Medicaid expansion changed who can get coverage in some states, but not all

Medicaid expansion is a real change in who qualifies for free coverage in certain states. Under the expansion, adults without children can now get Medicaid in states that chose to expand the program — but only in those states. If you live in a state that expanded Medicaid, your income threshold for coverage went up. If you live in a state that did not expand, the old rules still explore. The difference between the two can mean you may have access to in one state but not the other, even at the same income level.

Whether expansion happened in your state depends on a decision your state legislature made, not on any action you took. You need to know which category your state falls into, because it changes what income level gets you coverage. This guide explains how expansion works, which states have it, and how to find out whether you now may have access to.

Key Takeaways

  • Medicaid expansion allows adults earning up to roughly 138% of the federal poverty line to get free coverage in expansion states, compared to much lower thresholds in non-expansion states.
  • Thirty-eight states plus Washington, D.C. have expanded Medicaid; twelve states have not, and the list does not change often.
  • Your state's Medicaid office is the only place that can tell you whether you may have access to under your state's specific rules, because income limits and what counts as income vary by state.
  • If you do not may have access to for Medicaid in a non-expansion state, you may still may have access to for subsidized private insurance through the federal marketplace.

How Medicaid expansion changed income thresholds

Before expansion, Medicaid covered mainly children, pregnant women, parents of young children, and people with disabilities. Adults without children almost never may have access to, no matter how low their income was. Medicaid expansion removed that barrier in participating states.

In expansion states, Medicaid now covers adults earning up to approximately 138% of the federal poverty line. For 2024, that means a single adult earning roughly $18,000 per year or less may may have access to. The exact number changes each year because the federal poverty line changes. Non-expansion states kept the old rules, which means adults without children still do not may have access to unless they fall into one of the original categories.

The expansion is optional for states, so the decision to expand or not was made by each state's legislature. Once a state expanded, it has stayed expanded — no state has reversed the decision. But twelve states have never expanded, and they are unlikely to do so in the near term.

Which states have expanded Medicaid

Thirty-eight states plus Washington, D.C. have expanded Medicaid. The expansion states are: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, West Virginia, and Wyoming.

The twelve non-expansion states are: Alabama, Georgia, Idaho, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Utah, Wisconsin, and Wyoming. (Note: Kansas and Wyoming appear in both lists because they expanded in some years and then faced legislative changes; check your state's current status with your state Medicaid office.)

This list does not change often. A state that expands stays expanded. A state that has not expanded has not done so for over a decade. If you live in one of these twelve states and do not may have access to for Medicaid under the old rules, you may still may have access to for subsidized private insurance through Healthcare.gov.

How to learn about you may have access to in your state

Your state's Medicaid office is the only source that can tell you whether you may have access to, because each state sets its own rules within federal guidelines. Income limits, what counts as income, and what assets you can have all vary by state. Calling your state Medicaid office or visiting its website is the fastest way to get an answer specific to your situation.

To find your state Medicaid office, search "[your state name] Medicaid" or visit Medicaid.gov and select your state from the map. Most state offices have a phone line and a website where you can enter your income and household size to see whether you likely may have access to. Some states also let you start the process online.

When you contact your state Medicaid office, have ready: your Social Security number, your household income for the past month or the past year (your state will tell you which), and the names and ages of anyone in your household. If you are self-employed, bring documentation of your business income. The office will tell you what counts as income in your state — some states count child support or unemployment benefits differently than others do.

What happens if you do not may have access to for Medicaid

If you live in a non-expansion state and your income is above your state's Medicaid threshold, you do not may have access to for Medicaid. But you may still may have access to for subsidized private insurance through the federal marketplace at Healthcare.gov. The marketplace uses a different income calculation than Medicaid does, and subsidies are available to people earning between 100% and 400% of the federal poverty line.

To check whether you may have access to for marketplace subsidies, visit Healthcare.gov and enter your income and household size. You can also call 1-800-318-2596 to speak with someone who can walk you through the process. Open enrollment for the marketplace runs from November 1 to January 15 each year, but if you have a may have access to life event — such as losing job-based coverage, moving, or having a baby — you can enroll outside that window.

If you do not may have access to for either Medicaid or marketplace subsidies, look into whether your state has a high-risk pool, a charity care program at a local hospital, or a community health center that offers sliding-scale fees based on income. Your state health department website can point you toward these options.

Income and household size matter more than you might think

Medicaid looks at your household income, not just your individual income. Your household includes you, your spouse if you are married, and any children under 19 who live with you. It does not include adult children, parents, or siblings, even if they live in your home and share expenses.

Income includes wages, self-employment income, Social Security, unemployment benefits, and child support. It does not include food stamps, housing information, or most other government benefits. Some states count tax refunds or one-time payments differently, so ask your state Medicaid office what counts in your state.

Your household size and income together determine your may be able to access. A family of four has a higher income threshold than a single adult, because the federal poverty line is higher for larger households. If your income is close to the threshold, small changes — such as a raise, a job loss, or a change in household size — can move you from ineligible to may be able to access or vice versa.

What to do if your state has not expanded Medicaid

If you live in a non-expansion state, you have fewer options through Medicaid, but you are not without coverage paths. Start by checking whether you may have access to for marketplace subsidies at Healthcare.gov. Many people who do not may have access to for Medicaid in non-expansion states do may have access to for subsidized private insurance.

If you do not may have access to for marketplace subsidies either, contact your local community health center. Community health centers are federally funded and offer primary care, dental, and mental health services on a sliding fee scale based on income. You can find one near you at FindAHealthCenter.HRSA.gov. Some also help uninsured patients navigate other coverage options.

If you have a chronic condition or take regular medications, ask your doctor's office whether the pharmaceutical company offers patient information programs. Many drug manufacturers provide free or low-cost medications directly to uninsured patients who meet income requirements. Your doctor's office can help you find and explore for these programs.

Frequently Asked Questions

Does Medicaid expansion mean I automatically get coverage?

No. Expansion only changes who can may have access to; you still have to meet your state's specific income and household requirements. You must contact your state Medicaid office to find out whether you may have access to under your state's rules.

What if I live in a state that expanded Medicaid but I still do not may have access to?

Even in expansion states, you must meet the income threshold. If your income is above the limit, check whether you may have access to for subsidized private insurance through Healthcare.gov. You may also may have access to for other information programs through your state health department or local community health center.

Can I move to an expansion state to get Medicaid?

Medicaid is tied to your state of residence, not citizenship. You must live in a state to use its Medicaid program. Moving solely to access Medicaid is not a practical solution, but if you are moving for other reasons, your new state's Medicaid rules will explore once you establish residency.

How long does it take to learn about I may have access to?

Most state Medicaid offices can give you a preliminary answer over the phone or online within minutes. A full information usually takes two to four weeks after you submit all required documents. Some states are faster; call your state office to ask about their typical timeline.

What if my income changes after I get Medicaid?

You must report income changes to your state Medicaid office. If your income rises above the threshold, your coverage will end. If your income drops, you may become may be able to access. Your state will tell you how often you need to report changes — usually once a year, but sometimes more often if your income is unstable.