What Is Medicaid?
Medicaid is a joint federal-state health insurance program for people with low incomes. It is the largest health insurance program in the United States, covering more than 82 million Americans, including children, pregnant women, seniors, and people with disabilities.
Medicaid is not one program. It is 56 different programs across states, territories, and DC, each with different rules, all partially funded by the federal government. 27 states use names that don’t include “Medicaid” (Medi-Cal in California, Apple Health in Washington).
Key facts
- 82 million Americans are enrolled in Medicaid and CHIP. Children are the largest group at 35.8 million (36.5% of enrollees).
- Medicaid pays for 42% of all U.S. births. In Mississippi, it is 65%. It is the single largest payer of maternity care.
- 1 in 3 people with disabilities rely on Medicaid. It covers 2.3 million children, 8.8 million working-age adults, and 4.4 million adults over 65 with disabilities.
- Medicaid finances 30.6% of all nursing home care and 42% of all long-term services and supports. Private insurance rarely covers this.
- 64% of Medicaid enrollees under 65 are working. 44% full-time, 20% part-time. Another 28% are caregiving, disabled, sick, or in school.
Medicaid is not health insurance for people who refuse to work. It is health insurance for people who work jobs that do not offer it. 4 in 10 adults under 65 with opioid addiction are covered by Medicaid. Half of all children’s hospital patients are on Medicaid. 50% of children of color rely on it.
How Medicaid Is Funded
The federal government and states split the cost. The federal share is called the FMAP (Federal Medical Assistance Percentage). It varies by state.
For traditional Medicaid, the federal government pays between 50% and 83% of costs, depending on state income. Poorer states get a higher match. Mississippi gets 76.6%. California gets 50%.
For ACA expansion adults (people earning up to 138% of the federal poverty level, about $21,597 per year for a single adult), the federal government pays 90%. States pay 10 cents of every dollar.
Medicaid costs more than basic insurance because it covers what private insurance will not. It is the primary payer for long-term care (42% of all long-term services and supports), nursing homes (30.6%), and behavioral health and substance use disorder treatment (24%). Private insurance rarely covers these at the same depth.
Which States Expanded and Which Did Not
In 2010, the Affordable Care Act gave states the option to expand Medicaid to cover all adults earning up to 138% of the federal poverty level. The federal government would pay 90% of the cost. 40 states expanded. 10 did not.
The 10 states that refused are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.
Source: KFF Status of State Medicaid Expansion Decisions (May 2026)
| State | Expanded | Method | Status |
|---|---|---|---|
| Alabama | No | N/A | Not expanded. Coverage gap exists. |
| Alaska | 2015 | Legislative | Expanded |
| Arizona | 2014 | Legislative | Expanded |
| Arkansas | 2014 | Legislative | Expanded |
| California | 2014 | Legislative | Expanded |
| Colorado | 2014 | Legislative | Expanded |
| Connecticut | 2014 | Legislative | Expanded |
| Delaware | 2014 | Legislative | Expanded |
| District of Columbia | 2014 | Legislative | Expanded |
| Florida | No | N/A | Not expanded. Coverage gap exists. |
| Georgia | No | N/A | Not expanded. Coverage gap exists. |
| Hawaii | 2014 | Legislative | Expanded |
| Idaho | 2020 | Ballot measure | Expanded |
| Illinois | 2014 | Legislative | Expanded |
| Indiana | 2015 | Legislative | Expanded |
| Iowa | 2014 | Legislative | Expanded |
| Kansas | No | N/A | Not expanded. Coverage gap exists. |
| Kentucky | 2014 | Legislative | Expanded |
| Louisiana | 2016 | Legislative | Expanded |
| Maine | 2019 | Ballot measure | Expanded |
| Maryland | 2014 | Legislative | Expanded |
| Massachusetts | 2014 | Legislative | Expanded |
| Michigan | 2014 | Legislative | Expanded |
| Minnesota | 2014 | Legislative | Expanded |
| Mississippi | No | N/A | Not expanded. Coverage gap exists. |
| Missouri | 2021 | Ballot measure | Expanded |
| Montana | 2016 | Legislative | Expanded |
| Nebraska | 2020 | Ballot measure | Expanded |
| Nevada | 2014 | Legislative | Expanded |
| New Hampshire | 2014 | Legislative | Expanded |
| New Jersey | 2014 | Legislative | Expanded |
| New Mexico | 2014 | Legislative | Expanded |
| New York | 2014 | Legislative | Expanded |
| North Carolina | 2023 | Legislative | Expanded |
| North Dakota | 2014 | Legislative | Expanded |
| Ohio | 2014 | Legislative | Expanded |
| Oklahoma | 2021 | Ballot measure | Expanded |
| Oregon | 2014 | Legislative | Expanded |
| Pennsylvania | 2015 | Legislative | Expanded |
| Rhode Island | 2014 | Legislative | Expanded |
| South Carolina | No | N/A | Not expanded. Coverage gap exists. |
| South Dakota | 2023 | Ballot measure | Expanded |
| Tennessee | No | N/A | Not expanded. Coverage gap exists. |
| Texas | No | N/A | Not expanded. Coverage gap exists. |
| Utah | 2020 | Ballot measure | Expanded |
| Vermont | 2014 | Legislative | Expanded |
| Virginia | 2019 | Legislative | Expanded |
| Washington | 2014 | Legislative | Expanded |
| West Virginia | 2014 | Legislative | Expanded |
| Wisconsin | No | N/A | Not expanded. Coverage gap exists. |
| Wyoming | No | N/A | Not expanded. Coverage gap exists. |
| Period | Value |
|---|---|
| Non-expansion states (2024) | 14.5% |
| Expansion states (2024) | 8.0% |
| Change | -6.5 pts |
In most non-expansion states, a childless adult has no Medicaid pathway at all. In Texas, a single adult earning $5,000 per year is too wealthy for Medicaid. In Arkansas, before the cuts, that same person was covered.
1.4 million people fall into the coverage gap in non-expansion states. They earn too much for their state’s Medicaid but too little for marketplace subsidies. The gap only exists because their state refused to expand.
Sources: KFF, Health Affairs, ScienceDirect, MACPAC
| Metric | 40 States That Expanded | 10 States That Did Not |
|---|---|---|
| Adult eligibility | 138% FPL (~$21,597/yr) | 0% FPL in most states (no pathway) |
| Uninsured rate (2024) | 8.0% | 14.5% |
| Maternal mortality per 100K | 20.7 | 26.0 (35% higher) |
| Infant mortality per 1K | 5.6 (falling) | 6.5 (rising) |
| Rural uninsured | 9% (halved from 16%) | Significantly higher |
| Federal dollars forfeited | N/A | $8.4 billion (Health Affairs estimate) |
| Coverage gap population | 0 (gap eliminated) | 1.4 million people |
Sources: WashU CAHSPER, Georgetown CCF, NC DHHS, KFF
| State (year, method) | Before Expansion | After Expansion |
|---|---|---|
| Missouri (2021, ballot 53%) | ~14% uninsured | ~11% uninsured. 272,574 enrolled in first year. |
| Oklahoma (2021, ballot 50.5%) | 14.2% uninsured (2nd highest) | ~10% uninsured. 100,000 approved in 10 days. |
| South Dakota (2023, ballot 53%) | ~11% uninsured | ~8% uninsured. 29,500 enrolled. Rate fell while 18 states rose. |
| North Carolina (2023, legislative) | ~11% uninsured | ~8% uninsured. 600,000+ enrolled in half the projected time. |
Three of these four states expanded through ballot measures because their legislatures refused to act. Voters chose expansion directly.
What the Evidence Shows
Expansion states have lower maternal mortality. 20.7 maternal deaths per 100,000 live births in expansion states versus 26.0 in non-expansion states. Expansion is associated with 7 fewer maternal deaths per 100,000. In Texas alone, more than 25% of maternal deaths occur between 43 days and one year after pregnancy. Texas has not expanded Medicaid.
Expansion states have lower infant mortality. Infant mortality in expansion states fell from 5.9 to 5.6 per 1,000 live births. In non-expansion states, it rose from 6.4 to 6.5. Expansion states saw infant mortality decline more than 50% faster than non-expansion states.
Expansion keeps rural hospitals open. Rural uninsured rates in expansion states fell from 16% to 9%, nearly halving. Texas has had 15 rural hospital closures, the most of any state. Tennessee had 9. Georgia had 7. The majority of rural hospital closures occurred in non-expansion states.
- 300
- rural hospitals projected to close
- 50%
- of rural hospitals at negative margins
- 10M
- rural Americans on Medicaid
- 15
- rural closures in Texas alone
Expansion improves cancer survival. Young adults newly diagnosed with cancer had better two-year survival in expansion states, with especially strong effects for Hispanic and Black patients.
The arguments against expansion do not match the evidence. Opponents cite cost, federal uncertainty, and ideology. The data show expansion reduces uncompensated care, improves hospital finances, and brings federal dollars that outweigh state costs. Florida Senate President Kathleen Passidomo said expansion “is not going to happen in Florida.” Florida’s uninsured rate is 13.9%.
2025-2026: The Largest Medicaid Cut in History
On July 4, 2025, President Trump signed the One Big Beautiful Bill Act into law. It cut $911 billion from Medicaid over ten years. The CBO projects 10 million more Americans will be uninsured by 2028.
The law requires most adults on Medicaid to document 80 hours of work per month to keep coverage. The requirement applies in all 40 states plus DC that expanded Medicaid. The deadline is January 1, 2027.
Four states are implementing work requirements before the federal deadline. Nebraska started May 1, 2026 (28,000-41,000 projected to lose coverage). Montana starts July 1. Arkansas begins a soft implementation July 1 without disenrollment until January 2027. Iowa starts December 1. Six governors (Oregon, Michigan, Washington, New York, Maine, New Mexico) have publicly pushed back, arguing they lack clear guidance and time.
Georgia is the only state with an active work requirement waiver. It expires December 31, 2026.
15 states have trigger laws that automatically roll back Medicaid expansion if the federal match drops below a threshold. The $911 billion cut reduces the federal match. Expansion states could become non-expansion states involuntarily. Utah changed its trigger law in March 2026 to prevent automatic rollback. It is the only state to take that step.
Who Loses
Arkansas tried work requirements. They failed.
In June 2018, Arkansas became the first state to implement Medicaid work requirements. Adults ages 30-49 had to report 20 hours of work per week. In seven months, 18,164 people lost coverage. One in four of those subject to the requirement.
55.9% delayed needed care because of cost. 49.8% reported serious problems paying medical debt. 63.8% delayed taking medications. Nearly half of the people subject to the requirement did not know it applied to them.
Employment did not increase. Not by any measure. Not in any study. Arkansas spent $26 million implementing the program. A federal judge halted it in 2019.
Adrian McGonigal worked full-time at a chicken processing plant in Arkansas. He reported his work hours once but did not know he had to do it every month. He lost coverage. He could not afford his $800/month COPD breathing treatments. He was hospitalized repeatedly, lost his job, and died of a heart attack in 2024 at 46.
Congress is imposing the same requirement nationwide. In Nebraska, where work requirements started May 1, 2026, Schmeeka Simpson has relied on Medicaid since 2014. She previously lost SNAP benefits when a technical error caused her to miss renewal. She fears the same will happen with Medicaid.
In Georgia, the only state with an active work requirement waiver, Luke Seaborn appeared in a state promotional video for the Pathways program. His benefits were canceled twice due to bureaucratic errors despite logging hours monthly. “I used to think of Pathways as a blessing,” he told ProPublica. “Now, I’m done with it.”
The paperwork is the barrier, not the work. During the Medicaid continuous coverage unwinding, 18.22 million people were disenrolled. 70% of those disenrollments were procedural. In Kentucky, Beverly Likens lost Medicaid days before a needed surgery for chronic uterine bleeding. She required a lawyer to get reinstated. In Florida, Indira Navas learned her 6-year-old son was disenrolled while her 12-year-old daughter in the same household kept coverage. Administrative error, not eligibility.
Children lose too. Medicaid covers nearly 40% of all children in the United States. When parents lose coverage, children are more likely to become uninsured even when children themselves are exempt. A Manatt analysis estimates 480,000 children will lose Medicaid if work requirements apply to expansion adults. If applied to all nondisabled adults, that number rises to 914,000. For every 100 adults who lose coverage, about 5 children lose it too.
2 million fewer children are enrolled than in January 2025. 25 states are below pre-pandemic children’s enrollment levels. In Wisconsin, Codie Peschl is a home health caregiver earning $17.50 an hour. She lost the Medicaid coverage she relied on for 17 years. Her wage was $433 per month too high for her own coverage but low enough for her three children to stay enrolled.
Common Misconceptions About Medicaid
Medicaid is not Medicare. Medicare covers people 65 and older regardless of income. Medicaid covers people with low incomes regardless of age. 84% of Medicaid-covered nursing home residents are enrolled in both programs.
Expansion enrollees are not getting free healthcare. Most states charge premiums and copays for expansion enrollees. The coverage is subsidized, not free.
Work requirements do not mean people are lazy. 64% of enrollees are working. 28% are caregiving, disabled, sick, or in school. Fewer than 10% are unemployed for other reasons, and most of those are over 65.
Not every expansion state is safe. 15 states have trigger laws that could automatically end expansion if the federal match drops. The $911 billion cut makes that more likely.
Cutting Medicaid does not save money if hospitals close. Non-expansion states still pay for uninsured ER visits through uncompensated care. They spend more per person to cover fewer people. Virginia estimated a $290-480 million reduction in hospital uncompensated care after expanding. The cost shifts from a 90/10 federal match to a 100% state burden.
Frequently asked questions
Will I lose my Medicaid? It depends on your state and your eligibility category. Children, pregnant women, and people with disabilities are not subject to work requirements. If you are an adult on expansion Medicaid, you will need to document 80 hours of work per month starting January 1, 2027, unless your state implements earlier.
Do work requirements apply to everyone on Medicaid? No. Exemptions exist for pregnant women, people with disabilities, people in treatment, caretakers, and some other categories. But the documentation requirements apply broadly, and exemptions require proof.
What is the coverage gap? The gap between state Medicaid eligibility and marketplace subsidy eligibility. In non-expansion states, adults who earn too much for Medicaid but too little for marketplace subsidies (roughly $0-$14,000 per year) have no affordable option. 1.4 million people are in this gap.
Can my state’s trigger law activate? If the federal FMAP drops below the threshold set in your state’s law, expansion can end automatically. The $911 billion cut makes this more likely. Only Utah has changed its trigger law to prevent this.
What about people who had Medicaid during COVID and lost it? 18.22 million people were disenrolled during the continuous coverage unwinding. 70% lost coverage because of paperwork, not ineligibility. If you were disenrolled, you may still qualify. Check your state Medicaid office or healthcare.gov.
Do undocumented immigrants get Medicaid? No. Federal law prohibits Medicaid coverage for undocumented immigrants except emergency medical services in some states. Undocumented enrollment is not a significant factor in Medicaid spending. The claim is used to build opposition to a program that covers 82 million citizens, including 35.8 million children.
Is Medicaid free? No. Most states charge premiums, copays, or both for expansion enrollees. The coverage is federally subsidized, not free. The federal government pays 90% of expansion costs. States pay 10%.
Is expansion too expensive for states? The federal government pays 90% of expansion costs. Multiple studies have found that federal dollars, state savings on uncompensated care, and improved hospital finances outweigh the added state cost. States that refused expansion forfeited an estimated $8.4 billion in federal payments.
What you can do
- Call your governor and ask whether your state is implementing work requirements before the January 2027 federal deadline. Nebraska started May 1. Montana starts July 1. If your state is moving early, demand the enrollment process be fixed before anyone is disenrolled.
- Call both senators and ask them to restore the federal Medicaid match and oppose the $911 billion in cuts. The expansion match was 90%. Reducing it punishes states that expanded and triggers automatic rollback in 15 states.
- Check your Medicaid enrollment at healthcare.gov or your state Medicaid office. If you were disenrolled during the unwinding, you may still qualify. 70% of disenrollments were paperwork errors.
- Show up at your state budget hearings. Medicaid is 28.8% of your state’s budget. Cuts at the federal level become cuts at the state level. Your state legislators are deciding right now how to absorb $911 billion in reductions.
- Use the letter below to contact your representatives with the specific data from this page.