Which states have a Medicaid coverage gap in 2027?
Eight states didn’t expand Medicaid and have no program that covers all adults up to the poverty line. KFF’s July 27, 2026 analysis of Census Bureau survey data counts the uninsured adults in each state’s gap:
| State | Uninsured adults in the gap | Parents qualify up to | Adults without children |
|---|---|---|---|
| Texas | 605,000 | 15% of the poverty line | Not eligible |
| Florida | 267,000 | 26% | Not eligible |
| Tennessee | 89,000 | 105% | Not eligible |
| Alabama | 86,000 | 18% | Not eligible |
| South Carolina | 63,000 | 67% | Not eligible |
| Mississippi | 56,000 | 21% | Not eligible |
| Kansas | 33,000 | 38% | Not eligible |
| Wyoming | 8,000 | 43% | Not eligible |
KFF’s total is 1,208,000 adults, and 78% of them have no dependent children. The parent limits are KFF’s January 2026 figures. Florida’s comes from an earlier year because Florida didn’t answer KFF’s 2026 survey.
Georgia and Wisconsin didn’t expand Medicaid either, but both cover adults up to the poverty line, so KFF counts no one in a gap there. Wisconsin covers them through BadgerCare Plus. Georgia covers them through Pathways, which requires 80 hours a month of work or other activities.
What happens to Georgia Pathways in 2027?
Georgia Pathways to Coverage is the only way most Georgia adults without children can get Medicaid. Pathways covers adults 19 to 64 up to 95% of the poverty line plus a 5% income disregard, which works out to 100%. Its federal approval runs through Dec. 31, 2026, per CMS’s Sept. 25, 2026 letter to Georgia. As of Oct. 25, 2026, these are the filings on Medicaid.gov:
| Date | Filing | Status as of Oct. 25, 2026 |
|---|---|---|
| April 28, 2025 | Georgia asks to extend Pathways for at least five years | No five-year approval posted |
| Sept. 23, 2025 | CMS grants a temporary extension instead | Approved through Dec. 31, 2026 |
| Sept. 30, 2026 | Georgia asks CMS to pay 90% of Pathways costs from Jan. 1, 2027, up from its 66.86% match for federal fiscal year 2027 | CMS found the request complete on Oct. 9, 2026 and posted it for a 30-day federal comment period |
Georgia’s Sept. 30 request says the federal law of 2025 (P.L. 119-21) widens who Pathways must cover. Georgia estimates about 20,000 people in Pathways now and nearly 120,000 by June 30, 2028. Georgia puts the cost from Jan. 1, 2027 to June 30, 2028 at $1,433,200,000. Georgia asked for the 90% match in its original Pathways application too, and CMS turned it down.
If Pathways lapsed with nothing in its place, Georgia adults under 100% of the poverty line would have no Medicaid route and, by law, no tax credit. Georgians apply for Pathways at pathways.georgia.gov and for Marketplace plans at Georgia Access. Coverage Decider will update this page when CMS decides.
Why does the coverage gap exist?
The tax credit starts at 100% of the poverty line by law (26 U.S.C. 36B(c)(1)(A)), and Medicaid expansion covers adults below that line only in states that adopted it. HealthCare.gov says adults under 100% in states that didn’t expand, who don’t qualify for Medicaid through disability, age or other factors, “fall into a gap.”
The 2027 credit uses the 2026 HHS poverty guidelines. In the 48 states and DC, 100% of the poverty line is:
| Household size | 100% of the poverty line |
|---|---|
| 1 | $15,960 |
| 2 | $21,640 |
| 3 | $27,320 |
| 4 | $33,000 |
Every other line is in the 2027 federal poverty level chart. Since 2026, lawfully present immigrants under 100% who can’t get Medicaid because of their status also get no credit (P.L. 119-21, section 71302), in every state. More in ACA subsidies for immigrants.
Who in a gap state can still get Medicaid?
The gap is for adults. Children and pregnant people qualify at much higher incomes in all 8 states, per KFF’s January 2026 survey (Florida’s figures are from an earlier year):
| State | Children qualify up to | Pregnancy coverage up to |
|---|---|---|
| Alabama | 317% of the poverty line | 317% |
| Florida | 215% | 196% |
| Kansas | 255% | 171% |
| Mississippi | 214% | 199% |
| South Carolina | 213% | 199% |
| Tennessee | 255% | 255% |
| Texas | 206% | 207% |
| Wyoming | 205% | 159% |
People with disabilities and people 65 and older can qualify under other Medicaid rules. HealthCare.gov says to fill out an application anyway, because each state has options, “particularly if you have children, are pregnant, or have a disability.” From Jan. 1, 2027, Medicaid can pay for care from 2 months before the month you apply for these groups, down from 3 (P.L. 119-21, section 71112).
Limits for adults and children in every state are in Medicaid income limits by state.
What can adults in the coverage gap do?
- Apply on HealthCare.gov anyway. A detailed income estimate may land at 100% or more, and the application checks Medicaid for everyone who applies.
- Watch your income. If your expected yearly income rises to at least 100% of the poverty line, HealthCare.gov says to contact its call center within 60 days to enroll with a tax credit (45 CFR 155.420(d)(6)(iv)).
- Get a hardship exemption for a catastrophic plan. If you’re 30 or older and Medicaid turns you down because your state didn’t expand, you qualify for an exemption for the whole calendar year (45 CFR 155.605(d)(3)). Apply with HealthCare.gov’s hardship exemption form; the exemption certificate number lets you buy a catastrophic plan, at full price. Under 30, you need no exemption. Catastrophic plans aren’t sold in every area.
- Use a community health center. Health centers can’t turn anyone away for inability to pay, and patients at or below 100% of the poverty guidelines get a full discount or pay a nominal fee, under HRSA’s rules. Find one at findahealthcenter.hrsa.gov.
- Ask nonprofit hospitals for financial assistance. Tax-exempt hospitals must have a written financial assistance policy for each hospital (26 U.S.C. 501(r)). Ask for it when a bill comes.
A full-price Marketplace plan is also available during 2027 open enrollment, Nov. 1, 2026 to Jan. 15, 2027.
What if your income ends up under 100% after you got the credit?
The IRS has a safe harbor for honest estimates (26 CFR 1.36B-2(b)(6)). You still count as eligible for the year if all of these are true:
- The Marketplace estimated your income at 100% to 400% of the poverty line when you enrolled.
- Advance credits were paid for at least one month.
- You didn’t give incorrect information on purpose or with reckless disregard for the facts.
The credit is then figured on your actual income. The rule protects honest estimates, not inflated ones.
Could the coverage gap close?
KFF’s tracker lists no expansion measure on the 2026 ballot in any of the 8 states. Florida’s ballot campaign is aiming at 2028. South Carolina asked CMS in June 2025 to cover parents from 67% to 100% of the poverty line who meet a work requirement (Palmetto Pathways), and Medicaid.gov still listed the request as pending on Oct. 25, 2026.
How does Coverage Decider handle the coverage gap?
Coverage Decider’s calculator checks your state’s Medicaid limits for each person, then the tax credit. When an adult falls in the gap, it says so, shows the income where the credit starts for your household, and points to community health centers. How Coverage Decider calculates lists the rules it uses.
HealthCare.gov and your state Medicaid agency make the final decisions. Free local help can walk you through the application and the hardship exemption.