The Medicaid Coverage Gap, by state
In the 10 states that haven't adopted ACA Medicaid expansion, low-income adults without dependent children often have no Medicaid pathway at all — and earn too little for marketplace subsidies. Where a state sits determines whether your obesity-burden denominator even exists. 2026 thresholds.
41+DC
states expanded Medicaid
10
have not (8 with a true gap)
~1.4M
adults stuck in the gap
~42%
of the gap is in Texas alone
So what for a Medicaid planner: in a non-expansion state, the adult obesity burden you'd target is structurally smaller and poorer — the program simply doesn't cover most low-income childless adults. Any burden or GLP-1 projection has to start from who is actually eligible, which is why this map is the denominator behind the projection.
Coverage status — all 51
Expanded (adults ≤138% FPL)
Partial / waiver (≤100% FPL)
Coverage gap (no adult pathway)
The 10 non-expansion states — how deep the gap goes
Parent/caretaker income ceiling (the only adult Medicaid pathway in most of these states), shown as % FPL and as annual dollars for a family of three (2026 FPL = $27,320). A childless adult usually has no pathway at all.
| State | Parent ceiling (% FPL) | ≈ $ / yr (family of 3) | Childless-adult pathway |
|---|
Sources: Expansion status — KFF, Status of State Medicaid Expansion Decisions (2026). Parent thresholds — MACPAC MACStats Exhibit 36 (July 2025). FPL — HHS ASPE 2026. Coverage-gap counts — KFF. Georgia ("Pathways") and Wisconsin cover adults to ~100% FPL via 1115 waivers (partial, not full expansion). Estimate/illustration; verify individual eligibility with the state agency.
Built entirely on public data (KFF, MACPAC, HHS) — an estimate, not a prediction of individuals.