As of 2026, 41 states plus Washington, D.C. have expanded Medicaid under the Affordable Care Act, covering adults with incomes up to 138% of the Federal Poverty Level (FPL). That threshold equals $22,025 per year for a single adult and $45,540 per year for a family of four. If you live in one of the 10 states that have not expanded Medicaid, your eligibility rules are different and typically much stricter. This guide lists every expansion state, what income limits apply in 2026, and how to check whether you qualify today.
What Medicaid Expansion Means in 2026
Before the ACA, most states limited Medicaid to narrow categories: children, pregnant women, elderly adults, and people with disabilities. Non-elderly adults without children were often excluded regardless of income. Expansion changed that. Under Medicaid.gov's expansion provisions, states that chose to expand cover nearly all adults under 65 who fall below 138% of FPL.
The federal government pays 90% of the cost for expansion enrollees. States cover the remaining 10%. That deal has been in place since 2016 and continues through 2026.
States that have not expanded offer coverage only to specific groups. A person earning $12,000 per year with no children could be uninsured in a non-expansion state even though they would qualify in a neighboring expansion state. This is called the "coverage gap."
Full List of Medicaid Expansion States in 2026
As of 2026, the following 41 states plus D.C. have expanded Medicaid. The year shown is when each state's expansion took effect.
| State | Expansion Year | State Medicaid Program Name |
|---|
| Alaska | 2015 | Medicaid |
| Arizona | 2014 | AHCCCS |
| Arkansas | 2014 | ARHOME |
| California | 2014 | Medi-Cal |
| Colorado | 2014 | Health First Colorado |
| Connecticut | 2014 | HUSKY Health |
| Delaware | 2014 | Medicaid |
| Hawaii | 2014 | Med-QUEST |
| Idaho | 2020 | Medicaid |
| Illinois | 2015 | Medicaid |
| Indiana | 2015 | HIP (Healthy Indiana Plan) |
| Iowa | 2014 | Medicaid |
| Kentucky | 2014 | Medicaid |
| Louisiana | 2016 | Medicaid |
| Maine | 2019 | MaineCare |
| Maryland | 2014 | Medicaid |
| Massachusetts | 2014 | MassHealth |
| Michigan | 2014 | Medicaid |
| Minnesota | 2014 | Medical Assistance |
| Missouri | 2021 | Medicaid |
| Montana | 2016 | Medicaid |
| Nebraska | 2020 | Medicaid |
| Nevada | 2014 | Medicaid |
| New Hampshire | 2014 | Medicaid |
| New Jersey | 2014 | NJ FamilyCare |
| New Mexico | 2014 | Medicaid |
| New York | 2014 | Medicaid |
| North Carolina | 2023 | Medicaid |
| North Dakota | 2014 | Medicaid |
| Ohio | 2014 | Medicaid |
| Oklahoma | 2021 | Medicaid |
| Oregon | 2014 | OHP (Oregon Health Plan) |
| Pennsylvania | 2015 | Medicaid |
| Rhode Island | 2014 | Medicaid |
| South Dakota | 2023 | Medicaid |
| Utah | 2020 | Medicaid |
| Vermont | 2014 | Medicaid |
| Virginia | 2019 | Medicaid |
| Washington | 2014 | Apple Health |
| West Virginia | 2014 | Medicaid |
| Wisconsin | Partial only | BadgerCare (limited) |
| Washington, D.C. | 2014 | Medicaid |
Note on Wisconsin: Wisconsin extended coverage to adults up to 100% FPL but has not adopted full ACA expansion to 138% FPL. It is counted among partial-expansion states.
The 10 States That Have Not Expanded Medicaid (2026)
Ten states have not adopted full Medicaid expansion as of 2026, according to KFF's state expansion tracker:
- Alabama
- Florida
- Georgia (partial waiver program only, with work requirement)
- Kansas
- Mississippi
- South Carolina
- Tennessee
- Texas
- Wyoming
- Wisconsin (partial, 100% FPL only)
Adults in these states who earn below the poverty line may fall into the coverage gap. They earn too little to qualify for ACA marketplace subsidies (which start at 100% FPL) and too much for traditional Medicaid in their state.
2026 Medicaid Expansion Income Limits by Household Size
In all full-expansion states, the income cutoff is 138% of the 2026 Federal Poverty Level. The 2026 FPL guidelines are published by HHS ASPE and took effect January 2026.
Medicaid Expansion Income Limits 2026 (48 Contiguous States and D.C.)
| Household Size | Annual Income Limit (138% FPL) | Monthly Income Limit |
|---|
| 1 | $22,025 | $1,835 |
| 2 | $29,863 | $2,489 |
| 3 | $37,702 | $3,142 |
| 4 | $45,540 | $3,795 |
| 5 | $53,378 | $4,448 |
| 6 | $61,217 | $5,101 |
| 7 | $69,055 | $5,755 |
| 8 | $76,894 | $6,408 |
| Each additional person | +$7,838/year | +$653/month |
These thresholds apply to Modified Adjusted Gross Income (MAGI). Medicaid uses MAGI rather than gross income, which means certain non-taxable income sources like SSI payments are excluded from the calculation.
Alaska and Hawaii Income Limits
Alaska and Hawaii have higher FPL thresholds because of higher costs of living. The 2026 138% FPL limits in those states are higher than the figures above. Check your state's Medicaid agency directly for the exact Alaska and Hawaii thresholds.
How Medicaid Expansion Works: Coverage Details
Who qualifies under expansion: Adults ages 19 to 64 who are U.S. citizens or qualified immigrants, are not eligible for Medicare, and have income at or below 138% FPL. Expansion removed the prior requirement to have children or a disability.
What expansion Medicaid covers: The same essential health benefits as other Medicaid plans, including doctor visits, hospital care, prescription drugs, mental health services, preventive care, and emergency services. There are no premiums in most expansion states, and cost-sharing is minimal.
When coverage starts: In most states, Medicaid coverage can begin the month you apply or even retroactively for up to three months. Expansion states process applications year-round with no open enrollment window.
Continuous eligibility: As of 2026, the COVID-era continuous enrollment protections have ended. States are running regular eligibility renewals. You need to respond to renewal notices from your state Medicaid agency to keep coverage.
How to Apply for Medicaid Expansion Coverage in 2026
Medicaid is open year-round. There is no annual enrollment window. You can apply any month.
Application Steps
- Check your income against the 138% FPL table above for your household size. If your income is at or below the limit, you likely qualify in an expansion state.
- Go to your state's Medicaid portal or visit Healthcare.gov to apply. Healthcare.gov will route you to Medicaid automatically if you qualify.
- Complete the application with your household information, income details, and citizenship status. Most applications take 15 to 30 minutes online.
- Submit and wait for a determination. States are required to process Medicaid applications within 45 days (90 days for disability-based applications).
- Receive your Medicaid card and enrollment confirmation by mail or through your state's online portal.
- Respond to renewal notices. States send annual renewal letters. Failure to respond can result in termination of coverage even if you still qualify.
Documents You Will Need
- Proof of identity (driver's license, state ID, passport)
- Proof of residency (utility bill, lease agreement)
- Social Security numbers for all household members
- Proof of income (pay stubs, W-2, tax return, or employer letter)
- Immigration documentation if applicable
- Proof of any health insurance you currently have
Common Reasons Medicaid Applications Get Denied
- Income is over 138% FPL based on the household size provided
- Missing or incomplete documentation submitted with the application
- Applicant listed as a non-qualified immigrant status
- Household size was reported differently than what documentation supports
- Applying in a non-expansion state as a childless adult
What If You Live in a Non-Expansion State?
If you live in one of the 10 non-expansion states, your options depend on your income and family status:
- Income between 100% and 400% FPL: You likely qualify for subsidized ACA marketplace coverage. Subsidies through Healthcare.gov can reduce your monthly premium significantly, sometimes to $0.
- Income below 100% FPL with children: You may qualify for traditional Medicaid or CHIP for your children.
- Income below 100% FPL as an adult without children: You may fall in the coverage gap. Some non-expansion states offer limited state-funded programs. Contact your state Medicaid agency or a navigator to review options.
For Medicaid-related questions, Medicaid.gov maintains a state-by-state resource directory.
State Program Highlights
Several expansion states run Medicaid under well-known program brands. Knowing your state's brand can help you find the right application portal faster:
- Medi-Cal (California): The largest state Medicaid program in the country. As of 2026, California also covers adults 26 to 49 regardless of immigration status.
- AHCCCS (Arizona): Arizona's integrated Medicaid managed care program. Covers physical health, behavioral health, and long-term care.
- ARHOME (Arkansas): Arkansas runs its expansion through a private insurance option using federal Medicaid funds.
- Apple Health (Washington): Washington's Medicaid program uses managed care organizations statewide.
- OHP (Oregon Health Plan): Oregon's program includes Coordinated Care Organizations and integrates physical, mental, and dental health.
- MassHealth (Massachusetts): Massachusetts expanded Medicaid before the ACA and has some of the country's highest income thresholds.
- NJ FamilyCare (New Jersey): New Jersey's unified program covers children, adults, and families.
- HIP (Indiana): Indiana's expansion includes premiums and health savings account-style features.
- MaineCare (Maine): Maine voters passed expansion via ballot initiative in 2017; it took effect in 2019.
- HUSKY Health (Connecticut): Connecticut's program covers children and adults through managed care.
Frequently Asked Questions
Which states have NOT expanded Medicaid in 2026?
Ten states have not adopted full Medicaid expansion as of 2026: Alabama, Florida, Georgia (partial only), Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin (partial only), and Wyoming. According to KFF, these states continue to operate under pre-ACA Medicaid eligibility rules for most adults.
What income qualifies for Medicaid expansion in 2026?
In expansion states, adults ages 19 to 64 qualify if their 2026 income is at or below 138% of the Federal Poverty Level. For a single adult, that is $22,025 per year or $1,835 per month. For a family of four, it is $45,540 per year or $3,795 per month. These figures come from the HHS ASPE 2026 poverty guidelines.
Does Medicaid expansion cover adults without children?
Yes. That was one of the main changes under the ACA. Before expansion, most states required applicants to be parents, pregnant, elderly, or disabled. Expansion states now cover single adults and childless couples who fall below the income limit.
How do I know if my state expanded Medicaid?
Check the state list above or visit the KFF expansion status tracker. You can also go to Healthcare.gov and enter your information. It will tell you whether you qualify for Medicaid or ACA marketplace coverage based on your state and income.
Is there an open enrollment period for Medicaid expansion?
No. Medicaid has no annual enrollment window. You can apply any time of year. If your income drops below 138% FPL at any point, you can apply immediately and coverage can start that same month in most states.
What is the coverage gap?
The coverage gap affects adults in non-expansion states who earn below 100% FPL. They are too poor to qualify for ACA marketplace subsidies (which start at 100% FPL) but do not meet their state's Medicaid rules because their state has not expanded. An estimated 2 to 4 million adults are in this gap, concentrated in Texas, Florida, Georgia, and other southern states.
Can I get Medicaid expansion coverage if I have a job?
Yes. Medicaid does not require you to be unemployed. If your total household income from any source, including wages, falls below 138% FPL, you may qualify. Many part-time and low-wage workers qualify for Medicaid expansion even while employed.
What happens at the 138% FPL threshold exactly?
If your income is exactly at 138% FPL or below, you likely qualify for Medicaid expansion. If your income is just above 138% FPL, you become eligible for ACA marketplace subsidies instead. The transition is designed to be seamless. You should never have a gap in coverage options between Medicaid and the ACA marketplace.
Use the free screener at CoveredUSA to see whether you qualify for Medicaid expansion or ACA coverage based on your actual income and household size. Check your eligibility now at CoveredUSA, it takes 2 minutes.
Check My Eligibility at CoveredUSA
