The Current Number of Able-Bodied Adults on Medicaid

There is no single official count of able-bodied adults on Medicaid because states do not report this data in a standardized way, and the definition of "able-bodied" itself varies. However, the Centers for Medicare & Medicaid Services (CMS) tracks total Medicaid enrollment by state and category. As of 2023, roughly 70 to 75 million people were enrolled in Medicaid across all categories — children, elderly people, disabled people, and non-disabled adults — but the breakdown between able-bodied and disabled adults is not published as a single national figure.

What we do know is that Medicaid expansion under the Affordable Care Act (ACA) in 2014 opened the program to non-disabled adults earning up to 138% of the federal poverty line in states that chose to expand. About 21 million adults gained Medicaid through expansion as of 2023, though not all of them are able-bodied — some have disabilities but do not meet the stricter disability standards Medicaid used before expansion. The number of able-bodied adults specifically is embedded within that larger figure and varies by state.

Key Takeaways

  • Medicaid enrollment data is reported by state and category, but federal agencies do not publish a single count of able-bodied adults on the program.
  • Medicaid expansion states cover non-disabled adults up to 138% of the federal poverty line, but this group includes people with disabilities who do not meet stricter disability standards.
  • The number of able-bodied adults on Medicaid has fluctuated with policy changes, including the end of continuous enrollment rules during the COVID-19 pandemic.
  • States that did not expand Medicaid have far fewer non-disabled adults enrolled, because the program in those states is still limited mainly to children, elderly people, and disabled people.

Why the Count Is Hard to Pin Down

Medicaid is a joint federal-state program, which means each state runs its own program within federal guidelines. States report enrollment numbers to CMS, but they do not all use the same categories when they report. Some states break out "non-disabled adults" as a separate line item; others lump them into broader categories. The federal government does not require states to distinguish between able-bodied adults and adults with disabilities who do not meet the federal disability standard.

Additionally, "able-bodied" is not a legal or medical term in Medicaid. The program recognizes "disabled" (people who meet the Social Security Administration's disability standard) and "non-disabled" (everyone else), but non-disabled does not mean able-bodied. A person might have a chronic illness, mental health condition, or other health issue that does not rise to the level of disability under Social Security rules but still affects their work capacity. So the actual number of people on Medicaid who are truly without any health limitation is smaller than the non-disabled adult count, but no one measures it.

How Medicaid Expansion Changed the Picture

Before 2014, Medicaid in most states was limited to children, pregnant people, elderly people, disabled people, and a small number of non-disabled adults (usually parents of young children, with strict income limits). The ACA allowed states to expand Medicaid to all non-disabled adults earning up to 138% of the federal poverty line — roughly $18,000 per year for a single person in 2024, though this amount changes annually.

As of 2024, 38 states plus Washington, D.C. have adopted Medicaid expansion. The 12 states that have not expanded — Alabama, Florida, Georgia, Idaho, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming — still limit Medicaid to the narrower pre-2014 groups. This means the number of able-bodied adults on Medicaid is heavily concentrated in expansion states. In non-expansion states, the non-disabled adult population on Medicaid is much smaller and usually consists of parents or caretakers of young children who meet income thresholds.

What Happened During and After the COVID-19 Pandemic

During the COVID-19 pandemic, the federal government suspended the normal Medicaid rule that requires states to check whether people still meet the program's rules. This continuous enrollment period lasted from March 2020 through March 2023. During this time, Medicaid enrollment grew significantly — partly because people lost jobs and income, and partly because no one was being removed from the rolls for any reason.

When continuous enrollment ended in April 2023, states began the process of checking whether people still met the rules. This "unwinding" period lasted through the end of 2023 in most states. Millions of people were removed from Medicaid, including some non-disabled adults who no longer met income limits or who had found employment. The exact number of able-bodied adults removed is not tracked separately, but state reports suggest that a significant portion of those disenrolled were working-age adults without disabilities.

State-by-State Variation in Non-Disabled Adult Enrollment

Because Medicaid is state-run, the number of able-bodied adults on the program varies dramatically by state. Expansion states with higher income limits and broader definitions of who can enroll have more non-disabled adults. States with stricter rules have fewer. For example, California and New York, which expanded Medicaid and set relatively high income thresholds, have millions of non-disabled adults enrolled. Texas and Florida, which did not expand, have far fewer.

Some expansion states have also chosen to cover non-disabled adults beyond the federal minimum. A few states cover non-disabled adults up to 200% of the federal poverty line or higher. Others have added work requirements or other conditions that affect how many able-bodied adults actually stay enrolled. These state choices mean that the national picture is really a patchwork of 50 different programs with 50 different enrollment levels.

Why This Number Matters for Policy Debates

The question of how many able-bodied adults are on Medicaid often comes up in debates about work requirements, program costs, and the purpose of Medicaid. Some argue that Medicaid should focus on children, elderly people, and disabled people, while others argue that covering working-age adults without disabilities reduces uninsured rates and improves public health. Both sides cite enrollment numbers to support their position, but because the data is not standardized, different sources report different figures.

If you are trying to understand whether you might be covered by Medicaid in your state, the enrollment numbers matter less than your own income and household situation. Your state's Medicaid program will have specific rules about who can enroll, and those rules are the ones that explore to you — not the national average or what another state does.

Frequently Asked Questions

Does Medicaid cover able-bodied adults in every state?

No. Medicaid covers non-disabled adults in 38 states plus Washington, D.C. because those states expanded the program under the ACA. The 12 states that did not expand still limit Medicaid mainly to children, elderly people, disabled people, and some parents of young children. If you live in a non-expansion state and are a non-disabled adult, you may not be covered unless you fall into one of the narrower categories.

What income limit applies to able-bodied adults on Medicaid?

In expansion states, the federal minimum is 138% of the federal poverty line, which is roughly $18,000 per year for a single person in 2024. Some states set higher limits. Your state's Medicaid program website will show the exact income threshold that applies where you live, because it changes annually and varies by state.

If I work, can I stay on Medicaid?

Yes, in most expansion states. Medicaid looks at your income, not whether you work. If your job pays less than the income limit, you can stay enrolled. Some states have added work requirements or time limits for non-disabled adults, so check your state's rules. Non-expansion states have stricter rules and may limit coverage to people who are not working or who work very few hours.

Why don't we have an exact count of able-bodied adults on Medicaid?

States report enrollment data to the federal government, but they do not all use the same categories. Some states track non-disabled adults separately; others do not. The federal government does not require a standardized report on able-bodied adults specifically, so no single agency publishes that number.

Did the number of able-bodied adults on Medicaid change after the pandemic?

Yes. When the federal government ended continuous enrollment in March 2023, states began checking whether people still met the rules. Millions of people were removed from Medicaid, including many working-age adults without disabilities. The exact number of able-bodied adults removed is not published separately, but state reports show that a large portion of those disenrolled were non-disabled adults.