The Medicaid Coverage Gap: Which States Have It and What to Do
In states that haven’t expanded Medicaid, many adults earn too much for Medicaid but too little for a Marketplace tax credit, which starts at 100% of the poverty line. That’s the coverage gap. Here is where it exists, who falls into it, and what options are left.
How the gap happens
The Affordable Care Act expected every state to cover adults up to 138% of the poverty line through Medicaid, so the Marketplace tax credit starts at 100%. States can choose not to expand. In those states, adults without children usually can’t get Medicaid at any income, and parents qualify only at very low incomes. Adults below 100% of the poverty line then have neither Medicaid nor a tax credit.
States with the gap
| State | Parents qualify up to | Other adults qualify up to | Gap for adults without children |
|---|---|---|---|
| Alabama | 13% | Not covered | 0% to 100% |
| Florida | 24% | Not covered | 0% to 100% |
| Georgia | 28% | Not covered | 0% to 100% |
| Kansas | 33% | Not covered | 0% to 100% |
| Mississippi | 19% | Not covered | 0% to 100% |
| South Carolina | 62% | Not covered (limited waiver program) | 0% to 100% |
| Tennessee | 84% | Not covered | 0% to 100% |
| Texas | 12% | Not covered | 0% to 100% |
| Wisconsin | 95% | 95% (waiver) | Little or none |
| Wyoming | 45% | Not covered | 0% to 100% |
Percentages are of the federal poverty line. States without the expansion: no adult-group enrollment in CMS’s New Adult Group data for June 2025, the latest month published. Parent limits: Medicaid.gov eligibility levels table as of December 1, 2023, the latest posted; some states set dollar amounts that CMS converted to a percentage. Parents above their state’s limit and below 100% are in the gap too. “Waiver program” = a Section 1115 demonstration covering some low-income adults, which can have eligibility limits or caps.
Who is not in the gap
- Children and pregnant people qualify for Medicaid or CHIP at higher incomes in every state.
- People 65 and older or with a disability may qualify through other Medicaid groups or Medicare.
- Adults at or above 100% of the poverty line can get the Marketplace tax credit. For 2027 coverage that’s $15,960 for one person, plus $5,680 for each additional person, in the 48 states and DC. Near the bottom of the range you pay 2.15% of income for the benchmark plan, and a silver plan comes with cost-sharing reductions.
Options if you’re in the gap
- Apply anyway. Apply at HealthCare.gov or your state’s Marketplace. Your application is checked for Medicaid, CHIP and the tax credit at once, and you may qualify through a group you didn’t expect.
- Estimate your income for the whole year. The tax credit uses expected income for the calendar year. If you expect a raise or more hours that puts you at 100% or above, estimate it carefully; the subsidy calculator shows the credit at your number.
- Use community health centers. Federally funded health centers charge on a sliding scale by income, whether or not you have insurance. Find one at findahealthcenter.hrsa.gov.
- Check job-based coverage. An employer plan, even a limited one, may be available to you or through a family member.
New rules in expansion states
Under a federal law passed in 2025, states must generally require adults 19 to 64 in the Medicaid expansion group to show 80 hours a month of work, community service, a work program or half-time school, or earnings at that level, by January 1, 2027. Parents of young children, people who are medically frail, pregnant or postpartum people and several other groups are exempt. If you live in an expansion state, watch for notices from your state Medicaid agency.
Questions
What is the Medicaid coverage gap?
In states that haven’t expanded Medicaid, adults with income below 100% of the poverty line who don’t qualify for their state’s Medicaid have no tax credit for a Marketplace plan either.
Which states haven’t expanded Medicaid?
Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming, based on CMS data for June 2025. Wisconsin covers adults up to 95% of the poverty line through a waiver, so it has little or no gap.
Can I buy a Marketplace plan if I’m in the gap?
Yes, at full price. You can’t get the premium tax credit below 100% of the poverty line.
Sources
Checked October 28, 2026.
- Medicaid.gov, Medicaid, CHIP and BHP eligibility levels (as of December 1, 2023) — medicaid.gov.
- CMS, Medicaid Enrollment – New Adult Group (June 2025) — data.medicaid.gov.
- HealthCare.gov, “Medicaid expansion & what it means for you” — healthcare.gov.
- CMS, Medicaid Community Engagement Requirement interim final rule fact sheet — cms.gov.
- HHS poverty guidelines (2026) — Federal Register; IRS Rev. Proc. 2026-26 — irs.gov PDF.
Educational information, not legal advice. Your state Medicaid agency decides eligibility. · Advertiser disclosure