Can I Keep Medicaid After Getting a Job? (2026)

Full answer: It depends on your income and how long the increase lasts. Federal Transitional Medical Assistance (TMA) lets many people keep Medicaid for up to 12 months after earnings from a new job push household income over the limit. If income stays under 138% of the federal poverty level, about $22,025 for an individual in 2026, you can usually keep standard Medicaid coverage with no time limit at all.

Starting a new job while on Medicaid raises an immediate worry: will the paycheck cost you your health coverage? The short version is that Medicaid is built to handle this transition, not punish it. Federal law includes a specific safety net called Transitional Medical Assistance (TMA) that keeps many people covered for up to 12 months after earnings rise, and plenty of workers stay on regular Medicaid indefinitely because their income never crosses the eligibility line in the first place.

The sections below break down what actually happens to your Medicaid case when you start earning a paycheck in 2026: how income is counted, what Transitional Medical Assistance covers and for how long, how expansion versus non-expansion states handle the transition differently, special work incentive rules for people with disabilities, how to report the change, and what to do if you do lose coverage. If you are not yet on Medicaid and wondering whether a job disqualifies you from applying, see can you get Medicaid if you have a job.

Coverage Breakdown

Coverage by type
Situation	Can You Keep Medicaid?	What Applies	Time Limit (2026)
New job, income stays under 138% FPL in an expansion state	Yes	Regular Medicaid expansion coverage continues	No time limit while income stays under the threshold
New job pushes income above the limit, prior 3-of-6-month Medicaid history	Yes, temporarily	Transitional Medical Assistance (TMA) applies	Up to 12 months, with quarterly income reporting after month 6
Income stays high after the 12-month TMA period ends	No	Must transition to ACA Marketplace or employer coverage	Special Enrollment Period opens for 60 days after loss of Medicaid
Person with a disability returns to work, earnings above the SSI/Medicaid limit	Yes	1619(b) continued Medicaid eligibility or state Medicaid Buy-In program	Continues as long as state-specific earned income threshold is not exceeded
New job, non-expansion state, not pregnant/disabled/caring for a child	Depends	Narrower categorical Medicaid rules; TMA may be shorter or unavailable	Check state Medicaid agency; ACA coverage gap possible below 100% FPL

Transitional Medical Assistance is a federal requirement under Section 1925 of the Social Security Act. It applies to families who lose Medicaid because of increased earnings, hours, or loss of an earned income disregard, provided the household received Medicaid in at least 3 of the 6 months immediately before the increase. Rules for single adults without dependent children under the ACA expansion category can differ by state; contact your state Medicaid agency to confirm.

Source: Social Security Act Section 1925 (ssa.gov); Medicaid.gov Eligibility; SSA 1619(b) Continued Medicaid Eligibility; KFF Medicaid Expansion Tracker 2026

Quick Answer: Can You Keep Medicaid After Getting a Job? (2026)

It depends on your income and how long the increase lasts. Federal Transitional Medical Assistance (TMA) lets many people keep Medicaid for up to 12 months after earnings from a new job push household income over the limit. If income stays under 138% of the federal poverty level, about $22,025 for an individual in 2026, you can usually keep standard Medicaid coverage with no time limit at all.

How a New Job Affects Your Medicaid Eligibility

Medicaid uses Modified Adjusted Gross Income (MAGI) to test eligibility for most working-age adults, and a new job adds gross wages, tips, and any overtime pay directly into that count. In the 40 expansion states plus DC, an adult can earn up to 138% of the federal poverty level and stay eligible, which is $22,025 a year for a single person and $45,540 a year for a household of 4 in 2026. Most states also apply a 5% FPL income disregard, so the effective cutoff runs slightly higher in practice.

Because Medicaid counts household income, not just your individual paycheck, a part-time job or a job that pays close to minimum wage often leaves a single adult, or a larger family, comfortably under the 2026 limit. It is only when the new job's income, combined with any other household earnings, crosses the state's threshold that the case moves into a redetermination and possibly a transition period.

Transitional Medical Assistance: Up to 12 Months After a Raise

Transitional Medical Assistance (TMA) is a federal Medicaid requirement, established under Section 1925 of the Social Security Act, that every state must offer. If your household loses standard Medicaid eligibility because earnings from employment (including a raise, more hours, or a new job) push income over the limit, and you received Medicaid in at least 3 of the 6 months right before the increase, your state must continue Medicaid coverage for up to 12 additional months.

TMA runs in two 6-month blocks. During the first 6 months, coverage generally continues automatically as long as the household still includes a dependent child (in the family-based TMA category) and remains a state resident. For the second 6 months, most states require you to report income quarterly and may add a cap, commonly around 185% of the federal poverty level, above which the extended period ends early. TMA does not apply to every Medicaid category; check with your state Medicaid agency about how it applies to childless adults covered only through the ACA expansion group, since state practice varies.

Medicaid Expansion vs Non-Expansion States: Why It Matters When You Start Working

Whether you keep Medicaid after getting a job depends heavily on whether your state expanded Medicaid under the ACA. In the 40 expansion states plus DC, most working-age adults are covered under a single income-based category, which makes TMA and the 138% FPL threshold straightforward to apply. In the 10 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming), Medicaid still runs on older, categorical rules limited mainly to pregnant women, children, parents below very low income limits, and people with disabilities.

In a non-expansion state, a non-disabled adult without dependent children who takes a job typically was not eligible for Medicaid to begin with, so the question of keeping it does not arise the same way. But a working parent whose earnings rise past that state's much lower income limit can lose Medicaid and, if income still falls below 100% of the federal poverty level ($15,960 for a single person in 2026), land in the ACA coverage gap: too much income for Medicaid, too little for Marketplace subsidies.

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Working With a Disability: 1619(b) and Medicaid Buy-In Programs

People who qualify for Medicaid through Supplemental Security Income (SSI) or a disability determination have an additional protection when they return to work. Under Section 1619(b) of the Social Security Act, you can keep Medicaid even after earnings become too high for an SSI cash payment, as long as you still meet SSI's disability and resource rules and your earnings stay under a state-specific threshold amount, which is generally well above the standard income limit. Many states also run a separate Medicaid Buy-In program under the Ticket to Work and Work Incentives Improvement Act, letting working adults with disabilities pay a sliding-scale monthly premium to keep Medicaid at income levels far higher than 138% FPL.

Dual-eligible beneficiaries, meaning people who have both Medicare and Medicaid, feel this rule most directly; roughly 12 million Americans fall into that category. If you qualified for Medicare through disability and later return to work, Original Medicare (Medicare Part A for hospital stays, Medicare Part B for outpatient care, and Medicare Part D for prescription drugs) remains your primary coverage, while Medicaid or a work-incentive program continues paying premiums, deductibles, and services Medicare does not cover. Some dual-eligibles use a Medicare Advantage Dual Special Needs Plan instead of Original Medicare plus a separate Medigap policy, since Medicaid already covers much of what a Medigap plan would.

Reporting Your New Job to Medicaid and the Redetermination Process

Most states require you to report a new job or a significant income change to your state Medicaid agency within 10 to 30 days, depending on the state. You can typically report online through your state Medicaid portal or healthcare.gov, by phone, or in writing, and you will usually need to submit pay stubs or an employer letter showing gross wages and hours. Beyond mid-year changes, every state also runs an annual redetermination where it re-verifies your household income and composition, so a job you started earlier in the year will be reconciled at your next renewal even if you already reported it.

Failing to report a job promptly can create two different problems. If you under-report income, you risk an overpayment finding that your state can later try to recover. If you simply forget to respond to a redetermination notice, states can close a Medicaid case for procedural reasons even when the person is still financially eligible, which is one of the most common causes of coverage loss unrelated to income at all. Responding to every notice on time, even with incomplete paperwork, keeps your case active while you gather documents.

Alternatives If You Lose Medicaid After Getting a Job

If your household income stays too high after Transitional Medical Assistance ends, three main options open up. First, losing Medicaid because of increased income triggers a Special Enrollment Period on the ACA Marketplace, giving you 60 days to enroll in a plan outside the normal open enrollment window. Any Marketplace plan sold there is ACA-compliant, meaning it must cover the ACA's 10 essential health benefits and cannot deny you coverage or charge you more for a preexisting condition. Note that enhanced premium tax credits expired on January 1, 2026, so the subsidy cliff at 400% of the federal poverty level has returned; check your exact subsidy amount at healthcare.gov before comparing premiums.

Second, if your new employer offers group health coverage, you can enroll during the plan's new-hire window, which typically opens once you lose other coverage as a qualifying life event. Third, if you recently left a job that offered Medicaid-adjacent employer coverage, COBRA lets you keep that exact plan for up to 18 months, though you pay the full premium plus up to a 2% administration fee. Finally, if you have children, remember that CHIP eligibility limits are usually higher than Medicaid's, so kids often stay covered even after a parent's raise pushes the family off Medicaid.

Frequently Asked Questions

Will I automatically lose Medicaid the day I start a new job?

No. Medicaid does not end automatically just because you start working. Your case continues until your state processes a redetermination based on your reported income. If your income, including the new job, stays under the 2026 threshold (about $22,025 for a single adult in expansion states), coverage simply continues. Only if income exceeds the limit does the case move toward closure or Transitional Medical Assistance.

What is Transitional Medical Assistance (TMA)?

Transitional Medical Assistance is a federal Medicaid requirement under Section 1925 of the Social Security Act that extends Medicaid coverage for up to 12 months after a household loses standard eligibility because of increased earnings, as long as the household received Medicaid in at least 3 of the previous 6 months. It exists specifically to prevent people from losing health coverage right when they start or increase employment.

How long does Transitional Medical Assistance last?

Up to 12 months, split into two 6-month periods. The first 6 months generally continue with minimal extra paperwork. The second 6 months usually require quarterly income reports, and many states apply an income cap, often around 185% of the federal poverty level, above which coverage ends before the full 12 months are up.

Do I have to report my new job to Medicaid?

Yes. Most states require you to report a new job or income change within 10 to 30 days. You can typically report online, by phone, or in writing, and you will need pay stubs or an employer letter. Failing to report can lead to an overpayment finding later, and failing to respond to a redetermination notice can close your case even if you are still eligible.

What if I live in a state that has not expanded Medicaid and I get a job?

In the 10 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming), Medicaid eligibility runs on narrower categorical rules, mainly for pregnant women, children, parents below very low income limits, and people with disabilities. A working parent whose income rises can lose Medicaid, and if income still falls below 100% of the federal poverty level, may land in the ACA coverage gap with no marketplace subsidy option either.

Can people with disabilities work and keep Medicaid?

Yes, through two main pathways. Section 1619(b) of the Social Security Act lets people who qualify for Medicaid through SSI keep it even after earnings exceed the level for an SSI cash payment, as long as earnings stay under a state-specific threshold. Many states also run a Medicaid Buy-In program under the Ticket to Work Act, letting working adults with disabilities pay a sliding-scale premium to stay covered well above the standard 138% FPL limit.

Will my kids lose Medicaid or CHIP if my income goes up?

Not necessarily. CHIP and children's Medicaid income limits are usually higher than the limits for working-age adults, so kids frequently remain covered even after a parent's raise moves the parent off Medicaid. Each state sets its own CHIP threshold, so check your state's specific limit, but a family losing adult Medicaid coverage should not assume children lose coverage automatically.

What are my options if I lose Medicaid after getting a job?

Losing Medicaid because of increased income triggers a 60-day Special Enrollment Period on the ACA Marketplace, where any plan is ACA-compliant and cannot deny you for a preexisting condition. You may also be able to enroll in a new employer's group health plan as a new hire, or elect COBRA for up to 18 months if you are leaving a job that offered coverage. Compare options at healthcare.gov before your coverage ends.