ACA Expansion — The Biggest Dividing Line
The ACA allowed states to expand Medicaid to adults with incomes up to 138% FPL regardless of household composition. As of 2026, 41 states plus DC have adopted expansion. The 10 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming) have not, leaving a significant coverage gap for low-income adults.
In expansion states, most adults earning at or below 138% FPL (approximately $20,785/year for a single person in 2026) qualify — regardless of whether they have children, work, or have a disability. This is the coverage for the largest share of Medicaid enrollees added under the ACA.
In non-expansion states, most adults without children and incomes above a very low threshold (often below 50% FPL for parents) do not qualify. These individuals fall into the "coverage gap" — too poor for Marketplace subsidies (which start at 100% FPL) but ineligible for Medicaid.
Income Limits by Household Type
| Household Type | Expansion States | Non-Expansion (typical) |
|---|---|---|
| Adults without children | Up to 138% FPL | Generally not eligible |
| Parents/caretakers | Up to 138% FPL | 50–75% FPL (varies) |
| Pregnant women | 138–200%+ FPL | 138–200%+ FPL (broader even in non-expansion) |
| Children (Medicaid) | 133–138% FPL | 100–133% FPL |
| SSI/disability recipients | SSI-linked | SSI-linked |
For 2026: 138% FPL for an individual ≈ $20,785/year; for a family of four ≈ $42,894/year.
Non-Expansion States — Who Can Still Qualify
In non-expansion states, these groups typically can still qualify: children (through Medicaid and CHIP), pregnant women, parents with dependent children at low income thresholds, adults who are elderly/blind/disabled meeting SSI-related criteria, and foster care youth up to age 26. If you're in a non-expansion state without children and below 100% FPL, ACA Marketplace coverage with subsidies may be your best option.
Special Rules for Pregnant Women
Every state covers pregnant women at a higher income threshold — typically 138–200% FPL — because federal law specifically requires it. Coverage includes the full pregnancy, labor and delivery, and 12 months postpartum under a 2021 federal mandate. See Medicaid for Pregnant Women.
Children and CHIP
Children above the Medicaid income threshold are typically covered by CHIP up to 200–300% FPL in most states. Healthcare.gov routes children to the right program automatically. See What Is CHIP.
Immigration Status and Medicaid
Qualified immigrants (lawful permanent residents, refugees, asylees, certain other statuses) who have been in qualifying status for 5+ years can enroll in Medicaid in expansion states. Some states use state funds to cover the 5-year waiting period. Undocumented immigrants generally qualify only for emergency Medicaid. U.S.-born children of immigrants are citizens and qualify regardless of parents' status.
How to Check Eligibility Today
Apply at healthcare.gov — it routes you to Medicaid automatically based on your income. Or apply directly at your state's Medicaid agency. Use the Benefits Match Quiz to check Medicaid alongside SNAP, CHIP, and other programs. When in doubt, apply — there's no penalty for applying and being found ineligible.