Medicaid Expansion and the Coverage Gap, State by State

Whether your state expanded Medicaid under the Affordable Care Act shapes your coverage options more than almost anything else. In expansion states, most low-income adults qualify for Medicaid. In non-expansion states, some adults fall into a "coverage gap" — earning too much for Medicaid but too little for marketplace subsidies.

Quick answer: In our 2026 footprint, 10 states have not adopted full Medicaid expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Two are special cases — Wisconsin has no coverage gap, and Georgia offers a limited alternative instead of full expansion.

What the "coverage gap" actually is

The ACA was designed so that Medicaid would cover the lowest incomes and marketplace subsidies would cover everyone above that. When a state doesn't expand Medicaid, a gap opens in the middle: adults who earn too much to qualify for that state's (often very limited) Medicaid, but too little to qualify for marketplace premium subsidies. People in this gap can be left with no affordable, comprehensive option — which is exactly the situation short-term and fixed-indemnity plans are often marketed into, even though those aren't comprehensive coverage.

Non-expansion states (2026)

Every other state in our footprint has expanded Medicaid, so most low-income adults there can qualify for it.

Two states that don't fit the usual pattern

Wisconsin technically hasn't adopted ACA expansion, but it's a genuine exception: its BadgerCare program covers adults up to 100% of the federal poverty level, so there's no coverage gap of the kind seen in other non-expansion states.

Georgia hasn't adopted full expansion either, but it runs a limited "Pathways to Coverage" program with a work requirement. It's narrower than full expansion, and some adults may still fall into a gap if they don't meet the requirements.

If you might be in the coverage gap

Being in the gap doesn't mean you're out of options — it means you have to look carefully:

• Recheck marketplace eligibility. Subsidy thresholds depend on your household size and projected income; a small change can move you above the line into subsidy eligibility. Always run your numbers through the marketplace.
• Recheck Medicaid. Eligibility categories (children, pregnancy, disability, very low-income parents) may still apply to you or family members.
• Understand supplemental products for what they are. Short-term and fixed-indemnity plans are sometimes pitched to people in the gap. They can provide limited financial protection, but they are not comprehensive coverage, don't cover pre-existing conditions, and aren't minimum essential coverage.

Key takeaways

• 10 states haven't adopted full Medicaid expansion in 2026: AL, FL, GA, KS, MS, SC, TN, TX, WI, WY.
• Wisconsin is the exception with no coverage gap; Georgia offers a limited Pathways program instead of full expansion.
• If you might be in the gap, re-run both Medicaid and marketplace eligibility before settling for a non-comprehensive plan.

Get help checking your eligibility

Coverage-gap situations are exactly where good, unbiased guidance pays off. As an independent, carrier-neutral brokerage, we can help you check Medicaid and marketplace eligibility and compare your real options — free, with no obligation.