that is income between roughly $15,650 and $62,600 in 2026. Use the CoveredUSA screener to get a quick answer based on your specific income and household size.
What if my income is below 100% FPL and I live in a non-expansion state?
This is the coverage gap. Your income is too low for marketplace subsidies but your state's Medicaid does not cover you. In this situation, look into Federally Qualified Health Centers (FQHCs) for primary care, hospital charity care for larger medical needs, and any state-specific drug assistance programs. Congress has periodically debated closing this gap, so check for any policy changes in your state.
Can my children still get coverage even if I lose mine?
Yes. CHIP (Children's Health Insurance Program) has higher income limits than adult Medicaid and covers children through age 18 in most states. Even if you fall off Medicaid, your children may still qualify for CHIP or Medicaid coverage. Apply through your state Medicaid office or at HealthCare.gov.
How do I find out what caused my Medicaid termination?
The termination notice should state the reason. If it does not explain it clearly, call your state Medicaid office directly and ask for the specific reason and case details. Common reasons include income changes detected through data matches with the IRS or Social Security, failure to complete annual renewal paperwork, a change in household composition, or a state residency issue.
How quickly can I get a new plan after losing Medicaid?
If you apply for a marketplace plan and choose your coverage before your Medicaid ends, the new plan can start the first day of the following month after you complete enrollment. Depending on timing, you can have continuous coverage with no gap at all.
