Rule change · 2027 plan year
Medicaid expansion: where each state stands for 2027
As of October 16, 2026, 41 states (including DC) have expanded Medicaid under the ACA. 10 states have not: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
Why it matters for your clients
- Expansion states: adults under 138% of the poverty level usually qualify for Medicaid, not Marketplace subsidies.
- Non-expansion states: adults from 100% to 138% of poverty can get Marketplace subsidies. Adults below 100% often fall into the coverage gap, with no Medicaid and no subsidy.
What to watch
- Work requirements start January 1, 2027 for Medicaid expansion adults under the 2025 federal reconciliation law. Clients who lose Medicaid may need Marketplace coverage.
- Trigger laws: some expansion states have laws that would end or scale back expansion if federal funding drops. Illinois and North Carolina have proposals to remove or scale back theirs, and South Dakota and West Virginia have looked at adding one.
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