Medicaid expansion is the single biggest factor in whether low-income adults can get free or low-cost health coverage. The ACA gave every state the option to expand Medicaid in 2014 to cover adults earning up to 138% of the federal poverty level. By 2026, 41 states plus DC have taken that option. The remaining 10 states have not, leaving millions of low-income adults in what is called the coverage gap: they earn too little for ACA marketplace subsidies but too much for their state's traditional Medicaid rules.
This guide tells you exactly which states have expanded, which have not, what the coverage gap means if you live in a non-expansion state, and what your income limit is in 2026 based on household size. See Medicaid income limits by state for the exact figures. Use the table below to look up your household, then scroll to the state list to confirm your state's status.
Coverage Breakdown
Direct Answer: Which States Have Expanded Medicaid in 2026?
It depends on your state. As of 2026, 41 states plus the District of Columbia have expanded Medicaid under the ACA. Income eligibility is based on MAGI. The 10 states that have not expanded are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. If you live in one of those 10 states and your income falls below 100% of the federal poverty level ($15,650/year for one person for 2026 coverage), you likely fall in the coverage gap with no subsidized coverage option.
- Expansion states (41 + DC): Adults ages 19 to 64 earning up to 138% FPL qualify for Medicaid. No asset test under MAGI rules. Year-round enrollment.
- Non-expansion states (10): Medicaid covers only narrow categories: parents/caretakers below very low income thresholds, pregnant women, children, people with disabilities, and seniors. Childless adults below 100% FPL often have no coverage option.
- Recent expansions: North Carolina expanded December 2023. South Dakota expanded July 2023. No new expansions have been enacted through May 2026.
The 41 Medicaid Expansion States Plus DC (2026)
The following 41 states and the District of Columbia have adopted Medicaid expansion as of 2026. Adults ages 19 to 64 in these states can apply for Medicaid if their household income falls at or below 138% of the 2026 federal poverty level. Income is measured using MAGI (Modified Adjusted Gross Income), which excludes Social Security income for children and some other deductions.
Expansion states include: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia.
The 10 Non-Expansion States and Their Medicaid Limits in 2026
In the 10 non-expansion states, traditional Medicaid covers adults only in narrow categories and at much lower income thresholds. See how much can you make and still get Medicaid. Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming have not adopted the ACA Medicaid expansion as of 2026. Adults in these states without children, a disability, pregnancy, or senior status typically cannot qualify for Medicaid regardless of how low their income is.
What Is the Medicaid Coverage Gap in Non-Expansion States?
The coverage gap in non-expansion states affects adults who earn too little to qualify for ACA marketplace subsidies but too much for their state's traditional Medicaid. ACA marketplace subsidies begin at 100% of the federal poverty level ($15,650/year for one person for 2026 coverage). Adults earning below that threshold were supposed to be covered by Medicaid under the ACA, but because the Supreme Court made expansion optional in 2012, states that did not expand left those adults with no federally subsidized option.
In practical terms: if you live in Texas and earn $12,000/year as a single adult without children, you earn too much for traditional Texas Medicaid (which requires you to be a parent below 18% FPL) but too little for marketplace subsidies (which start at 100% FPL, or $15,650 for 2026 coverage). You fall in the gap. KFF estimates approximately 2 million adults nationally are in this coverage gap in 2026.
Is Your State an Expansion State? (Full 2026 List)
The quickest way to confirm your state's expansion status is Medicaid.gov or the KFF Medicaid Expansion Tracker. As of May 2026, expansion states are: AK, AZ, AR, CA, CO, CT, DE, DC, HI, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, MN, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OR, PA, RI, SD, UT, VT, VA, WA, WV. Non-expansion states are: AL, FL, GA, KS, MS, SC, TN, TX, WI (state-funded gap coverage only), WY.
Some expansion states have unique program names. California uses Medi-Cal, Arizona uses AHCCCS, Washington uses Apple Health, Oregon uses OHP (Oregon Health Plan), Massachusetts uses MassHealth, Tennessee's Medicaid program is called TennCare (but Tennessee has NOT expanded ACA Medicaid). Arkansas uses ARHOME, Indiana uses HIP (Healthy Indiana Plan), Maine uses MaineCare, and Connecticut uses HUSKY Health. Using the program brand when you search or call that state's office will get you to the right place faster.
What to Do If You Are in the Coverage Gap
Adults who fall in the coverage gap in non-expansion states have several options worth investigating. If you are on Medicare, check Extra Help eligibility to reduce drug costs. First, check whether your income is actually below 100% FPL. If it is, use HealthCare.gov during open enrollment (November 1, 2025 through January 15, 2026 for 2026 plan year coverage) to confirm you are in the gap, and consider low-cost alternatives such as Federally Qualified Health Centers (FQHCs), which charge on a sliding scale regardless of insurance status.
Second, check whether your income has changed or can be estimated higher. If you can document income at or above 100% FPL, you become eligible for marketplace subsidies. Third, check whether you qualify for traditional Medicaid in your state through a different category: pregnancy, disability, caretaker of a child. Fourth, children in the household can nearly always enroll in Medicaid or CHIP even in non-expansion states, because CHIP income thresholds are set much higher (200% to 400% FPL depending on state).
How to Appeal a Medicaid Denial
Medicaid denials must be provided in writing with a specific reason. If you are denied, you have the right to appeal within 90 days of the denial notice (some states allow longer). To appeal, request a state fair hearing through your state Medicaid agency. You can continue receiving benefits during the appeal if you were previously enrolled and request the hearing within 10 days of the notice. Legal aid organizations in your state can often assist with appeals at no cost.
Frequently Asked Questions
Has every state expanded Medicaid by 2026?
No. As of 2026, 41 states plus DC have expanded Medicaid. The 10 states that have not expanded are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Wisconsin provides some state-funded coverage up to 100% FPL but has not formally adopted ACA Medicaid expansion.
What is the income limit for Medicaid in expansion states in 2026?
In expansion states, adults ages 19 to 64 can qualify for Medicaid with income up to 138% of the federal poverty level. In 2026 that is $22,025/year for a single person, $29,863 for a household of 2, and $45,540 for a household of 4. Income is measured under MAGI rules, which excludes certain deductions and does not require an asset test for expansion-eligible adults.
What is the coverage gap?
The coverage gap is the income range in non-expansion states where adults earn too little for ACA marketplace subsidies (below 100% FPL, or $15,650/year for one person for 2026 coverage) but too much for their state's traditional Medicaid. KFF estimates about 2 million adults fall in this gap nationally in 2026. Childless adults with no disability who earn below 100% FPL ($15,650/year for one person for 2026 coverage, $15,960 for 2027 coverage) in Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, or Wyoming are typically affected.
Can I get Medicaid if I am a childless adult in a non-expansion state?
In most non-expansion states, no. Traditional Medicaid in states like Texas, Florida, and Alabama generally does not cover childless adults at any income level. You must be a parent or caretaker relative, pregnant, a person with a disability, or a senior. Georgia is a limited exception with its Pathways to Coverage waiver, which requires work or community engagement. Wisconsin covers adults up to 100% FPL through a state-funded program.
What are the most recent states to expand Medicaid?
North Carolina expanded Medicaid in December 2023 and South Dakota expanded in July 2023. No additional states have adopted expansion through May 2026. Ballot measures and legislative proposals have been pending in several non-expansion states including Florida and Wyoming, but none have been enacted as of this writing.
Does Medicaid expansion affect CHIP coverage for my children?
No. CHIP (Children's Health Insurance Program) is separate from Medicaid expansion and covers children up to 200% to 400% FPL depending on the state, in all 50 states. Children in non-expansion states are still eligible for Medicaid or CHIP based on their own eligibility rules, which are more generous than adult Medicaid rules in every state.
How do I apply for Medicaid in my state in 2026?
Start at HealthCare.gov, which routes you to your state Medicaid agency, or go directly to your state's Medicaid portal. Medicaid accepts applications year-round with no open enrollment window. Most states process applications within 45 days (90 days if disability is a basis). In expansion states, approval is often expedited within a few days for income-only determinations.
What happens to ACA subsidies if my state has not expanded Medicaid?
ACA marketplace subsidies (premium tax credits) are available only to people with income at or above 100% of the federal poverty level ($15,650/year for one person for 2026 coverage). If your income falls below 100% FPL and you live in a non-expansion state, you fall into the coverage gap and are not eligible for marketplace subsidies. The enhanced PTCs from ARPA expired January 1, 2026, so the subsidy cliff has returned for incomes above 400% FPL as well.
