The Medicaid coverage gap refers to the population of uninsured adults with incomes above Medicaid eligibility limits but below the federal poverty level (FPL), leaving them ineligible for both standard Medicaid and Affordable Care Act premium subsidies. The states with a Medicaid coverage gap are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming.
The Affordable Care Act introduced Medicaid expansion, allowing states to expand health care coverage to many low-income adults who did not previously qualify for Medicaid. While states are not mandated by the Supreme Court to participate in the ACA Medicaid expansion, federal funding covers most of the cost, so it is financially advantageous to participate. To date, 40 states and the District of Columbia have adopted Medicaid expansion. Most of these states have adopted the expansion without limits, however, some states have used federal waivers to impose requirements like monthly premiums or work requirements for expansion enrollees.
The 10 states mentioned above are non-expansion states and have not adopted Medicaid expansion at all. These states have what is called a Medicaid coverage gap – a population of adults who do not qualify for state Medicaid, but who also cannot afford unsubsidized marketplace health insurance coverage and do not qualify for premium tax credits in the marketplace. The vast majority of the gap is made up of childless adults without disabilities, many of whom work at low-wage jobs without access to employer-sponsored private insurance. While most states have scaled income eligibility for Medicaid, most non-expansion states exclude most non-disabled childless adults, regardless of their individual income (or lack thereof).
For more information regarding Medicaid enrollment, please visit Medicaid.gov or your state’s Medicaid website.