Medicaid Expansion Under the ACA: State-by-State Status (2025)

The Affordable Care Act (ACA) significantly altered Medicaid coverage in 2025 by expanding eligibility to nearly all adults earning up to 138% of the Federal Poverty Level, which equates to $21,597 for an individual. This expansion also included an enhanced federal matching rate (FMAP) for states participating in the programme.

State Adoption of Medicaid Expansion

As of today, February 13, 2026, 41 states, along with the District of Columbia, have chosen to adopt the Medicaid expansion. However, 10 states have not yet expanded coverage under the ACA. This status is based on ongoing tracking and analysis by KFF.

Did You Know? The ACA’s Medicaid expansion provides states with an enhanced federal matching rate (FMAP) for their expansion populations.

Implications and Context

The decision to expand Medicaid has significant implications for access to healthcare for low-income individuals. The enhanced FMAP provides financial support to states, making expansion more feasible. The differing rates of adoption across states create a patchwork of coverage, impacting millions of Americans.

Expert Insight: The varying levels of state adoption highlight the complex political and economic factors influencing healthcare policy. The financial incentives offered through the enhanced FMAP were designed to encourage widespread participation, but state-level decisions continue to shape the landscape of Medicaid coverage.

What Might Happen Next

additional states could consider expanding Medicaid in the future, potentially influenced by changing political climates or economic conditions. Alternatively, states that have already expanded coverage could face challenges related to maintaining funding levels or managing enrollment. A possible next step for states that have not expanded is to re-evaluate the potential benefits and costs of participation.

Frequently Asked Questions

What income level qualifies for Medicaid expansion?

Nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025) qualify for Medicaid expansion.

How many states have adopted the Medicaid expansion?

To date, 41 states (including DC) have adopted the Medicaid expansion, while 10 states have not.

Where can I find more detailed information about state-by-state expansion status?

Detailed information, including a table and downloadable presentation, is available from KFF. table format and Powerpoint.

As states continue to navigate the complexities of healthcare policy, how might future decisions impact access to care for vulnerable populations?