Medicaid Coverage Gap

Definition current for the 2026 plan year · Last reviewed July 2026

The coverage gap is the cruelest quirk in US health policy. Marketplace subsidies begin at 100% of the federal poverty level — the ACA assumed everyone below that would get expanded Medicaid. But in the 10 states that never expanded (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin*, Wyoming), adults can earn too much for the state's traditional Medicaid yet too little for subsidies — often literally too poor for help. Roughly 1.5 million people sit in this gap, most of them working.

*Wisconsin covers adults to 100% of FPL through a waiver, so it has no gap despite not formally expanding.

If you're in the gap: check whether you qualify for a traditional Medicaid category (pregnancy, disability, caretaker of minor children — limits vary); recheck the math with a precise FPL calculation, since even small income increases can (paradoxically) qualify you for marketplace subsidies at 100%+; and use community health centers, which charge on a sliding scale regardless of insurance. State-by-state expansion status is on each state page.