Medicaid Expansion

Medicaid expansion refers to the ACA’s provision that allowed states to extend Medicaid eligibility to nearly all adults with incomes up to 138% of the Federal Poverty Level (FPL). Before the ACA, Medicaid had much stricter eligibility rules that left many low-income adults — particularly those without children — without coverage options.

The Supreme Court ruled in 2012 that Medicaid expansion must be optional for states. As of 2026, 40 states and D.C. have adopted expansion. The 10 non-expansion states (including Florida, Texas, Georgia, and others) maintain more restrictive Medicaid eligibility, leaving a significant coverage gap for residents whose incomes fall below the federal poverty line.

In expansion states:

• Adults earning up to 138% FPL (~$20,783/year for an individual in 2026) generally qualify for Medicaid
• The federal government covers 90% of the cost of newly eligible enrollees

In non-expansion states like Florida:

• Adults without dependent children have very limited Medicaid eligibility regardless of income
• Residents earning between 100% and 138% FPL can access Marketplace plans with Premium Tax Credits
• Residents below 100% FPL face a coverage gap with no Medicaid and no subsidy eligibility