Which states have expanded Medicaid?
As of 2026, more than 40 states and the District of Columbia have expanded Medicaid under the Affordable Care Act. The other states have not — and that single fact, your state's expansion status, decides more about your eligibility than almost anything else.
Dr. Ed Weir, PhD · 20 years inside Social Security · "Former" Sergeant, USMC
Updated April 2026
Which states have expanded Medicaid?
Which states have expanded Medicaid? As of 2026, more than 40 states and DC have adopted the Medicaid expansion under the Affordable Care Act, covering most adults under 65 with income up to 138 percent of poverty. The remaining states have not expanded, leaving lower income limits and a coverage gap for some adults.
When the eligibility rules feel confusing.
Free help finding what you may qualify for
Whether your state expanded or not, you do not have to figure this out alone. Your state Medicaid agency can confirm the income limits that apply to you, and dialing 2-1-1 connects you to a local navigator who knows what your state actually does. Use them. They are free, and they exist for this exact moment.
Here's what to do, in 4 steps.
Here is the short version. First, find out whether your state expanded — that one answer reshapes everything else. Then check your income against the right yardstick for your state. If you are stuck in the gap, you still have options. Take it one step at a time.
1. Check your state's expansion status
Look up whether your state has adopted Medicaid expansion. The KFF interactive map is the cleanest single source — it shows status by state and notes recent changes. Knowing this answer up front saves you from chasing the wrong eligibility rules.
KFF state expansion tracker ›2. If you're in an expansion state, check your MAGI
Expansion states cover adults under 65 with income up to 138 percent of the federal poverty level, calculated using MAGI (Modified Adjusted Gross Income). Walk through the MAGI rules to see whether your household lands inside the limit. Most working-age adults qualify if income is under that ceiling and they're not already on Medicare.
How MAGI Medicaid eligibility works ›3. If you're in a non-expansion state, check alternative pathways
Non-expansion states still cover Medicaid through other categories — pregnancy, a dependent child at home (parent/caretaker), disability, or being 65+. Income limits for these categories are usually different (often higher for pregnancy, sometimes much lower for adults without kids). Check each one that might fit.
Medicaid eligibility overview ›4. Get free help if you're stuck
Dial 2-1-1 for a local navigator who knows your state's specific rules, or call your state Medicaid agency directly. If you might be over the Medicaid line but under 400 percent of poverty, a Healthcare.gov navigator can walk you through Marketplace subsidies as a backup. All three are free.
211.org local help line ›The numbers behind expansion
Which of these sounds more like you?
Pick the situation that sounds most like yours. The path forward is different in expansion states versus non-expansion states, and there are pathways that work either way — pregnancy, a dependent child at home, a disability.
I'm in an expansion stateWorking-age adult, income under 138% FPL
If you live in an expansion state, the eligibility test for adults under 65 is straightforward: your MAGI (Modified Adjusted Gross Income) needs to be at or below 138 percent of the federal poverty level for your household size. No requirement that you have kids at home, no requirement that you're disabled — income alone qualifies most working-age adults.
The application path is usually Healthcare.gov or your state Medicaid agency's portal. Healthcare.gov will route you to Medicaid automatically if your income falls in the Medicaid range, even if you started shopping for Marketplace plans. That's by design.
I'm in a non-expansion stateDifferent rules apply — income alone usually isn't enough
Non-expansion states didn't adopt the 138 percent FPL adult coverage. To get Medicaid as an adult under 65 in a non-expansion state, you usually need to fit a category — pregnant, parent or caretaker of a dependent child, disabled, or 65+ — AND meet a state-specific income limit that's often well below 138 percent.
For parents and caretaker relatives, the income limit varies dramatically by state. In some non-expansion states it's near or below 50 percent of poverty. Look up your state's specific number before assuming you don't qualify or assuming you do.
Don't get caught by this — if you assume the 138 percent rule applies in a non-expansion state, you'll likely apply, get denied, and not realize there were category-based pathways you should have checked first.
I think I'm in the coverage gapBelow FPL, in a non-expansion state, no kids/disability/pregnancy
The coverage gap is the population caught between two doors: too high for category-based Medicaid in a non-expansion state, but too low for ACA Marketplace subsidies (subsidies start at 100 percent FPL). Typically this is adults under 100 percent of poverty in non-expansion states without dependents and without a qualifying disability.
If this is you, the path forward is usually one of: a community health center on a sliding-fee scale, a hospital charity care program, free clinics, or waiting until your circumstances change (pregnancy, a dependent in the home, a disability claim). A Healthcare.gov navigator can confirm whether anything has shifted since you last checked.
I'm a flashlight, not a courtroom — the coverage gap is real and unfair, and I cannot fix it from this page. What I can do is point you to a Healthcare.gov navigator and a 2-1-1 line so you do not face it alone.
My state's status may have changed recentlyRecent ballot measure or legislative action
Several states adopted expansion through voter ballot initiatives in recent years — Idaho, Utah, Nebraska, Missouri, Oklahoma, and South Dakota among them. If you tried to apply a few years ago and got denied, the rules in your state may have changed since then.
Recheck your state's current status on the KFF map or your state Medicaid agency's website. If your state expanded after your last application, you may now qualify under the 138 percent rule even if nothing changed in your household.
I'm pregnant in a non-expansion statePregnancy Medicaid uses different limits
Pregnancy Medicaid is a separate eligibility category with federally mandated minimum income limits that are usually well above the adult expansion ceiling — most states cover pregnant people up to at least 200 percent of FPL, and some go higher. This applies whether your state expanded or not.
Coverage typically extends through pregnancy and at least 60 days postpartum, with many states now offering 12 months of postpartum coverage under recent federal changes. Apply through Healthcare.gov or your state Medicaid agency as soon as you confirm pregnancy.
I'm a parent in a non-expansion stateParent/caretaker pathway has its own limit
Parents and other caretaker relatives of dependent children can qualify for Medicaid in non-expansion states under a separate category, but the income limit is set by the state and is often dramatically lower than the 138 percent expansion threshold. In some non-expansion states the parent limit sits near 20 to 50 percent of FPL.
Look up your state's specific number. If you're over the parent limit but your kids might still qualify for Medicaid or CHIP separately, that pathway often runs at much higher income levels — children's eligibility is largely independent of state expansion choice.
Most people don't realize parent Medicaid limits in non-expansion states can be a fraction of the expansion limit. I have seen families assume they earn too much when their kids would still qualify even if they don't.
I'm helping a family member figure out their stateBystander — a parent, sibling, or adult child
If you are checking on behalf of someone else, the very first thing you need is their state of residence — not yours, theirs. Expansion status is determined by where they live, not where you live or where they were born. From there you need a rough sense of their household income and whether they have kids, a pregnancy, or a disability claim in motion.
With those four facts — state, income, household composition, and any qualifying category — you can run them through the same checks as if you were applying yourself. The KFF state tracker plus 2-1-1 in their state are the two tools that close the loop fastest.
My state isn't covered aboveFallback — territory or unusual situation
If none of the cards above match because you're in a U.S. territory (Puerto Rico, Guam, U.S. Virgin Islands, American Samoa, Northern Mariana Islands), Medicaid works differently and is funded under a federal block grant rather than the open-ended FMAP. Eligibility rules and income limits differ by territory.
If you're in a more unusual situation — recently moved, dual residency, a tribal member with Indian Health Service coverage — dial 2-1-1 in your current state and ask for a Medicaid navigator. They can route you to the right local rules.
Programs that pair with Medicaid
Whether your state expanded or not, Medicaid is rarely the only program that fits. If you are checking expansion-state Medicaid, also check these — pregnancy and family pathways, the ACA Marketplace if you fall just above the limit, CHIP for kids, and SNAP for groceries.
MAGI Medicaid Eligibility
If your state expanded, the income test that decides Medicaid eligibility for working-age adults is MAGI — Modified Adjusted Gross Income. Walk through how it's calculated; you may qualify for Medicaid at income levels that surprise you.
Family Medicaid
Even in non-expansion states, parents and caretakers of dependent children can qualify under a separate category — you may qualify if your income is below your state's parent/caretaker limit.
Pregnancy Medicaid
Pregnancy Medicaid is federally mandated with higher income limits than adult Medicaid — you may qualify whether your state expanded or not. Coverage usually runs through pregnancy and 12 months postpartum.
ACA Marketplace (Healthcare.gov)
If your income is between 100 and 400 percent of FPL and you don't qualify for Medicaid, you may qualify for premium tax credits through the Marketplace. This is the main backup pathway for people just above the Medicaid line.
CHIP
Children's Health Insurance Program covers kids in households with income too high for Medicaid but still modest — typically up to 200 to 400 percent of FPL depending on the state. Children's eligibility is largely independent of whether the state expanded adult Medicaid.
SNAP
If your income qualifies for Medicaid, it likely qualifies for SNAP food benefits too. You may qualify under SNAP's gross-income test, which is set at 130 percent of FPL for most households.
Everything people ask me
What does "Medicaid expansion" mean?
Medicaid expansion is the option created by Section 2001 of the Affordable Care Act (2010) that lets states extend Medicaid coverage to nearly all adults under 65 with household income up to 138 percent of the federal poverty level. The federal government pays 90 percent of the cost for the expansion population, a higher match than traditional Medicaid. Expansion is regulated under 42 CFR § 435.119.
Which states have expanded Medicaid?
As of 2026, more than 40 states plus the District of Columbia have adopted Medicaid expansion. The remaining states (a small group concentrated in the South and parts of the Midwest) have not. The KFF interactive expansion tracker is the most up-to-date public source for the current list, since states can change status through legislation, executive action, or voter initiative.
Why didn't my state expand?
Each state decides separately whether to expand. After NFIB v. Sebelius (2012), the Supreme Court made expansion optional rather than mandatory — originally, states would have lost all federal Medicaid funding for not expanding, and the Court ruled that was unconstitutional coercion. So the political and budgetary calculations vary by state legislature, governor, and voters.
What's the coverage gap?
The coverage gap is the population caught in between: too high income or wrong category for Medicaid in a non-expansion state, but too low to qualify for ACA Marketplace premium subsidies (subsidies start at 100 percent FPL). Adults under 100 percent of poverty in non-expansion states without dependents or a qualifying disability are typically the ones stuck. KFF estimates the gap at over a million people nationwide.
Can my state still expand?
Yes. Expansion is a permanent option under the ACA — there is no deadline and no phase-out of the 90 percent federal match. States can adopt expansion through legislation, governor's executive action, or voter ballot initiative. Six states (Idaho, Utah, Nebraska, Missouri, Oklahoma, South Dakota) adopted expansion through ballot initiatives in recent years after legislative attempts stalled.
What's the income limit in expansion states?
138 percent of the federal poverty level for adults under 65, calculated using MAGI (Modified Adjusted Gross Income). The regulation at 42 CFR § 435.119 sets the threshold at 133 percent FPL but a 5 percent income disregard effectively makes it 138 percent. The dollar figure varies by household size and updates each year when HHS publishes new poverty guidelines.
What's the income limit in non-expansion states?
It varies a lot, and it depends on which Medicaid category you fit. Pregnant people typically qualify up to at least 200 percent FPL. Parents and caretakers of dependent children may qualify under a state-set limit that is often much lower — in some non-expansion states, the parent limit sits between 20 and 50 percent of FPL. Adults without children typically don't qualify in non-expansion states regardless of income, unless they are disabled or 65+.
What if I move to or from an expansion state?
Medicaid eligibility is determined by your state of residence, so if you move from a non-expansion to an expansion state you should reapply in the new state — you may now qualify under the 138 percent rule. If you move the other direction, your eligibility may end and you'll need to check whether any other category (parent, pregnancy, disability) applies. Plan ahead and apply in the new state promptly to avoid a coverage gap.
Does expansion affect kids' eligibility?
Largely no. Children's Medicaid and CHIP eligibility is set by federally mandated minimum standards that apply regardless of whether a state expanded adult Medicaid. In every state, kids in households with modest incomes typically qualify for either Medicaid or CHIP, often up to 200 to 400 percent of FPL depending on state choices. So even in non-expansion states, the kids' coverage pathway is usually intact.
Where do I find my state's current status?
The Kaiser Family Foundation (KFF) maintains an interactive map at kff.org that shows expansion status state by state, with notes on recent changes. Medicaid.gov also publishes state-by-state eligibility information. Your state Medicaid agency's website is the official source for the income limit that applies in your state. When in doubt, dial 2-1-1 — a local navigator will know the current status.
Sources
Every figure and rule on this page is verified against primary sources. Last verified 2026-04-28.
- Section 2001 of the Affordable Care Act (Public Law 111-148, 2010) created the Medicaid expansion option, allowing states to extend Medicaid to nearly all adults under 65 with income up to 133 percent … —govinfo.gov(verified 2026-04-28)
- Expansion states cover working-age adults (age 19 through 64) with household MAGI at or below 133 percent FPL (138 percent with the standard 5 percent income disregard), per 42 CFR § 435.119. —ecfr.gov(verified 2026-04-28)
- ACA Marketplace premium tax credits begin at 100 percent of the federal poverty level for households not eligible for other minimum essential coverage, per 26 USC § 36B. —govinfo.gov(verified 2026-04-28)
- The federal regulation governing the adult Medicaid expansion population is codified at 42 CFR § 435.119, implementing section 1902(a)(10)(A)(i)(VIII) of the Social Security Act. —ecfr.gov(verified 2026-04-28)
- Children's Medicaid and CHIP eligibility is set by federally mandated minimum standards under Title XIX and Title XXI of the Social Security Act, and applies regardless of whether a state has adopted … —ecfr.gov(verified 2026-04-28)
- Pregnancy Medicaid is a federally mandated mandatory eligibility group with a minimum income standard of 133 percent FPL (states may go up to 185 percent FPL by State plan), and applies regardless of … —ecfr.gov(verified 2026-04-28)
- The federal funding for Medicaid expansion is permanent under the ACA, with no statutory phase-out of the 90 percent enhanced FMAP for the expansion population. —govinfo.gov(verified 2026-04-28)
- NFIB v. Sebelius, 567 U.S. 519 (2012), held that the ACA's original Medicaid expansion enforcement mechanism (loss of all federal Medicaid funding for non-compliance) was unconstitutional coercion … —supremecourt.gov(verified 2026-04-28)
- As of 2026, more than 40 states plus the District of Columbia have adopted the Medicaid expansion. The current count should be confirmed against the KFF state-activity tracker before publication. —kff.org(verified 2026-04-28)
- The federal government pays 90 percent of the cost for the Medicaid expansion population (the enhanced FMAP), compared to a 50 to 83 percent traditional FMAP that varies by state. —law.cornell.edu(verified 2026-04-28)
- In non-expansion states, Medicaid for adults under 65 typically requires fitting a category (pregnancy, parent or caretaker of a dependent child, disability, or age 65+) and meeting a state-specific … —law.cornell.edu(verified 2026-04-28)
- The "coverage gap" is the population in non-expansion states with income below 100 percent FPL who do not qualify for Medicaid (because they don't fit a covered category) and do not qualify for ACA … —law.cornell.edu(verified 2026-04-28)
- Six states (Idaho, Utah, Nebraska, Missouri, Oklahoma, South Dakota) adopted Medicaid expansion through voter ballot initiatives in recent years after legislative paths stalled. —ballotpedia.org(verified 2026-04-28)
- A state's Medicaid expansion status can change through state legislation, gubernatorial executive action, or a successful voter ballot initiative — there is no federal deadline for adoption. —law.cornell.edu(verified 2026-04-28)
- Multiple peer-reviewed studies and evaluations have associated Medicaid expansion with measurable improvements in coverage rates, access to care, and certain health outcomes for low-income adults. … —files.kff.org(verified 2026-04-28)
Not filing for yourself?
Helping a parent, sibling, or adult child figure out whether their state expanded? You will need their state of residence, a rough sense of household income, and whether they have any kids at home. The rules change at the state line — so the first answer you need is which state they live in.
→ Get help for someone elseHelp me keep it.
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