Note: On November 8, 2022, voters in South Dakota approved a ballot measure which adds Medicaid expansion to the state constitution. The state must implement expansion coverage beginning July 1, 2023. This page and map will be updated to reflect that 39 states and DC have adopted Medicaid expansion, and 11 states have not.

Prior to the Affordable Care Act, Medicaid eligibility was limited to specific low-income groups, such as the elderly, people with disabilities, children, pregnant women, and some parents.

The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($17,609 for an individual in 2020).

As of February 2021, 12 states have not adopted the ACA Medicaid expansion. Across all non-expansion states, 4.0 million uninsured nonelderly adults would become eligible for Medicaid if all opted to expand their programs.

Who would become eligible for Medicaid if these states chose to expand? The table below the map links you to state-specific fact sheets with key data that answers that question.

Notes:

Data sourced from KFF analysis of the 2019 American Community Survey, 1-Year Estimates. All other sources can be found linked within the fact sheets.

Geographic areas are defined by PUMAs, or Public-Use Microdata Areas. PUMAs are geographic areas defined as a collection of counties or tracts within counties with more than 100,000 people, based on the decennial census population counts. We use PUMA designations available on the public-use ACS microdata files.

To help support states and promote stability of coverage amidst the COVID-19 pandemic, the Families First Coronavirus Response Act (FFCRA) provides a 6.2 percentage point increase in the federal share of certain Medicaid spending with requirements to meet certain maintenance of eligibility (MOE) requirements that include ensuring continuous coverage for current enrollees.