The numbers behind expansion
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.
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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.
Time: 5 minutes Cost: Free KFF state expansion tracker
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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.
Time: 10 minutes Cost: Free How MAGI Medicaid eligibility works
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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.
Time: 15 minutes Cost: Free Medicaid eligibility overview
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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.
Time: Same day Cost: Free 211.org local help line
Dr. Ed explains Medicaid expansion
Video coming soon
I'm working on a short walkthrough of how expansion status changes the rules in your state. Check back soon.
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.
If your state didn't expand, see the non-expansion card below.
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.
If you're under poverty but don't fit a category, see the coverage gap card.
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.
Income just over the line? Check Marketplace subsidies instead.
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.
Confirmed your state expanded? Apply through Healthcare.gov.
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.
See the pregnancy Medicaid page for full details.
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.
Even if you don't qualify, your kids might — see CHIP.
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.
Need to apply on their behalf? You'll likely need a signed authorization.
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.
Still not sure? Call your state Medicaid agency directly.
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.
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.
Help me keep it.
State expansion status changes. Voter initiatives pass. Legislatures act. If you want a heads-up when your state's status shifts, drop your email below.
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