When Medicaid Coverage Stops: Appeals, Protections, and New Plans

Medicaid coverage stops at the end of the month in which your state determines you’re no longer eligible. The usual triggers are income rising above the limit, a change in your household that lowers the threshold you’re measured against, or a missed response to an annual renewal notice. Before benefits actually end, your state must send a written termination notice at least 10 days ahead of the cutoff date, and you have the right to appeal—and in many cases keep coverage running while the appeal is pending.¹

Why Medicaid Ends

Your Income Went Up

Rising income is the most common reason people are dropped. Eligibility for most enrollees is based on Modified Adjusted Gross Income, which tracks the adjusted gross income on your tax return with a few additions like non-taxable Social Security benefits and tax-exempt interest.²³⁴ States that did not expand set lower limits, and children are often covered at higher income levels.

A raise, a new job, added hours, or a spouse who starts working can each push a household past the line. Wages, self-employment earnings, unemployment, rental income, and all Social Security payments count. Supplemental Security Income and veterans’ disability payments do not.²

Your Household Changed

Because the income threshold scales with household size, changes in who lives with you can flip your eligibility even when your paycheck doesn’t move. A child moving out, a divorce, or a spouse’s death shrinks the household and lowers the ceiling. Marriage that adds a higher-earning partner can put combined income over the limit.

Age matters too. Children may age out of Medicaid or CHIP somewhere between 18 and 21, depending on the state. Turning 65 doesn’t automatically end Medicaid, but eligibility shifts into a different category that often counts assets rather than just income. Many people in that group become dually eligible for both Medicare and Medicaid.⁵

Moving to another state ends your coverage in the old one; you’ll need to apply fresh where you now live, and rules differ. Changes in immigration status can matter as well: qualified non-citizens with legal status are generally eligible, though most face a five-year waiting period, with exceptions for refugees, asylees, certain trafficking victims, and, in many states, lawfully residing children and pregnant individuals.⁶

You Missed a Renewal

Federal regulations require states to renew every beneficiary’s eligibility once every 12 months. The state first tries to confirm your eligibility from data it already has. If that doesn’t work, it mails you a pre-filled renewal form, and you get at least 30 days from the date of mailing to review, correct, and return it.⁷

Miss that deadline and the state will end your coverage even if you would have qualified. This is called a procedural termination and it drives a large share of Medicaid losses. There’s a cushion: if you send in the form within 90 days after being terminated for not responding, the state must treat it as a new application without making you start over. Past 90 days, you’re filing a full new application.

Reading the Termination Notice and Appealing

The written notice must arrive at least 10 days before coverage ends and must state the specific reason, the effective date, and your right to a hearing.¹ Read the stated reason first. If the state used outdated income figures, miscounted your household, or terminated you procedurally when you had actually replied, the appeal is straightforward.

You have 90 days from the mailing date to request a fair hearing. Timing changes what happens to your coverage while you wait. Request the hearing before the termination date on the notice and your benefits must continue during the appeal.¹ Request it after that date and you’ll go without coverage until the decision comes back. If you keep coverage during the appeal and lose, the state can recover what it paid, so continuing benefits is a calculated bet worth taking when you have a real basis for the appeal.

Protections That May Keep You Covered

Children Are Locked In for 12 Months

Since January 1, 2024, every state must provide 12 months of continuous eligibility for children under 19 enrolled in Medicaid or CHIP.⁸ A mid-year raise that pushes a parent off Medicaid does not knock the child off. The child’s coverage holds until the next scheduled renewal.

Twelve Months After Giving Birth

Medicaid historically ended pregnancy-related coverage 60 days after delivery. States can now extend it to a full 12 months postpartum, an option made permanent by the Consolidated Appropriations Act of 2023.⁹ As of early 2026, 49 states plus the District of Columbia have adopted the extension. Check your state before assuming coverage ends at two months.

Transitional Medical Assistance for Working Families

If a family loses Medicaid specifically because someone started earning more or working more hours, Transitional Medical Assistance can extend coverage for up to 12 months. The first six months are automatic regardless of earnings. For the second six months, family income cannot exceed 185% of the Federal Poverty Level, and the parent or caretaker must have filed a quarterly report due in the fourth month of the first period.¹⁰ Some states combine both periods into a single 12-month extension.

Reporting Changes Between Renewals

Waiting for the annual renewal to disclose a change is risky. States generally require you to report significant changes—a new job, a raise, a marriage, a move, a change in household—within 10 to 30 days. If you keep receiving benefits after a change that would have ended your eligibility, the state can seek to recover the cost. In cases of intentional misrepresentation, federal law allows civil penalties of up to $20,000 per item or service tied to an unreported overpayment, plus an assessment of up to three times the amount claimed.¹¹ Those figures target egregious conduct, but even an honest lapse can leave a bill.

Getting New Coverage Right Away

Marketplace Plans

Losing Medicaid opens a Special Enrollment Period for a Marketplace plan under the Affordable Care Act. You can apply as early as 60 days before your Medicaid ends and up to 90 days after. Applying before Medicaid ends is the best way to avoid a gap. The Marketplace application checks automatically for a premium tax credit and cost-sharing reductions, and most people who just crossed the Medicaid income line qualify for significant subsidies.¹²

Medicare

If you’re 65 or older, or you have a qualifying disability, losing Medicaid may point you to Medicare. A Special Enrollment Period for Medicare Part B starts when you’re notified of your Medicaid loss and runs for six months after coverage ends.¹³ Enrolling in that window protects you from the Part B late enrollment penalty, which permanently increases your monthly premium by 10% for each full year you were eligible but not enrolled.¹⁴ If you qualify for both programs, you may remain dually eligible, with Medicaid covering premiums and services Medicare doesn’t, such as long-term care and dental.⁵

An Employer’s Plan

Losing Medicaid is a qualifying life event for employer coverage too. Contact HR quickly; most employer plans give you 30 days from the event to enroll. When the employer picks up a large share of the premium, the plan can be more affordable than a Marketplace option, so it’s worth comparing both.

1
eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries
2
Centers for Medicare & Medicaid Services. Job Aid – Income Eligibility Using MAGI Rules
3
ASPE HHS. 2026 Poverty Guidelines
4
Medicaid.gov. Eligibility Policy
5
Medicaid.gov. Seniors and Medicare and Medicaid Enrollees
6
HealthCare.gov. Health Coverage for Lawfully Present Immigrants
7
eCFR. 42 CFR Part 435 Subpart J – Redeterminations of Medicaid Eligibility
8
Medicaid.gov. Continuous Eligibility
9
Office of the Law Revision Counsel. 42 USC 1396a – State Plans for Medical Assistance
10
Medicaid.gov. Implementation Guide – Transitional Medical Assistance
11
eCFR. 42 CFR Part 1003 – Civil Money Penalties, Assessments and Exclusions
12
HealthCare.gov. Staying Covered if You Lose Medicaid or CHIP
13
Centers for Medicare & Medicaid Services. Application for Medicare Part A and Part B – Special Enrollment Period Exceptional Conditions
14
Medicare.gov. Avoid Late Enrollment Penalties