Medicaid Expansion States: Does Your State Cover You?

As of 2026, 40 states plus Washington D.C. have expanded Medicaid under the Affordable Care Act, covering adults earning up to 138% of the federal poverty level. The 10 states that have not expanded leave an estimated 1.5 to 2 million low-income adults in a coverage gap, earning too much for traditional Medicaid but too little for marketplace subsidies.

What Medicaid Expansion Actually Means

The ACA gave states the option in 2014 to extend Medicaid eligibility to adults under 65 with incomes up to 138% of the federal poverty level. In 2026, that threshold equals roughly $20,800 for a single adult and $35,600 for a family of three. States that expanded receive enhanced federal matching funds, covering roughly 90% of the expansion population's costs.

Without expansion, most states only cover parents with very young children, pregnant women, or adults with disabilities. A childless adult earning $12,000 a year in a non-expansion state gets nothing from Medicaid and often can't afford marketplace premiums even with subsidies.

The Full List: Who Expanded and Who Didn't

The 40 expansion states plus D.C. include every state in New England, all of the Pacific Coast, and most of the Midwest. The most recent additions were South Dakota (2023) and North Carolina (2024), both of which passed expansion after years of legislative resistance.

The 10 states that have not expanded Medicaid as of 2026:

• Alabama
• Florida
• Georgia
• Kansas
• Mississippi
• South Carolina
• Tennessee
• Texas
• Wisconsin
• Wyoming

Florida is the largest holdout by population, leaving an estimated 700,000 adults in the coverage gap. Texas follows closely, with over 1 million uninsured adults who would qualify under expansion. Wisconsin operates a partial expansion program that covers adults up to 100% of the poverty level but does not use ACA expansion funding.

If you are weighing a move from Texas to a state like New Mexico or Illinois strictly for healthcare coverage access, that decision has real dollar value. A single adult earning $18,000 a year in Texas pays full price for coverage or goes uninsured. The same person in New Mexico qualifies for Medicaid with $0 in premiums.

Which States Are the Easiest to Qualify For

Among expansion states, the income threshold is largely uniform at 138% FPL, but some states go further. Washington D.C. covers adults up to 215% FPL. New York covers adults up to 138% FPL under expansion but has additional state-funded programs that extend coverage further. California's Medi-Cal now covers income-eligible adults regardless of immigration status, following full implementation of the state's expansion to undocumented adults.

For straightforward eligibility with minimal red tape, states like New Mexico, Kentucky, and Oregon consistently rank high. New Mexico had a Medicaid enrollment rate of roughly 40% of its total population as of late 2025, one of the highest in the country. That figure reflects both the state's high poverty rate and its aggressive outreach and enrollment infrastructure.

The state with the highest percentage of residents on Medicaid is New Mexico, followed by Louisiana and West Virginia. All three are expansion states with high poverty rates and active enrollment systems.

Who Benefits Most From Expansion

The groups with the most to gain from living in an expansion state are working-age adults without employer-sponsored insurance, gig workers, part-time employees, and early retirees who retire before Medicare eligibility at 65.

That last group matters a lot for retirement planning. If you retire at 60 and draw down investments while keeping reportable income low, you could qualify for Medicaid in an expansion state. That is a significant benefit when you consider that marketplace premiums for a 62-year-old can run $600 to $900 per month before subsidies. Our Best States for Retirees to Avoid Taxes post covers which states combine low taxes with favorable benefit access, including Medicaid eligibility windows before Medicare kicks in.

For retirees managing income specifically to access subsidies or public programs, pairing Medicaid expansion access with a state that doesn't tax Social Security is a real financial strategy. See our breakdown of States That Don't Tax Social Security for the full list.

You can also run the numbers on how Medicaid eligibility interacts with your total cost of living using our state comparison calculator.

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Key Takeaways

• 40 states plus D.C. have expanded Medicaid as of 2026, covering adults earning up to roughly $20,800 per year (single adult, 138% FPL).
• Florida and Texas are the two largest non-expansion states, collectively leaving an estimated 1.7 million adults in the coverage gap.
• New Mexico has the highest Medicaid enrollment rate in the country, at approximately 40% of the state population as of late 2025.

If Medicaid access factors into where you live or retire, compare expansion states side by side at LiveOrDieHere.com.