Yes, you can keep Medicaid if you go back to work, as long as your earnings stay under your state’s income limit or you qualify for one of the federal protections built for exactly this situation. In most states that expanded Medicaid, a single adult can earn up to about $22,025 in 2026 and keep full coverage. Families leaving Medicaid because of a new job get up to a year of transitional coverage, and workers with disabilities have separate rules that let them earn far more without losing benefits. What ends coverage is usually not the job itself but failing to report the change on time.
The Income Limit That Decides It
For working-age adults, Medicaid uses a formula called Modified Adjusted Gross Income (MAGI). It looks at taxable income and tax-filing relationships to set your household income, and for most groups it ignores assets like savings or a car.1Medicaid. Eligibility Policy Your paycheck counts dollar-for-dollar, so a raise or a new job moves you directly along the scale.
The scale is anchored to the Federal Poverty Level. For 2026, the poverty guideline for a single person in the 48 contiguous states is $15,960.2HHS ASPE. 2026 Poverty Guidelines In the 40 states plus D.C. that expanded Medicaid, most adults qualify with household income up to 138 percent of the FPL, roughly $22,025 for one person or $45,540 for a family of four.3HealthCare.gov. Federal Poverty Level (FPL) The ten non-expansion states set their own limits, which are often much lower for adults without disabilities.
One detail catches people off guard. Eligibility is assessed month by month, so a single big pay period, an extra shift, or a bonus can push you over the line for that month alone. A short spike does not permanently end coverage. If your income drops back, your state can reinstate you without a full new application.
Transitional Medical Assistance for Families
If you had Medicaid as part of a family with children and your new hours or new job push household income above the limit, Transitional Medical Assistance (TMA) gives you up to 12 additional months of coverage. It is required by Section 1925 of the Social Security Act, and Congress made it permanent in 2015.4Medicaid.gov. Implementation Guide: Transitional Medical Assistance
The coverage comes in two pieces. States must provide an automatic six-month extension, then a second six-month extension for families that meet certain reporting rules. Some states simplify things into a single 12-month block.5Social Security Administration. Social Security Act 1925 Many families never hear about TMA and lose coverage that they were legally entitled to keep, so ask your state agency about it by name if a job change is bumping you over the income threshold.
Working with a Disability
Federal law includes several overlapping protections so that people with disabilities do not have to choose between a paycheck and healthcare. The one that applies depends on whether you get Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or neither.
Section 1619(b) for SSI Recipients
If you receive SSI and begin earning too much for a cash payment, Section 1619(b) can let you keep Medicaid anyway. You must have received at least one SSI cash payment previously, still meet the disability and other non-disability SSI requirements, need Medicaid to continue working, and have gross earnings below your state’s threshold.6Social Security Administration. Continued Medicaid Eligibility (Section 1619(B))
The threshold varies widely by state because it reflects both the earnings level that would stop SSI and the average cost of Medicaid services locally. For 2026, thresholds range from $29,412 in the Northern Mariana Islands to $84,208 in Minnesota. California is $66,078, Texas $53,165, Florida $42,946, and New York $68,654.6Social Security Administration. Continued Medicaid Eligibility (Section 1619(B)) If your earnings exceed the standard number, Social Security can calculate an individualized threshold that accounts for impairment-related work expenses, a plan to achieve self-support, or medical costs above the state average.
Medicaid Buy-In for Workers with Disabilities
Many states run a separate Medicaid Buy-In program that extends coverage to workers with disabilities whose earnings exceed the ordinary income limits. States often give the program a local brand name, so you may not see the words “Buy-In” on the application.7U.S. Department of Labor. Medicaid Buy-in Q&A Each participating state sets its own income limits, asset limits, and premiums. Some charge a modest sliding-scale premium, some charge nothing, and some impose no income cap at all to encourage employment.8Medicaid.gov. Ticket to Work To find your state’s rules, contact your state Medicaid agency and ask about the buy-in program by name.
SSDI: Trial Work Period and SGA
If you receive SSDI, you get a trial work period of up to nine months (within any rolling 60-month window) to test working without losing benefits. In 2026, any month you earn more than $1,210 counts as a trial work month, and during those months you receive your full SSDI payment regardless of earnings.9Social Security Administration. Trial Work Period
After the trial period ends, Social Security looks at whether your earnings exceed the substantial gainful activity (SGA) level. For 2026 that is $1,690 per month for non-blind individuals and $2,830 for blind individuals.10Social Security Administration. What’s New in 2026 Below SGA, SSDI continues. Above it, cash benefits eventually stop, but Medicaid can continue through Section 1619(b) or a state Buy-In program.
Reporting the Change
Whichever protection applies to you, it only works if the state knows about the income change. Most states require you to report a new job, a raise, or a change in hours within 10 to 30 days, depending on where you live. Missing that window can lead to overpayments you have to repay, penalties, or an abrupt loss of coverage when the income surfaces at renewal.
You can usually report through your state’s online benefits portal, by phone, or by mail. Keep recent pay stubs and any employer verification letters ready, because the state may ask for documentation. Reporting early is what triggers TMA, 1619(b), and the buy-in programs; silence is what causes gaps.
Every enrollee also goes through an annual renewal, sometimes called redetermination. If you have been reporting income all along, renewal is usually straightforward. If you have not, this is where problems surface. Watch your mail when renewal notices go out, because failing to respond typically results in automatic termination.
If You Do Lose Medicaid
If your earnings ultimately put you past the limits and none of the protections apply, you still have options. A gap is avoidable if you move quickly.
The ACA Marketplace
Losing Medicaid triggers a Special Enrollment Period on the Health Insurance Marketplace. You can apply as early as 60 days before your Medicaid ends and up to 90 days after it ends.11HealthCare.gov. Staying Covered If You Lose Medicaid or CHIP That is more generous than the standard 60-day window for most other life events.
If your household income falls between 100 and 400 percent of the FPL, you qualify for a premium tax credit that lowers your monthly premium.3HealthCare.gov. Federal Poverty Level (FPL) For a single person in 2026, that range runs from about $15,960 to $63,840.2HHS ASPE. 2026 Poverty Guidelines The credit is largest at lower incomes, so if your new job just barely pushes you over the Medicaid line, a subsidized Marketplace plan can still be affordable.
Your New Employer’s Plan
If the new job offers health benefits, that is usually the most practical option, because employers typically pay a large share of the premium. Under federal rules for 2026, an employer plan counts as “affordable” if the employee’s share of the lowest-cost self-only coverage is no more than 9.96 percent of household income.12Internal Revenue Service. Rev. Proc. 2025-25 If the offer meets that test, you generally cannot get Marketplace premium tax credits, so enrolling through the employer is the better financial move.
COBRA as a Bridge
COBRA is a narrower option. It applies when you already had employer-sponsored coverage and lost it because of reduced hours or job loss, and it lets you keep the same group plan for up to 18 months, or 36 in some circumstances.13U.S. Department of Labor. COBRA Continuation Coverage You pay the full premium plus a 2 percent administrative fee, and it only applies to employers with 20 or more employees.14U.S. Department of Labor. FAQs on COBRA Continuation Health Coverage for Employers and Advisors For someone leaving Medicaid for a new job, a subsidized Marketplace plan or the new employer’s coverage will usually cost less, but COBRA can be worth comparing if you need short-term coverage before a new plan begins.