Medicaid 2027 Income Limits and the New Work Requirement (Updated October 2026)

Last updated: November 2, 2026. Income figures use the 2026 HHS poverty guidelines. Work requirement details come from the CMS interim final rule of June 2026. Rules vary by state, so confirm with your state Medicaid agency.

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Medicaid is a joint federal and state program that provides free or low-cost health coverage. In states that expanded Medicaid, adults can qualify based on income alone if their household income is at or below 138% of the federal poverty level, which is about $22,025 a year for one person under the 2026 guidelines. Starting no later than January 1, 2027, many of these adults ages 19 to 64 will also have to show 80 hours a month of work or other qualifying activities to enroll or keep coverage, unless they are exempt.

Medicaid 2027 at a glance

Income limit for expansion adults	138% of the federal poverty level (a few states use a different limit)
138% of poverty, 1 person (2026 guidelines)	$22,025 a year, about $1,835 a month
New work requirement start	No later than January 1, 2027 (some states start earlier)
Who it applies to	Non-pregnant adults 19 to 64 in the expansion group who are not on Medicare, unless exempt
Monthly requirement	80 hours of work, community service, a work program or half-time school, or income of at least $580 a month
If the state cannot verify you	You get a notice and 30 calendar days to respond

Sources: HHS ASPE 2026 Poverty Guidelines, HealthCare.gov, CMS fact sheet on the Medicaid Community Engagement interim final rule (June 1, 2026).

1. Medicaid Income Limits for Adults in 2026 and 2027

Medicaid income limit of 138 percent of poverty by household size, 2026 guidelines

HealthCare.gov explains that in expansion states you qualify if your household income is below 133% of the federal poverty level, which works out to 138% because of the way income is counted. Using the 2026 HHS poverty guidelines for the 48 contiguous states and D.C., that means:

Household size	138% of poverty, per year	Per month (approx.)
1	$22,025	$1,835
2	$29,863	$2,489
3	$37,702	$3,142
4	$45,540	$3,795

Alaska and Hawaii have higher poverty guidelines, so their limits are higher. States that have not expanded Medicaid use different, often much lower, rules for adults. Children, pregnant women, older adults and people with disabilities are covered under separate groups with their own limits. Because poverty guidelines are updated each January, the dollar amounts above can change in 2027.

2. Who Can Qualify for Medicaid

Groups that can qualify for Medicaid: low-income adults, children, pregnant women, seniors and people with disabilities

Low-income adults ages 19 to 64 in states that expanded Medicaid, based on income alone.
Children, often through Medicaid or the Children's Health Insurance Program (CHIP).
Pregnant women, who usually have higher income limits for pregnancy coverage.
Seniors and people with disabilities, who often face separate income and asset rules. Many also qualify for Medicare, which changes how Medicaid works for them.

3. The New Medicaid Work Requirement

Ways to meet the Medicaid 80 hour a month work requirement

The 2025 federal law signed on July 4, 2025 (Public Law 119-21) created a Medicaid "community engagement" requirement. CMS issued the interim final rule on June 1, 2026. States must start no later than January 1, 2027, and CMS says 43 states and the District of Columbia cover the affected adults and must put it in place. Federal analysts at MACPAC reported that Nebraska, Montana, Iowa and Arkansas are starting earlier.

The rule applies to non-pregnant adults ages 19 to 64 who are not entitled to or enrolled in Medicare and who are in the Medicaid expansion group or certain similar waiver programs. In each required month you can meet it by:

Working at least 80 hours
Doing at least 80 hours of community service
Taking part in a work program for at least 80 hours
Being enrolled in an educational program at least half time
Any combination of these that adds up to 80 hours
Having monthly income of at least 80 times the federal minimum wage, which is $580 a month in 2026

4. Who Is Exempt

According to CMS, you do not have to meet the work requirement if you are:

Pregnant or eligible for postpartum coverage
A former foster care youth
American Indian or Alaska Native
A parent, guardian, caretaker relative or family caregiver of a child 13 or younger or of a person with a disability
A veteran with a total disability rating
Medically frail or have special medical needs that significantly limit your ability to comply
Meeting TANF work requirements, or in a household getting SNAP and not exempt from SNAP work rules
In a drug or alcohol treatment or rehabilitation program
An inmate of a public institution

States may also offer short-term hardship exceptions, for example if you are receiving inpatient hospital or nursing facility care, live in a county with a presidentially declared disaster or high unemployment, or must travel outside your community for serious medical care for yourself or a dependent.

5. How the Requirement Is Checked

How states check the Medicaid work requirement at application and renewal

At application: certain new applicants must show they met the requirement for at least one month before the month they apply.
At renewal: current members must show they met it for one or more months between renewals. States may check more often.
If the state cannot verify it: it must send a notice and give you 30 calendar days to show you comply or that you are exempt.
If coverage ends: you can reapply at any time, and the state will check the requirement again when you do.

Keep pay stubs, timesheets, school enrollment letters and volunteer hour records in one place, and answer every notice from your state Medicaid office quickly.

Optional: an accordion file or a medical records binder keeps pay stubs, notices and proof of hours together for renewals. You do not need any product to apply.
Document organizers on Amazon → Medical records binders on Amazon →
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6. How to Apply for Medicaid

Find your state Medicaid agency through Medicaid.gov, or apply through HealthCare.gov, where you can check whether you qualify based on income in your state.
Gather ID, Social Security numbers, proof of income such as pay stubs, proof of where you live and information about everyone in your household.
If you may be subject to the work requirement, have records of your hours or income for the month before you apply, or proof that you are exempt.
Respond quickly to any request for more information, and report changes in income or household size.

Not eligible for Medicaid? You may be able to buy subsidized coverage instead. See our Marketplace enrollment dates guide.

Frequently Asked Questions

Does the Medicaid work requirement apply to people 65 and older?

No. It applies to adults 19 to 64 who are not entitled to or enrolled in Medicare. People 65 and older are covered under different Medicaid rules.

I care for my child who is 10. Do I have to report work hours?

No. CMS lists parents, guardians and caretaker relatives of a child 13 or younger as exempt. Your state may still ask you to confirm the exemption.

Is the income limit the same in every state?

No. The 138% limit applies to adults in states that expanded Medicaid, and a few use a different limit. Non-expansion states use their own rules, and limits are higher in Alaska and Hawaii.

Related Guides

Sources

This guide is general information, not legal, medical or financial advice. Aid Hub is not affiliated with CMS, Medicaid.gov, state Medicaid agencies or any government agency. Always apply through official .gov websites.

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