Medicaid & Healthcare by State

The Affordable Care Act (ACA) gave states the option to expand Medicaid to cover most adults with incomes up to 138% of the Federal Poverty Level. As of 2026, 41 states plus DC have adopted expansion; the remaining states use stricter pre-ACA income limits. Whether your state expanded determines whether a low-income adult qualifies for Medicaid at all.

In states that did not adopt ACA Medicaid expansion, adults earning between 0% and 100% of the Federal Poverty Level may have no realistic coverage option: they earn too much for traditional Medicaid (which usually covers only parents, pregnant residents, or people with disabilities) and too little to qualify for marketplace subsidies, which start at 100% FPL. This income band is called the coverage gap.

Medicaid covers low-income individuals and families; CHIP (Children's Health Insurance Program) covers children whose families earn too much for Medicaid but cannot afford private insurance. Many states run CHIP as a separate program with its own enrollment, while others run it as a Medicaid-expansion CHIP under unified eligibility rules.

You can apply through Healthcare.gov (which screens for Medicaid and routes you to your state) or directly with your state's Medicaid agency. States that run their own marketplace (e.g., Covered California, kynect, New York State of Health) use a single combined application for Medicaid, CHIP, and marketplace plans. The state pages on this site link to the official application URL.

Federal Poverty Levels are updated each January by HHS. State Medicaid income limits update annually but expansion decisions, eligibility categories, and program rules can change mid-year via state legislation or 1115 waivers. KFF refreshes its state tables continuously; Mubboo refreshes this data when KFF and Medicaid.gov publish updates.