What Is Medicaid?
Medicaid is a government health insurance program for people with low incomes. It's jointly funded by the federal government and states, which means eligibility rules, program names, and covered services vary by state. Unlike the ACA marketplace, Medicaid enrollment is year-round — you can apply any time.
Who Qualifies for Medicaid
In Medicaid expansion states (39 states + DC as of 2026), adults qualify if they earn up to 138% of the Federal Poverty Level:
- Individual: Up to ~$21,597/year
- Family of 2: Up to ~$28,208/year
- Family of 4: Up to ~$43,056/year
In non-expansion states (TX, FL, GA, SC, and others), eligibility is much more limited. Many adults without children don't qualify regardless of income — this is the coverage gap.
Medicaid Program Names by State
Each state brands Medicaid differently:
- California: Medi-Cal
- New York: NY Medicaid
- Texas: Texas Medicaid (limited eligibility)
- Florida: Florida Medicaid (limited eligibility)
- Oregon: Oregon Health Plan (OHP)
- Washington: Apple Health
- Michigan: Healthy Michigan Plan
- Indiana: Healthy Indiana Plan (HIP)
Medicaid vs. ACA Marketplace
- Medicaid: Free or near-free. Income must be under ~$21,597 (individual). Enroll any time.
- ACA marketplace: Subsidized premiums. Income above Medicaid threshold. Enroll during OEP or SEP.
If your income fluctuates: Self-employed and gig workers often move between Medicaid and marketplace eligibility year to year. If your estimated annual income is near the threshold (~$21,597), you may want a marketplace plan instead — it gives you more provider choice and avoids disruption if your income increases mid-year.
Related Terms
- Coverage Gap (Medicaid Gap)
- Subsidy (Premium Tax Credit)
- Modified Adjusted Gross Income (MAGI)
- Open Enrollment Period
Last updated: March 30, 2026.
