What Is Medicaid Expansion?
The Affordable Care Act gave states the option to expand Medicaid eligibility to all adults earning up to 138% of the Federal Poverty Level (approximately $21,597/year for a single adult in 2026). The federal government covers 90% of the cost of expansion. States that chose to expand are called "expansion states."
Expansion States (as of 2026)
The following states (plus Washington, D.C.) have expanded Medicaid. Adults earning up to 138% FPL may qualify for free or low-cost Medicaid in these states:
Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee (pending), Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin (partial), Wyoming (pending)
Non-Expansion States (as of 2026)
The following states have not expanded Medicaid as of 2026. Adults without children or disabilities face very low income limits (often $9,000“$10,000/year or less) to qualify:
- Florida Voters passed Amendment 2 in 2024; implementation pending legislative action
- Texas Largest non-expansion state by population
- Georgia Limited expansion approved for some working adults only
- Alabama
- South Carolina
- Kansas
What This Means for Low-Income Adults
In expansion states, adults earning 100%“138% FPL have a choice: Medicaid (free) or marketplace plan (subsidized). Medicaid is almost always the better value at that income level, $0 premium, $0 deductible, minimal or no copays.
In non-expansion states, adults in that income range may fall into a "coverage gap": too high for state Medicaid, too low for marketplace subsidies (which begin at 100% FPL). If you are in this range in a non-expansion state, contact a licensed broker or your state's Medicaid office to confirm your options.
Wisconsin: The Special Case
Wisconsin has not formally adopted ACA expansion but covers adults up to 100% FPL through BadgerCare Plus, meaning there is no coverage gap for adults below the poverty line, but adults between 100% and 138% FPL go to the marketplace rather than Medicaid.
Kansas: Expansion Passed, Not Yet Implemented
Kansas passed Medicaid expansion legislation in 2023, but implementation has faced delays. As of 2026, expansion is not yet active in Kansas. Residents should check the Kansas Department of Health and Environment for the most current status.
What the Coverage Gap Means in Practice
The coverage gap is not theoretical, it affects hundreds of thousands of adults in non-expansion states. A single adult in Florida earning $14,000/year earns too much for Florida Medicaid and too little for ACA subsidies (which require income at or above 100% FPL, or $15,650). Their options are limited to community health centers and county indigent care programs, neither of which provide comprehensive coverage.
Adults near the 100% FPL threshold have an important option: if your income is close to the subsidy floor, you may be able to adjust your projected income slightly (for example, through additional work or accurate self-employment income projection) to qualify for marketplace subsidies. A licensed broker can help you understand your options without crossing any legal lines.
Marketplace Options in Non-Expansion States
If you live in a non-expansion state and earn above 100% FPL, the ACA marketplace is your primary coverage source. In non-expansion states like Florida, Texas, Georgia, Alabama, and South Carolina, carrier competition varies by county. With enhanced subsidies extended through 2026, Silver plans in many non-expansion state markets are available for very low premiums after tax credits.
An independent broker licensed in your state can pull exact plan options for your county, compare networks and formularies, and calculate your subsidy at no cost to you. Call (713) 575-9904 for a free quote, Health Advisory is licensed in Alabama, Arkansas, Georgia, Florida, South Carolina, and 16 other states.
Frequently Asked Questions
How do I know if my state has expanded Medicaid?
Check the list above. If you are in a state not listed under expansion, visit your state's Medicaid agency website or call 1-800-318-2596 to confirm current eligibility thresholds for your situation.
Can I get Medicaid even if my state has not expanded?
Yes, if you meet a qualifying category, pregnant, parent of a minor child, disabled, or over 65. Expansion specifically added non-categorical adults (working-age adults without children or disabilities) to eligibility in expansion states.