If you currently rely on Medicaid for health coverage, the Congressional Budget Office's reaffirmed forecast of a dramatic reduction in Medicaid enrollment starting in 2026 is directly relevant to your situation. The CBO's analysis, highlighted by The Century Foundation, projects that proposed federal budget and policy changes could cause millions of low-income Americans to lose Medicaid eligibility — making it critical to understand what programs may still be available to you and how to prepare now.
What the CBO Projection Actually Means for Medicaid Enrollees
The CBO is a nonpartisan federal agency that scores the fiscal and coverage impacts of proposed legislation. When it reaffirms a forecast of significant coverage loss, it means the proposed policy changes under consideration in Congress are projected — based on actuarial and economic modeling — to reduce the number of people enrolled in Medicaid by millions over the coming years.
The specific mechanisms under discussion include potential changes to the federal matching rate (FMAP), the introduction of work reporting requirements, and modifications to how states administer eligibility redeterminations. Each of these policy levers, individually or in combination, could make it harder for current enrollees to maintain coverage — even if their income and household situation hasn't changed.
This does not mean your coverage ends tomorrow. It means the policy environment is shifting, and understanding your options now is the most protective step you can take.
Who Is Currently Eligible for Medicaid
Medicaid eligibility is determined at the state level within federal guidelines. In the 40 states (plus Washington, D.C.) that have adopted the ACA Medicaid expansion, adults with household incomes at or below 138% of the Federal Poverty Level (FPL) may be eligible. In non-expansion states, eligibility thresholds are often much lower and typically limited to specific categories such as pregnant women, children, parents of dependent children, and people with disabilities.
Key Eligibility Categories to Know
- Adults in expansion states: Up to 138% FPL
- Children (CHIP): Generally up to 200%–300% FPL depending on state; some states cover children up to 400% FPL
- Pregnant women: Often covered up to 185%–200% FPL or higher
- People with disabilities or who are elderly: Separate eligibility pathways apply, often tied to SSI or Medicare dual-eligibility
Benefit amounts and covered services vary by household size and income, and by state program design.
If You Lose Medicaid: Programs That May Be Available to You
A loss of Medicaid coverage — whether through a policy change or a routine eligibility redetermination — typically triggers a Special Enrollment Period (SEP) for ACA Marketplace coverage. This is one of the most important protections in current law.
ACA Marketplace Plans and Premium Tax Credits
Through HealthCare.gov (or your state's Marketplace), households between 100% and 400% FPL may be eligible for premium tax credits that reduce monthly insurance costs. Under enhanced subsidies that have been in place since 2021, households above 400% FPL may also qualify for some level of subsidy depending on income relative to benchmark plan costs.
If you lose Medicaid, you generally have 60 days from the date of coverage loss to enroll in a Marketplace plan through a Special Enrollment Period. Missing this window means waiting until the next Open Enrollment Period, which typically runs November 1 through January 15 in most states.
To apply: Visit HealthCare.gov or your state's Marketplace. You will need documentation of income (pay stubs, tax returns, or a self-attestation form), proof of household size, and documentation of your Medicaid termination.
Note: If you submit a form or request assistance through any enrollment platform, you may be contacted by a licensed navigator or assister. Consent to contact is typically required and will be disclosed at the time of form submission.
Children's Health Insurance Program (CHIP)
If you have children who may lose Medicaid coverage, CHIP is a separate program that may cover children in households with incomes too high for Medicaid but who cannot afford private insurance. CHIP income thresholds vary significantly by state — many states cover children up to 200%–300% FPL, and some go higher. CHIP applications are processed through your state Medicaid agency.
Federally Qualified Health Centers (FQHCs)
Regardless of what happens with Medicaid policy, Federally Qualified Health Centers remain a critical resource. FQHCs receive federal funding under Section 330 of the Public Health Service Act and are required to serve patients regardless of ability to pay, using a sliding-fee scale based on income. There are over 1,400 FQHC organizations operating more than 14,000 service delivery sites across the United States.
To find an FQHC near you, use the Health Resources and Services Administration (HRSA) Find a Health Center tool at findahealthcenter.hrsa.gov.
Prescription Assistance Programs
If prescription drug coverage is disrupted, several programs may help:
- NeedyMeds.org maintains a database of patient assistance programs offered by pharmaceutical manufacturers
- RxAssist (rxassist.org) provides a similar directory
- 340B Drug Pricing Program: FQHCs and other safety-net providers often have access to deeply discounted medications through this federal program
Steps to Take Right Now
- Confirm your current Medicaid status by contacting your state Medicaid agency or logging into your state's benefits portal. Make sure your address and contact information are current so you receive any redetermination notices.
- Gather your documents: Recent pay stubs or proof of income, Social Security numbers for all household members, proof of residency, and any existing insurance cards.
- Know your income relative to FPL: Your state Medicaid agency or a certified navigator can help you calculate this. It determines which programs you may be eligible for if Medicaid coverage changes.
- Locate your nearest FQHC using the HRSA tool so you have a care option regardless of coverage status.
- Check your SEP eligibility window immediately if you receive a Medicaid termination notice — the 60-day clock starts from the date of coverage loss, not the date you receive the notice.
A Note on State Variation
Because Medicaid is jointly administered by federal and state governments, the impact of any federal policy changes will not be uniform. States have some flexibility in how they implement changes, and some states may use their own funds to maintain coverage levels. Checking directly with your state Medicaid agency is the most reliable way to understand what may change in your specific state.
Program eligibility and availability vary by state. Not affiliated with any government agency.
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People Also Ask
Q: If Medicaid cuts happen, will I automatically be enrolled in another program? A: No. If you lose Medicaid, you will need to actively apply for alternative coverage. Losing Medicaid typically triggers a 60-day Special Enrollment Period for ACA Marketplace plans, but you must initiate that application yourself through HealthCare.gov or your state Marketplace. No automatic transfer occurs between programs.
Q: What income level is too high for Medicaid but may still qualify for ACA subsidies? A: In Medicaid expansion states, adults above 138% FPL generally do not qualify for Medicaid but may be eligible for ACA premium tax credits starting at 100% FPL. Enhanced subsidies may extend meaningful assistance to households well above 400% FPL depending on plan costs in your area. A Marketplace calculator can estimate your specific subsidy.
Q: Are children protected from Medicaid cuts through CHIP? A: CHIP is a separate program from adult Medicaid and has its own federal funding structure. Children who lose Medicaid eligibility may be eligible for CHIP depending on household income and state thresholds, which typically range from 200% to 300% FPL or higher. Parents should apply for CHIP immediately if their child's Medicaid coverage is terminated.
Q: Can I get healthcare if I lose Medicaid and can't afford Marketplace premiums? A: Yes, Federally Qualified Health Centers (FQHCs) provide primary and preventive care on a sliding-fee scale based on income, including to uninsured patients. They cannot be turned away for inability to pay. Use the HRSA Find a Health Center tool at findahealthcenter.hrsa.gov to locate one near you.
Q: What documents do I need to apply for ACA Marketplace coverage after losing Medicaid? A: You will typically need proof of income (pay stubs, most recent tax return, or employer letter), Social Security numbers for all household members applying for coverage, proof of your Medicaid termination date, and proof of state residency. A certified navigator can help you gather and submit these documents at no cost.
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Last reviewed: April 2026