Getting a raise feels good until you start wondering whether it will cost you your Medicaid coverage. The short answer: it depends on how much your income increases and which state you live in. A small raise usually will not push you off Medicaid. A significant jump past the income threshold can end your coverage, but the transition does not have to leave you uninsured.
This guide covers the 2026 Medicaid income limits, what happens step by step when your income goes up, and how to avoid a gap in coverage if you do lose eligibility.
How Medicaid Income Eligibility Works in 2026
Medicaid eligibility is based on your Modified Adjusted Gross Income (MAGI), which is your household income compared to the Federal Poverty Level (FPL). In the 40 states plus Washington D.C. that expanded Medicaid under the Affordable Care Act, adults qualify with income up to 138% of the 2026 FPL, according to Medicaid.gov.
The 2026 Federal Poverty Level was set by the Department of Health and Human Services. Here is the income threshold at 138% FPL, which is the standard Medicaid expansion cutoff:
Medicaid Expansion Income Limits, 2026 (138% FPL, 48 Contiguous States and D.C.)
| Household Size | Annual Income Limit | Monthly Income Limit |
|---|
| 1 | $22,025 | $1,835 |
| 2 | $29,864 | $2,489 |
| 3 | $37,702 | $3,142 |
| 4 | $45,540 | $3,795 |
| 5 | $53,379 | $4,448 |
| 6 | $61,218 | $5,101 |
| 7 | $69,056 | $5,755 |
| 8 | $76,895 | $6,408 |
| Each additional | +$7,838/year | +$653/month |
Alaska and Hawaii use higher poverty guidelines and therefore higher dollar thresholds. Check your state Medicaid agency for the exact figures if you live in either state.
Non-expansion states are different. In Texas, Florida, Georgia, and the other states that did not expand Medicaid, the income limits for working-age adults are much lower and coverage often requires being a parent, pregnant, elderly, or having a disability. If you live in a non-expansion state, even a modest raise can affect your eligibility. Visit healthcare.gov to check whether your state expanded Medicaid.
When a Raise Ends Medicaid Coverage
You lose Medicaid when your household income rises above your state's eligibility threshold. Here is what actually triggers the coverage loss and how the timeline works.
You Must Report the Change
Federal rules require you to report a change in income to your state Medicaid agency. Most states require reporting within 10 to 30 days of the change. Failing to report can result in an overpayment that you would need to repay later, so reporting promptly protects you.
You can report the change through your state's Medicaid online portal, by phone, or in person at your local Medicaid office.
The Redetermination Process
After you report an income increase, your state runs a redetermination to check whether you still qualify. According to CMS guidance, the agency must generally complete the redetermination within 30 calendar days of receiving your report. If additional documentation is needed, the window extends to 60 days.
During this process, your current Medicaid coverage stays active. You are not cut off the moment you report the change.
If the redetermination finds you no longer qualify, your state will send you a notice of termination with an effective date. You have the right to appeal the decision, and in many states you can request a continuation of benefits while the appeal is pending.
The 6-Month Redetermination Change for 2026
Starting December 31, 2026, states will be required to conduct eligibility redeterminations every six months (instead of the previous 12-month cycle) for Medicaid expansion populations. This means if your income crosses the threshold, you are more likely to be caught in a routine check even if you did not proactively report the change. Annual raises, bonuses, and gig income will be reviewed more frequently going forward.
What Coverage Options Replace Medicaid After a Raise
Losing Medicaid does not mean you are automatically uninsured. You have specific options depending on your income level.
ACA Marketplace Plans and Premium Tax Credits
If you lose Medicaid due to an income increase, you qualify for a Special Enrollment Period (SEP) to sign up for an ACA marketplace plan. The SEP window is 90 days from the date you lose Medicaid coverage (longer than the standard 60-day SEP for other qualifying events).
The income range where ACA subsidies apply starts at 100% FPL in expansion states:
ACA Marketplace Subsidy Range, 2026 (uses 2025 FPL)
| Household Size | 100% FPL (subsidy floor) | 400% FPL (subsidy ceiling) |
|---|
| 1 | $15,650 | $62,600 |
| 2 | $21,150 | $84,600 |
| 3 | $26,650 | $106,600 |
| 4 | $32,150 | $128,600 |
| 5 | $37,650 | $150,600 |
| 6 | $43,150 | $172,600 |
| 7 | $48,650 | $194,600 |
| 8 | $54,150 | $216,600 |
| Each additional | +$5,500/year | +$22,000/year |
If your income after the raise falls between 138% FPL and 400% FPL, you likely qualify for premium tax credits that reduce your monthly premium. Some households with income above 400% FPL may still qualify for subsidies under current law. Use the screener at CoveredUSA to see what you qualify for based on your actual numbers.
Employer-Sponsored Insurance
If your raise comes with a new job or a promotion that includes health benefits, you may have access to employer-sponsored coverage. Losing Medicaid is a qualifying life event that triggers a special enrollment window for your employer's plan as well. Contact your HR department within 30 days of the Medicaid termination date.
CHIP for Children
If your income rises above the Medicaid threshold but your children were covered, they may still qualify for CHIP, which covers children in households with income too high for Medicaid but too low to afford private coverage. CHIP limits vary by state but often go up to 200% to 300% FPL for children. See healthcare.gov/medicaid-chip for your state's CHIP income limit.
Does Every Type of Income Count?
Not all income affects Medicaid eligibility the same way. Under MAGI rules, the following generally count:
- Wages and salary
- Self-employment income
- Rental income
- Unemployment compensation
- Social Security benefits (in some cases)
- Taxable interest and dividends
The following generally do not count toward MAGI:
- Child support received
- Gifts
- Most workers' compensation payments
- Supplemental Security Income (SSI)
If your raise is a one-time bonus rather than a permanent salary increase, you still need to report it, but a temporary spike in income does not necessarily mean you will lose coverage permanently. Your state will evaluate your current and projected annual income.
How to Apply and What to Do Next
If you are worried your income might push you off Medicaid, or if you have already received a termination notice, here is what to do:
- Report the income change to your state Medicaid agency. Do not wait. Most states require reporting within 10 to 30 days.
- Gather documentation. You will likely need pay stubs, an offer letter or employer verification, and potentially recent tax returns.
- Wait for the redetermination notice. Your coverage stays active during this period. Read the notice carefully for the termination date.
- If you lose Medicaid, act within 90 days. Visit HealthCare.gov to compare ACA marketplace plans during your SEP, or use the CoveredUSA screener to see if you qualify for subsidized coverage in under 2 minutes.
- If you think the decision is wrong, appeal. You have the right to request a fair hearing. The termination notice will include instructions for how to appeal.
- Check CHIP eligibility for your children even if you no longer qualify yourself. Children have separate and often higher income thresholds.
Documents you may need:
- Most recent pay stubs (usually last 30 days)
- Employer letter confirming new salary or hours
- Most recent federal tax return
- Bank statements showing income deposits
- Social Security award letter (if applicable)
Common reasons applications or redeterminations are denied:
- Income documentation does not match what was reported
- Household size changed but was not reported
- Missing or expired verification documents
- Address change not updated in the Medicaid system
- Income is above the threshold for expansion coverage but the state has not expanded
Check your eligibility now at CoveredUSA, it takes 2 minutes.
State-Specific Considerations
Medicaid rules vary significantly by state. Here are a few important variations to know:
Expansion vs. non-expansion: In states like Texas, Florida, Georgia, and others that did not expand Medicaid, the income cliff is much lower, particularly for adults without children. A raise to even $12,000 per year can disqualify some adults in non-expansion states.
State-brand Medicaid programs: Several states run Medicaid under different names. Oregon's program is Oregon Health Plan (OHP), Washington's is Apple Health, Massachusetts' is MassHealth, and Tennessee's is TennCare. The income rules and reporting requirements may differ slightly from the federal standard.
Medically needy pathways: Some states have a "medically needy" pathway that lets people with income above the standard threshold qualify for Medicaid if they have high medical expenses. This is separate from standard income-based eligibility and is worth checking if you have significant healthcare costs.
Frequently Asked Questions
How much of a raise will cause me to lose Medicaid?
It depends on your household size and state. In Medicaid expansion states, the cutoff in 2026 is 138% of the FPL: $22,025 per year for a single person, $45,540 for a family of four. Any raise that pushes your annual household income above that threshold can end your eligibility. A small raise that keeps you below the limit will not affect your coverage.
Do I have to tell Medicaid about a raise right away?
Yes. Most states require you to report income changes within 10 to 30 days. Report it through your state's Medicaid portal, by phone, or in person. Failing to report can result in having to repay benefits you received after you were no longer eligible.
Will I lose Medicaid immediately when I report a raise?
No. Your Medicaid coverage stays active while the state processes the redetermination. The state has 30 to 60 days to complete the review. If they determine you no longer qualify, they will send a written notice with a future termination date, not an immediate cutoff.
What happens to my kids' coverage if I lose Medicaid?
Your children may still qualify for CHIP even if your new income is above the Medicaid threshold. CHIP income limits are higher than Medicaid limits in most states, often reaching 200% to 300% FPL for children. Check with your state or use the CoveredUSA screener to see your children's options.
Can I get ACA marketplace coverage if I lose Medicaid?
Yes. Losing Medicaid is a qualifying life event that opens a 90-day Special Enrollment Period for ACA marketplace plans. If your income after the raise falls below 400% FPL, you likely qualify for premium tax credits. Visit healthcare.gov or the CoveredUSA screener to compare options.
What if my raise is temporary, like a bonus?
You still need to report the increase. However, Medicaid evaluates your projected annual income, not just a single paycheck. If a bonus was a one-time event and your ongoing annual income remains below the threshold, your state may determine you still qualify. Explain the nature of the income change when you report it.
I got a job offer with higher pay but I haven't started yet. Should I report it?
Report it when the income actually starts. You do not need to report a job offer before you begin receiving the new income. Once your first paycheck at the higher rate arrives, that is when the reporting window starts.
What is the deadline to enroll in an ACA plan after losing Medicaid?
You have 90 days from the date your Medicaid coverage ends to enroll in an ACA marketplace plan using a Special Enrollment Period. Do not wait too long, as the enrollment window closes and you would then need to wait for Open Enrollment.
