Ten states have not expanded Medicaid, leaving an estimated 1.2 million adults without insurance, according to a July 27 KFF analysis.
The rest of the country, including the District of Columbia, has expanded Medicaid, allowing adults who make up to 138% of the federal poverty level to be eligible. The minimum eligibility for marketplace subsidies is 100% FPL, prompting a gap in states without expansion.
HR 1 cut states’ financial incentive for expanding Medicaid, making the likelihood of those 10 states broadening coverage even less probable. The law also set up work requirements, and enhanced ACA subsidies expired heading into 2026, exacerbating possible gaps in coverage. KFF reviewed 2024 data to better understand those who may slip through the cracks.
Here are nine notes from the KFF report:
1. Those 1.2 million adults either earn too much to qualify for Medicaid or do not make enough to get ACA marketplace subsidies.
2. In the states that have not expanded Medicaid, the median income limit for parents is 40% FPL, or $10,928 annually for a family of three in 2026.
3. Texas’ eligibility threshold is 15% FPL for parents, the lowest in the country, KFF determined. Out of those 10 states, Tennessee’s threshold for parents was the highest, at 105% FPL.
4. Uninsured rates are nearly twice as high in states that have not expanded Medicaid, reaching 14.5% compared to 8%.
5. In 2024, 39% of adults lacking health insurance said they delayed or passed on healthcare due to the cost, compared to 17% of adults who have insurance.
6. Georgia and Wisconsin offer coverage to adults — regardless of whether they are parents — making up to 100% FPL through a 1115 waiver, closing gaps. To enroll in the Georgia Pathways to Coverage waiver, though, people must fulfill work requirements or get an exemption.
7. Six out of 10 adults falling in the coverage gap live with family, including a worker.
8. Fifty-eight percent of those employed and in the coverage gap work in the service, retail and construction industries.
9. If these 10 states expand Medicaid, 2.4 million uninsured people would gain eligibility, encompassing the 1.2 million in the coverage gap and 1.2 million with incomes between 100% and 138% FPL who could receive but are not enrolled in marketplace coverage.
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