Ten states continue to reject ACA Medicaid expansion under current law

Forty-one states and the District of Columbia have adopted the Affordable Care Act Medicaid expansion, while ten states have not, according to KFF Policy. The expansion extends Medicaid coverage to nearly all adults with incomes up to 138 percent of the Federal Poverty Level. [1]

KFF Policy reported that the income threshold for the expanded coverage equaled $21,597 for an individual in 2025. The federal government provides participating states with an enhanced federal matching rate to cover the expanded population. [1]

Individuals living in states that have not adopted the expansion may fall into the Medicaid coverage gap. These residents earn too much money to qualify for state Medicaid programs but not enough to qualify for federal premium tax credits that subsidize private health insurance. [1][2]