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As of October 2026, 41 states, including the District of Columbia, had adopted the Affordable Care Act (ACA) Medicaid expansion; 10 states had not. The states that had not adopted it were Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. State status and implementation dates below reflect KFF’s October 2026 tracker; CMS independently reported the same 41-to-10 split.
Which states have and have not expanded Medicaid?
The ACA expansion is a state decision. “Not adopted” means a state has not adopted the full ACA expansion; it does not mean the state has no Medicaid program or no other coverage pathways. KFF’s October 2026 status table lists these decisions and, where applicable, the date expansion took effect.
| State or jurisdiction | Decision | Implementation date |
|---|---|---|
| Alabama | Not adopted | Not applicable |
| Alaska | Adopted | September 1, 2015 |
| Arizona | Adopted | January 1, 2014 |
| Arkansas | Adopted | January 1, 2014 |
| California | Adopted | January 1, 2014 |
| Colorado | Adopted | January 1, 2014 |
| Connecticut | Adopted | January 1, 2014 |
| Delaware | Adopted | January 1, 2014 |
| District of Columbia | Adopted | January 1, 2014 |
| Florida | Not adopted | Not applicable |
| Georgia | Not adopted | Not applicable |
| Hawaii | Adopted | January 1, 2014 |
| Idaho | Adopted | January 1, 2020 |
| Illinois | Adopted | January 1, 2014 |
| Indiana | Adopted | February 1, 2015 |
| Iowa | Adopted | January 1, 2014 |
| Kansas | Not adopted | Not applicable |
| Kentucky | Adopted | January 1, 2014 |
| Louisiana | Adopted | July 1, 2016 |
| Maine | Adopted | January 10, 2019 |
| Maryland | Adopted | January 1, 2014 |
| Massachusetts | Adopted | January 1, 2014 |
| Michigan | Adopted | April 1, 2014 |
| Minnesota | Adopted | January 1, 2014 |
| Mississippi | Not adopted | Not applicable |
| Missouri | Adopted | October 1, 2021 |
| Montana | Adopted | January 1, 2016 |
| Nebraska | Adopted | October 1, 2020 |
| Nevada | Adopted | January 1, 2014 |
| New Hampshire | Adopted | August 15, 2014 |
| New Jersey | Adopted | January 1, 2014 |
| New Mexico | Adopted | January 1, 2014 |
| New York | Adopted | January 1, 2014 |
| North Carolina | Adopted | December 1, 2023 |
| North Dakota | Adopted | January 1, 2014 |
| Ohio | Adopted | January 1, 2014 |
| Oklahoma | Adopted | July 1, 2021 |
| Oregon | Adopted | January 1, 2014 |
| Pennsylvania | Adopted | January 1, 2015 |
| Rhode Island | Adopted | January 1, 2014 |
| South Carolina | Not adopted | Not applicable |
| South Dakota | Adopted | July 1, 2023 |
| Tennessee | Not adopted | Not applicable |
| Texas | Not adopted | Not applicable |
| Utah | Adopted | January 1, 2020 |
| Vermont | Adopted | January 1, 2014 |
| Virginia | Adopted | January 1, 2019 |
| Washington | Adopted | January 1, 2014 |
| West Virginia | Adopted | January 1, 2014 |
| Wisconsin | Not adopted | Not applicable |
| Wyoming | Not adopted | Not applicable |
Source: KFF, Status of State Medicaid Expansion Decisions, October 2026. KFF says there is no deadline for a state to implement expansion.
What Medicaid expansion changes
The ACA expansion extended Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level (FPL) and provides an enhanced federal matching rate for the expansion population. KFF’s October 2026 page illustrates the threshold as $21,597 for one person in 2025. That is a 2025 illustration, not a current-year dollar cutoff; income determinations should use the applicable year’s poverty guidelines and the state’s program rules.
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The 138% figure describes the expansion framework, not a guarantee that a particular person qualifies. Eligibility depends on the relevant year’s income measure and applicable program rules. For a state-by-state account of decisions, implementation dates, ballot-initiative adoption routes and reported trigger laws, see KFF State Health Facts: Status of State Action on the Medicaid Expansion Decision.
How to interpret proposals, waivers and trigger laws
A proposal or policy debate does not by itself change whether a state has adopted the full expansion. KFF’s tracker distinguishes legislative steps, executive proposals or announcements, ballot activity, limited coverage programs and changes affecting states that already expanded.
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- Proposals and activity: Bills, budget proposals, announcements or ballot efforts may indicate policy movement, but they are not the same as an adopted expansion.
- Limited coverage: A state may offer a narrower coverage pathway without adopting the full ACA expansion or receiving the expansion’s enhanced federal match.
- Waivers and requirements: In states that have expanded, Section 1115 waiver actions may add or change requirements for the expansion population without reversing the state’s adoption decision.
- Trigger laws: KFF reports trigger laws in 13 states in its October 2026 classification. These laws relate to potential reductions in federal funding and may terminate expansion coverage or require state action to address higher state costs if the federal expansion funding share falls. Their presence is a separate policy detail, not a separate adoption category.
KFF’s October 2026 table also identifies ballot initiatives as the adoption route for seven states. Those route and trigger-law counts are tracker classifications, not a substitute for checking a state’s current decision status.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What the national enrollment figure does—and does not—show
CMS reported 73,526,272 people enrolled in Medicaid and CHIP across the 50 states and the District of Columbia in May 2026. This combined, point-in-time total is not the number enrolled through Medicaid expansion. CMS counts enrollment on the last day of the reporting period and notes that totals can differ from other CMS data series because reporting periods and methods vary. See CMS Medicaid and CHIP Enrollment Data Monthly Reports.
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