Is my state expanding Medicaid coverage?
Some states are expanding their Medicaid programs. Others haven’t. Your coverage options depend on your state, your income and household size, and other factors.
To find out if your state is expanding Medicaid, scroll to the bottom of this page and use the “Get state information” menu.
You can apply for and enroll in Medicaid or CHIP any time of year. There’s no limited enrollment period for either Medicaid or the Children’s Health Insurance Program (CHIP). If you qualify, your coverage can begin immediately.
Options depend on your state, your income, and other factors
- If you live in a state that's expanding Medicaid, you'll probably qualify if you make up to $16,105 a year for 1 person ($32,913 for a family of 4).
- If you live in a state that hasn't expanded Medicaid you may not qualify for either Medicaid or reduced costs on a private insurance plan. It will depend on where your income falls.
- Even if your state hasn’t expanded Medicaid coverage, you should still apply. The Medicaid program provides health coverage to millions of lower-income individuals and families today. You may qualify under your state’s existing rules. Use the “Get state information” menu at the bottom of this page to get contact information for your state Medicaid office. The office can tell you if you qualify.
- States are continuing to make coverage decisions. They could expand Medicaid in the future.
If your state is expanding Medicaid
The health care law provides states with additional federal funding to expand their Medicaid programs to cover adults under 65 who make up to 133% of the federal poverty level. (Because of the way this is calculated, it’s effectively 138% of the federal poverty level.) Children (18 and under) are eligible up to that income level or higher in all states.
If your state is expanding Medicaid, you’ll probably qualify if you make up to $16,105 a year for 1 person ($32,913 for a family of 4). See this chart for income limits for different family sizes.
If you make more than this amount, you may be able to buy a private insurance plan in the Health Insurance Marketplace. You may be eligible for tax credits that lower the cost of your monthly premiums and for lower out-of-pocket costs. This will depend on your family size and income.
When you fill out a Marketplace application, you’ll find out whether you’re eligible for Medicaid or a private insurance plan at the same time.
If your state hasn’t expanded Medicaid
Some states haven’t expanded their Medicaid programs. If you live in one of these states, you may not have as many options for health coverage. It will depend on where your income falls.
- If your income is more than 100% of the federal poverty level -- $11,490 a year as a single person or about $23,550 for a family of 4 -- you will be able to buy a private health insurance plan in the Marketplace and may get lower costs based on your household size and income.
- If you make less than about $11,490 a year as a single person or about $23,550 for a family of 4, you may not qualify for lower costs for private insurance based on your income. You may be eligible for Medicaid, even without the expansion, based on your state’s existing rules. But if you aren’t, you won’t qualify for either of the affordability options under the health care law.
Why this coverage gap exists
When the health care law was passed, it required states to provide Medicaid coverage for adults between ages 18 and 65 with incomes up to 133% of the federal poverty level, regardless of their age, family status, or health.
It also provides tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Marketplace.
Under the law, the federal government will pay states all of the costs for newly eligible people for the first three years. It will pay no less than 90% of the costs in the future.
The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states have not expanded their Medicaid programs.
Many adults in those states with incomes below 100% of the federal poverty level fall into a gap. Their incomes are too high to get Medicaid under their state’s current rules. But their incomes are too low to qualify for help buying private coverage in the Marketplace.
Apply for Medicaid, even if your state hasn't expanded coverage
Even if your state hasn't expanded Medicaid, you should apply for coverage to see if you qualify. Each state has coverage options that could work for you - particularly if you have children, are pregnant, or have a disability.
You can apply today by contacting your state Medicaid office. Use the “Get State Information” menu at the bottom this page to get the contact information.
You can also apply by filling out an application in the Marketplace online or by contacting the call center at 1-800-318-2596 (TTY: 1-855-889-4325), 24 hours a day, 7 days a week.
Remember, you can apply for Medicaid and CHIP at any time. There’s no limited enrollment period for either program.
Get State Information
More answers on Medicaid expansion
If my state isn’t expanding Medicaid and I don’t qualify for Medicaid coverage, do I have to pay a penalty?
Under the law, most people who can afford it must have health coverage or pay a penalty.
But you won’t have to pay this penalty if all of the following apply:
- you live in a state that isn’t expanding Medicaid
- you would qualify for Medicaid if the state did expand Medicaid
- you don’t qualify for Medicaid under the state’s current rules or for lower costs on a private insurance plan in the Marketplace because of where your income falls.
This is called an exemption. You can get an exemption when you apply for coverage in the Marketplace.