United States · Medicaid · ACA expansion · Status as of November 2026
Medicaid expansion states 2026.
Every state’s expansion decision, implementation date, ballot-initiative origin and trigger law from KFF’s tracker, the ten non-expansion states, and a checker that pairs a state with the 138 percent of poverty income level for 2026.
Short answer: As of November 2026, 41 states including the District of Columbia have adopted the Affordable Care Act’s Medicaid expansion and 10 have not: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. Expansion covers most low-income adults up to 138 percent of the federal poverty level, which for 2026 is $22,024.80 a year for one person and $45,540 for a family of four in the 48 contiguous states and DC. Seven states adopted by ballot initiative and 13 expansion states carry a trigger law that would end coverage if federal funding changed. KFF notes there is no federal deadline for a state to expand.
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The ten states that have not adopted expansion
KFF’s State Health Facts indicator “Status of State Action on the Medicaid Expansion Decision,” dated November 2026, counts “Adopted: 41 states (incl. DC)” and “Not Adopted: 10 states.” The ten are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. KFF’s notes explain the policy: “The ACA expands Medicaid coverage for most low-income adults to 138% of the federal poverty level (FPL),” and, after the 2012 Supreme Court decision left the choice to states, “per CMS guidance, there is no deadline for states to implement the Medicaid expansion.” Status is “based on KFF tracking and analysis of state executive activity.”
Expansion states by implementation date
| Implementation date | States (ballot-initiative states marked B; trigger-law states marked T) |
|---|---|
| January 1, 2014 | Arizona (T), Arkansas (T), California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois (T), Iowa (T), Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico (T), New York, North Dakota, Ohio (T), Oregon, Rhode Island, Vermont, Washington, West Virginia |
| 2014, later in the year | Michigan (April 1), New Hampshire (August 15, T) |
| 2015 | Pennsylvania (January 1), Indiana (February 1, T), Alaska (September 1) |
| 2016 | Montana (January 1, T), Louisiana (July 1) |
| 2019 | Virginia (January 1, T), Maine (January 10, B: November 2017) |
| 2020 | Idaho (January 1, B: November 2018, T), Utah (January 1, B: November 2018, T), Nebraska (October 1, B: November 2018) |
| 2021 | Oklahoma (July 1, B: June 2020), Missouri (October 1, B: August 2020) |
| 2023 | South Dakota (July 1, B: November 2022), North Carolina (December 1, T) |
Seven states adopted through a ballot initiative and thirteen expansion states have a trigger law in place, meaning, in KFF’s footnote, a “state has a trigger law that would end expansion coverage” under specified federal funding changes. KFF also notes that South Dakota and West Virginia “are or were considering action to put a trigger law in place,” that a Virginia budget amendment to remove its automatic termination was introduced but not included in the final budget, and that proposals to remove or scale back trigger laws have been introduced in Illinois and North Carolina.
What 138 percent of poverty means in dollars
The 2026 HHS poverty guideline for the 48 contiguous states and DC is $15,960 for one person, rising by $5,680 for each additional person to $55,720 for eight. At 138 percent that is $22,024.80 for one person, $29,863.20 for two, $37,701.60 for three and $45,540 for four, or about $1,835.40 a month for one person. Alaska and Hawaii have their own guidelines ($19,950 and $18,360 for one person), so their 138 percent figures are higher. These are the income levels KFF describes for the expansion group; each state applies its own counting rules, and the checker labels its dollar figures as derived from the guideline.
The coverage gap
In a non-expansion state, Medicaid for adults depends on the state’s traditional categories (parents and caretakers, pregnancy, disability, age) and their income limits, which can be far below the poverty line; adults without dependent children generally have no income-based pathway at all. Because marketplace premium tax credits begin at 100 percent of poverty, a person below that line who fits no category can be ineligible for both, which is the gap. This page does not restate any state’s own parent or caretaker limits; the linked Texas page is an example of what a non-expansion state publishes.
Worked example
A single adult in Texas with no children earns $18,000 a year. Texas is one of the ten non-expansion states, so there is no adult expansion group for her to qualify under, and at 113 percent of the 2026 poverty guideline she is above the 100 percent line where marketplace tax credits start, so the marketplace is the route to look at. The same person in New Mexico, an expansion state since January 1, 2014 with a trigger law, is below the 138 percent level of $22,024.80 and falls within the expansion income range; New Mexico’s own application would confirm eligibility and apply its counting rules.
Common mix-ups
- Georgia and Wisconsin are non-expansion states even though they cover some adults. KFF counts both among the ten that have not adopted the ACA expansion; their adult coverage runs under their own programs and limits, not the 138 percent expansion group.
- A trigger law is not a repeal. It is a standing state law that would end expansion coverage if federal funding changed; the thirteen states marked T have expansion in place today.
- The 138 percent figure is a poverty-guideline multiple, not a Medicaid income chart. States count income under their own rules, so a state’s published monthly limit can differ from the arithmetic here.
- Adopted is not the same as implemented. KFF lists the implementation date separately; every state marked adopted here has an implementation date in the past.
Method
The checker looks up the state in the table above (status, implementation date, ballot initiative and trigger law as KFF published them for November 2026) and multiplies the 2026 HHS poverty guideline for the household size by 1.38, using the Alaska or Hawaii guideline where applicable, labelling the result DERIVED. The KFF indicator and the ASPE guidelines were read on November 11, 2026. Medicaid.gov’s eligibility pages refused automated requests on the build day, so the federal site is not quoted here.
What this does not cover
- Each state’s own income limits for parents, children, pregnant people and people with disabilities.
- Work and community engagement requirements for expansion adults, which the linked calculator covers.
- Pending legislation or litigation in any state after November 2026.
- Immigration status rules and other non-income eligibility tests.
Figures read from the sources below on November 11, 2026. Last updated November 11, 2026.
Sources
- KFF State Health Facts: Status of State Action on the Medicaid Expansion Decision (November 2026) (retrieved November 11, 2026)
- HHS ASPE: 2026 poverty guidelines (48 states and DC, Alaska, Hawaii) (retrieved November 11, 2026)
Frequently asked questions
Which states have not expanded Medicaid in 2026?
Ten, per KFF's tracker as of November 2026: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
How many states have adopted Medicaid expansion?
41 including the District of Columbia, as of November 2026. The most recent implementations were South Dakota on July 1, 2023 and North Carolina on December 1, 2023.
What income level does expansion cover?
KFF describes the ACA expansion as covering most low-income adults up to 138% of the federal poverty level. For 2026 that is $22,024.80 a year for one person and $45,540 for four in the 48 states and DC; Alaska and Hawaii have higher guidelines.
Which states expanded by ballot initiative?
Seven: Maine (November 2017), Idaho, Nebraska and Utah (November 2018), Oklahoma (June 2020), Missouri (August 2020) and South Dakota (November 2022).
What is a trigger law?
A state law that would end expansion coverage if federal funding changed. KFF's tracker marks 13 expansion states as having one: Arizona, Arkansas, Idaho, Illinois, Indiana, Iowa, Montana, New Hampshire, New Mexico, North Carolina, Ohio, Utah and Virginia.
What is the coverage gap?
In a non-expansion state, adults without dependent children generally have no income-based Medicaid pathway, and marketplace premium tax credits start at 100% of poverty, so people below that line with no other category can fall between the two. The state's own rules decide parents and other groups.
Is there a deadline for states to expand?
No. KFF notes that per CMS guidance there is no deadline for states to implement the Medicaid expansion.
Not legal, financial or medical advice
This page is general information from an unofficial guide, not legal, financial or medical advice, and it is not affiliated with any state Medicaid agency, CMS or KFF. Only the state agency decides eligibility. Nothing you type is sent anywhere. It runs in your browser.