MedicaidCalc

The Medicaid coverage gap in 2026

By the MedicaidCalc Editorial Team · Published · Updated

As of October 1, 2026, ten states have not adopted the Affordable Care Act’s Medicaid expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming.[1] In nine of them — every one but Wisconsin — an adult can earn too little to buy subsidized coverage and still not qualify for Medicaid. That space is the coverage gap.

Why the gap exists

Two rules meet in the middle. Marketplace premium tax credits start at 100% of the poverty line — $1,330 a month for one person under the 2026 guidelines — because the regulation defines an eligible taxpayer as one whose household income is at least 100% of the federal poverty line.[3][4] The ACA expected Medicaid to cover everyone below that. In a state that did not expand, Medicaid covers adults only through older categories: parents and caretakers at very low incomes, pregnancy, disability and age 65+. An adult without children who is under 65, not pregnant and not disabled has no category at all.

Parent limits in the non-expansion states

StateParent, family of 3 / moAdults without children
Alabama$410none
Florida$600none
Georgia$662Pathways, $1,330 + 80 hrs
Kansas$866none
Mississippi$498none
South Carolina$1,526none
Tennessee$2,391none
Texas$344none
Wisconsin$2,277BadgerCare, $1,330
Wyoming$987none
 Limits include the 5% disregard. Parent figures come from each state’s own chart where cited (sources 6–14) and otherwise from MACPAC.

A parent in Texas with two children loses Medicaid above $344 a month — about 15% of the poverty line — and gets Marketplace help only above 100%. A parent there earning $1,000 a month is in the gap, while both children qualify for Medicaid.[6]

The two exceptions

Wisconsin never adopted the expansion but covers parents and adults without children through BadgerCare Plus up to 100% of the poverty line, so nobody falls between Medicaid and Marketplace credits.[2]

Georgia covers adults 19–64 up to 100% of the poverty line through Georgia Pathways, but only if they document 80 hours a month of work, school, job training or community service. Someone who cannot meet that is still in the gap. From January 1, 2027 Pathways adopts the federal rules: earning at least $580 a month counts, and parents of a child 13 or under are exempt.[5]

Options inside the gap

  • Check every category. Pregnancy, a disability, caring for a child, or being 65+ each opens a separate door with its own limit. The calculator checks each person you select.
  • Re-check when income changes. Medicaid looks at current monthly income. Income rising above 100% of the poverty line can open Marketplace credits; falling can open the parent group.
  • Community health centers charge on a sliding fee scale regardless of insurance.
  • Children are almost never in the gap. Every non-expansion state covers children in Medicaid or CHIP up to at least 205% of the poverty line.

Is this changing?

KFF’s tracker lists no non-expansion state as having adopted expansion as of October 1, 2026.[1] The 2025 reconciliation law added work requirements and six-month renewals for expansion adults rather than new incentives to expand; see the 2027 work requirement.

Sources

  1. Status of State Medicaid Expansion Decisions — KFF; Published October 1, 2026. October 1, 2026: 41 states including DC have adopted the expansion; 10 have not. Read October 5, 2026.
  2. MACStats Exhibit 36: Medicaid Income Eligibility Levels for Non-Aged, Non-Disabled, Non-Pregnant Adults by State — Medicaid and CHIP Payment and Access Commission (MACPAC); MACStats: Medicaid and CHIP Data Book, February 2026. Eligibility levels as of July 2025. Read October 5, 2026.
  3. 26 CFR 1.36B-1(h) and 1.36B-2(b)(1) — poverty line and income floor for premium tax credits — Electronic Code of Federal Regulations (Treasury / IRS); 26 CFR 1.36B-1(h); 26 CFR 1.36B-2(b)(1). eCFR as of October 1, 2026. Read October 5, 2026.
  4. Annual Update of the HHS Poverty Guidelines (2026) — U.S. Department of Health and Human Services; 91 FR 1797, FR Doc. 2026-00755. Published January 15, 2026; effective January 13, 2026. Read October 5, 2026.
  5. Georgia Pathways to Coverage: eligibility and H.R. 1 changes — State of Georgia; pathways.georgia.gov. Read October 5, 2026. Read October 5, 2026.
  6. Texas Works Handbook C-131: Income Limits (Medical Programs) — Texas Health and Human Services Commission; C-131.1 (Revision 26-2), C-131.2 (Revision 15-4), C-131.4. 2026 FPL effective March 1, 2026; parent table effective October 1, 2015. Read October 5, 2026.
  7. Form 208 Medicaid Eligibility Handout — Alabama Medicaid Agency; Form 208 (01/26), monthly income effective February 1, 2026. February 1, 2026. Read October 5, 2026.
  8. Income Limits for Medicaid and CHIP Programs — Mississippi Division of Medicaid; medicaid.ms.gov. Effective March 1, 2026. Read October 5, 2026.
  9. Program Eligibility and Income Limits — South Carolina Department of Health and Human Services; scdhhs.gov. Effective March 1, 2026. Read October 5, 2026.
  10. TennCare Eligibility Reference Guide — Tennessee Division of TennCare; eligibilityrefguide.pdf. 2026 poverty guidelines. Read October 5, 2026.
  11. ESS Program Policy Manual, Appendix A-7: Family-Related Medicaid Income Limits — Florida Department of Children and Families; Appendix A-7, updated February 2, 2026. April 2026 standards. Read October 5, 2026.
  12. Medicaid Policy Manual, Appendix A2: Family Medicaid Financial Limits 2026 — Georgia Division of Family and Children Services; Appendix A2, MT 80. Effective March 1, 2026. Read October 5, 2026.
  13. Kansas Medical Assistance Standards (KEESM Appendix F-8, 04-26) — Kansas Department of Health and Environment (KanCare); F-8, updated April 1, 2026 — read from the Internet Archive copy captured May 20, 2026 because kancare.ks.gov refuses automated requests. April 1, 2026. Read October 5, 2026.
  14. Medicaid Income Requirements — Wyoming Department of Health; health.wyo.gov. 2026 poverty guidelines. Read October 5, 2026.