Medicaid is one program on paper and fifty programs in practice. It's a federal-state partnership, which means Washington sets the floor and your state fills in most of what actually affects your family: who qualifies, what long-term care is covered, how much the state can recover from your estate later, and how you apply. This guide explains what changes from state to state, then sends you straight to a full guide for yours.

In This Guide

What's Federal, and What Each State Decides

Here's the thing most families don't realize until they're deep in it: Medicaid isn't run from Washington. The federal government sets the rules of the road, requires states to cover certain groups of people and a core set of benefits, and pays part of the cost. But each state runs its own program, gives it its own name, and makes a long list of its own choices within the federal lines.

The single difference that matters most is whether a state adopted the ACA Medicaid expansion, which opened Medicaid to most adults ages 19 to 64 with income up to 138% of the federal poverty level. In 2026 the 138% ceiling works out to roughly $22,000 a year for one person and about $37,700 for a household of three in the 48 contiguous states and DC, based on that year's federal poverty guidelines of $15,960 and $27,320. Alaska and Hawaii have their own separate guidelines, and Medicaid counts income under its own rules, so treat these as a rough guide rather than a test of your paycheck.

There's a newer condition to know about, too. Starting no later than January 1, 2027 (earlier in states that choose, and later only for a state granted a temporary federal good-faith exemption, which must end by December 31, 2028), adults in this expansion group will also have to show community engagement to qualify and stay covered: 80 hours a month of work, community service, a work program, half-time school, or a mix of these, or earnings of at least the federal minimum wage times 80 hours. Many people are exempt, including anyone who is medically frail, blind, or disabled, a parent or caregiver of a child 13 or younger or of a person with a disability, someone pregnant or postpartum, and a veteran with a total disability rating.

As of 2026, 41 states including the District of Columbia have expanded, and 10 have not: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In nine of those ten (all but Wisconsin, which covers adults below the poverty level through a separate federal demonstration), a working-age adult with income below the poverty level can earn too much for Medicaid and too little for Marketplace help at the same time, a squeeze known as the coverage gap. Some non-expansion states do cover some additional low-income adults through those demonstrations, in some cases with limits on eligibility, benefits, or enrollment, so check your state's page before assuming the gap applies to you. So the very first question is simple: did your state expand or not?

The Things That Change From State to State

Beyond expansion, a handful of dimensions decide how Medicaid actually works where you live. These are the things worth checking on your state's page.

  • Who qualifies, and the dollar limits. Federal law sets the framework, but states set the specific income and asset limits for seniors and people with disabilities, and they don't all match. The dollar limits, what counts toward them, and how a married couple is treated are all worth checking on your state's page.
  • Long-term care and staying at home. Nursing-home care for adults is a mandatory Medicaid benefit in every state, but the home and community-based programs that pay for care in your own home are optional, so they vary a lot: different names, different benefits. When a state runs them through what are called waivers, it can limit them to certain groups and cap enrollment, which is how waitlists form. This is where families feel the state differences most.
  • Estate recovery. After a Medicaid recipient dies, federal law requires states to try to recoup certain costs from the estate (including, for care received at 55 or older, nursing-home, home and community-based care and related hospital and drug costs), and states may choose to recover for more than that federal minimum. A state may also reach beyond the probate estate to assets such as jointly owned property or a living trust. Federal law makes the state wait until a surviving spouse has died, bars recovery while a child under 21 or a blind or permanently disabled child survives, and requires every state to offer an undue-hardship waiver. Our guide to Medicaid estate recovery walks through it.
  • How you apply, and to whom. Each state has its own Medicaid agency, its own online portal, and its own timelines. The application that's routine in one state can involve a different office and a different process next door.

None of this means you have to become an expert in all fifty. It means you check your own state, which is what the directory below is for.

Find Your State's Medicaid Guide

Pick your state for a full, eldercare-focused Medicaid guide: who qualifies, the income and asset limits, long-term-care options, estate recovery, and how to apply.

AlabamaView guide AlaskaView guide ArizonaView guide ArkansasView guide CaliforniaView guide ColoradoView guide ConnecticutView guide DelawareView guide District of ColumbiaView guide FloridaView guide GeorgiaView guide HawaiiView guide IdahoView guide IllinoisView guide IndianaView guide IowaView guide KansasView guide KentuckyView guide LouisianaView guide MaineView guide MarylandView guide MassachusettsView guide MichiganView guide MinnesotaView guide MississippiView guide MissouriView guide MontanaView guide NebraskaView guide NevadaView guide New HampshireView guide New JerseyView guide New MexicoView guide New YorkView guide North CarolinaView guide North DakotaView guide OhioView guide OklahomaView guide OregonView guide PennsylvaniaView guide Rhode IslandView guide South CarolinaView guide South DakotaView guide TennesseeView guide TexasView guide UtahView guide VermontView guide VirginiaView guide WashingtonView guide West VirginiaView guide WisconsinView guide WyomingView guide
51 states

Frequently Asked Questions

Does Medicaid really vary by state?

Yes, quite a bit. Medicaid is a federal-state partnership: the federal government sets minimum rules and pays a share, but each state runs its own program and sets many of its own limits and options. That's why eligibility, covered services, and the application process differ depending on where you live.

Which states have not expanded Medicaid?

As of 2026, ten states have not adopted the ACA Medicaid expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In the other 40 states and DC, most adults ages 19 to 64 can qualify with income up to 138% of the federal poverty level. Starting January 1, 2027 at the latest (earlier in some states, later only where a state gets a temporary federal exemption), many of them will also need to meet a work or community-engagement requirement, though people who are medically frail or disabled, caregivers of a child 13 or younger or of a person with a disability, and several other groups are exempt.

What are the Medicaid income limits in my state?

They depend on which pathway you're using (expansion adult, aged/blind/disabled, or long-term care) and on your state. The expansion pathway uses 138% of the federal poverty level, but the senior and long-term-care limits are set state by state. Your state's guide below has the specific numbers.

How do I find and apply to my state's Medicaid program?

Each state has its own Medicaid agency and online application portal, and the program often has its own name. Pick your state in the directory above for the agency, the portal, and the steps that apply where you live.

Learn More

MedicaidHow to Apply for Medicaid by State: Steps, Documents, and Where to ApplyHow to apply for Medicaid: the ways you can apply, the documents to gather, how long a decision takes, and the application guide for your state. MedicaidMedicaid HCBS Waivers by State: Home Care Instead of a Nursing HomeMedicaid HCBS waivers pay for care at home instead of a nursing facility. How 1915(c) waivers work, who qualifies, why waitlists happen, and your state's guide. MedicaidMedicaid Income Limits by State: Which Number Applies to YouMedicaid income limits for 2026 depend on your pathway: expansion adults, aged and disabled, or nursing-home care. See the figures and your state's limits. MedicaidDoes Medicaid Cover Dental for Adults? Coverage in Every StateDoes Medicaid cover dental for adults? It depends on your state. See what every state and DC covers in 2026, from yearly caps and their periods to dentures. MedicaidMedicaid Planning: How to Qualify Without Going BrokeSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. MedicaidWhat Does Medicaid Cover? Mandatory and Optional Benefits ExplainedWhat does Medicaid cover? Every state must cover hospital, doctor, nursing facility and home health care. Drugs, dental and glasses are each state's choice.

Find personalized help finding and applying to your state's Medicaid program at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.